Interaction of maternal medication use with ambient heat exposure on congenital heart defects in the National Birth Defects Prevention Study

Yanqiu Ou; Eleni A Papadopoulos; Sarah C Fisher; Marilyn L Browne; Ziqiang Lin; Aida Soim; Yi Lu; Scott Sheridan; Jennita Reefhuis; Peter H Langlois; Paul A Romitti; Erin M Bell; Marcia L Feldkamp; Sadia Malik; Shao Lin; National Birth Defects Prevention Study

doi:10.1016/j.envres.2022.114217

Interaction of maternal medication use with ambient heat exposure on congenital heart defects in the National Birth Defects Prevention Study

Environ Res. 2022 Dec;215(Pt 1):114217. doi: 10.1016/j.envres.2022.114217. Epub 2022 Aug 28.

Authors

Affiliations

¹ Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
² Birth Defects Registry, New York State Department of Health, Albany, NY, USA.
³ Birth Defects Registry, New York State Department of Health, Albany, NY, USA; Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, USA.
⁴ Department of Preventive Medicine, School of Basic Medicine and Public Health, Jinan University, Guangzhou, 510632, China.
⁵ Health Effects Institute, Boston, MA, USA.
⁶ Department of Geography, Kent State University, Kent, OH, USA.
⁷ National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
⁸ Texas Department of State Health Services, Austin, TX, USA; Department of Epidemiology, Human Genetics, and Environmental Science, UT Health School of Public Health, Austin, TX, USA.
⁹ Department of Epidemiology, The University of Iowa, Iowa City, IA, USA.
¹⁰ Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, USA; Department of Environmental Health Sciences, University at Albany, Rensselaer, NY, USA.
¹¹ University of Utah School of Medicine, Salt Lake City, UT, USA.
¹² University of Arkansas for Medical Sciences, Little Rock, AR, USA.
¹³ Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, USA; Department of Environmental Health Sciences, University at Albany, Rensselaer, NY, USA. Electronic address: slin@albany.edu.

Abstract

Background: Maternal exposure to weather-related extreme heat events (EHEs) has been associated with congenital heart defects (CHDs) in offspring. Certain medications may affect an individual's physiologic responses to EHEs. We evaluated whether thermoregulation-related medications modified associations between maternal EHE exposure and CHDs.

Methods: We linked geocoded residence data from the U.S. National Birth Defects Prevention Study, a population-based case-control study, to summertime EHE exposures. An EHE was defined using the 90^th percentile of daily maximum temperature (EHE90) for each of six climate regions during postconceptional weeks 3-8. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between EHE90 and the risk of CHDs were estimated by strata of maternal thermoregulation-related medication use and climate region. Interaction effects were evaluated on multiplicative and additive scales.

Results: Over 45% of participants reported thermoregulation-related medication use during the critical period of cardiogenesis. Overall, these medications did not significantly modify the association between EHEs and CHDs. Still, medications that alter central thermoregulation increased aORs (95% CI) of EHE90 from 0.73 (0.41, 1.30) among non-users to 5.09 (1.20, 21.67) among users in the Southwest region, U.S. This effect modification was statistically significant on the multiplicative (P = 0.03) and additive scales, with an interaction contrast ratio (95% CI) of 1.64 (0.26, 3.02).

Conclusion: No significant interaction was found for the maternal use of thermoregulation-related medications with EHEs on CHDs in general, while medications altering central thermoregulation significantly modified the association between EHEs and CHDs in Southwest U.S. This finding deserves further research.

Keywords: Extreme heat events; Heart defects; Medication use during pregnancy; NBDPS; Thermoregulation.

Publication types

Research Support, U.S. Gov't, P.H.S.
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Case-Control Studies
Female
Heart Defects, Congenital* / epidemiology
Hot Temperature*
Humans
Maternal Exposure
Risk Factors

Abstract

Publication types

MeSH terms

Grants and funding