Maternal occupational exposure to ionizing radiation and major structural birth defects

Risk of congenital anomalies in children who have a sibling with cancer: A matched cohort study

PURPOSE

We assessed the risk of congenital anomalies in children who have a sibling with cancer.

METHODS

We performed a matched cohort study of children born between 2006 and 2022 in Quebec. The exposure was having a sibling with cancer. Exposed children were matched to unexposed children based on sex, number of siblings, birth order, and year. The outcome included heart defects, orofacial clefts, and other anomalies. Using conditional logistic regression, we estimated odds ratios (OR) and 95 % confidence intervals (CI) for the association between having a sibling with cancer and the likelihood of having a congenital anomaly.

RESULTS

A total of 2403 children who had a sibling with cancer were matched to 240,257 unexposed children. Congenital anomalies were more frequent in children who had a sibling with cancer compared with unexposed children (10.3 % vs 8.9 %). Overall, having a sibling with cancer was only weakly associated with congenital anomalies (OR 1.18, 95 % CI 1.04-1.35). Exposed children tended to have greater odds of polydactyly/syndactyly (OR 1.89, 95 % CI 1.11-3.21) and urinary defects (OR 1.50, 95 % CI 1.09-2.08) compared with unexposed children.

CONCLUSIONS

Children who have a sibling with cancer have an only weakly elevated risk of congenital anomalies.

Associations of maternal motor vehicle crashes during pregnancy with offspring's neonatal birth outcomes

BACKGROUND

Adverse events in fetuses are well researched but studies on the follow-up health outcomes of infants exposed to maternal motor vehicle crashes (MVCs) during pregnancy have yielded inconsistent results. This study aimed to investigate the association of maternal exposure to MVCs during pregnancy with the risk of adverse neonatal outcomes.

METHODS

This population-based cohort study used data from birth notifications in Taiwan. A total of 19 277 offspring with maternal exposure to MVCs during pregnancy and 76 015 randomly selected comparison offspring without such exposure were selected. Neonatal adverse outcomes were identified from National Health Insurance medical claims data. Conditional logistic regression was used to estimate the unadjusted and adjusted odds ratios (aORs) of neonatal adverse outcomes.

RESULTS

Offspring exposed to maternal MVCs during pregnancy had a higher risk of birth defects (aOR, 1.21; 95% CI, 1.04-1.41) than offspring without such exposure. This positive association was sustained with exposure to an MVC during the first or second trimester. A dose-response relationship (P = 0.0023) was observed between the level of injury severity and the risk of birth defects.

CONCLUSIONS

In the early stages of pregnancy, maternal exposure to MVCs may entail a risk of birth defects in the offspring. The potential mechanisms for the associations of maternal exposure to MVCs with birth defects need further investigation.

Current Status of Auricular Reconstruction Strategy Development

Microtia has severe physical and psychological impacts on patients, and auricular reconstruction offers improved esthetics and function, alleviating psychological issues. Microtia is a congenital disease caused by a multifactorial interaction of environmental and genetic factors, with complex clinical manifestations. Classification assessment aids in determining treatment strategies. Auricular reconstruction is the primary treatment for severe microtia, focusing on the selection of auricular scaffold materials, the construction of auricular morphology, and skin and soft tissue scaffold coverage. Autologous rib cartilage and synthetic materials are both used as scaffold materials for auricular reconstruction, each with advantages and disadvantages. Methods for achieving skin and soft tissue scaffold coverage have been developed to include nonexpansion and expansion techniques. In recent years, the application of digital auxiliary technology such as finite element analysis has helped optimize surgical outcomes and reduce complications. Tissue-engineered cartilage scaffolds and 3-dimensional bioprinting technology have rapidly advanced in the field of ear reconstruction. This article discusses the prevalence and classification of microtia, the selection of auricular scaffolds, the evolution of surgical methods, and the current applications of digital auxiliary technology in ear reconstruction, with the aim of providing clinical physicians with a reference for individualized ear reconstruction surgery. The focus of this work is on the current applications and challenges of tissue engineering and 3-dimensional bioprinting technology in the field of ear reconstruction, as well as future prospects.

Risk of ionizing radiation in pregnancy: just a myth or a real concern?

There are natural concerns regarding the risks posed to the foetus by ionizing radiation exposure during pregnancy. Therefore, many female physicians select to avoid working in an environment associated with ionizing radiation exposure like the catheterization laboratory and even exclude training as electrophysiology, interventional cardiologists, or radiologists. For those already working in this field, pregnancy involves usually a 1-year interruption (pregnancy and maternity leave) to their careers, leading at times to delays in the decision to become pregnant. This review describes the low added risk of malformation/cancer in the offspring, highlight gaps in our understanding, discuss several common wrong beliefs, and recommend how to further decrease radiation dose, especially during pregnancy.

Congenital Malformations and Perinatal Deaths Among the Children of Atomic Bomb Survivors: A Reappraisal

From 1948 to 1954, the Atomic Bomb Casualty Commission conducted a study of pregnancy outcomes among births to atomic bomb survivors (Hiroshima and Nagasaki, Japan) who had received radiation doses ranging from 0 Gy to near-lethal levels. Past reports (1956, 1981, and 1990) on the cohort did not identify significant associations of radiation exposure with untoward pregnancy outcomes, such as major congenital malformations, stillbirths, or neonatal deaths, individually or in aggregate. We reexamined the risk of major congenital malformations and perinatal deaths in the children of atomic bomb survivors (n = 71,603) using fully reconstructed data to minimize the potential for bias, using refined estimates of the gonadal dose from Dosimetry System 2002 and refined analytical methods for characterizing dose-response relationships. The analyses showed that parental exposure to radiation was associated with increased risk of major congenital malformations and perinatal death, but the estimates were imprecise for direct radiation effects, and most were not statistically significant. Nonetheless, the uniformly positive estimates for untoward pregnancy outcomes among children of both maternal and paternal survivors are useful for risk assessment purposes, although extending them to populations other than the atomic bomb survivors comes with uncertainty as to generalizability.

Nongenetic risk factors for infantile cataracts: Systematic review of observational studies

INTRODUCTION

While infantile cataracts are a major cause of childhood blindness, risk factors remain unknown for approximately two-thirds of cases.

METHODS

We systematically searched electronic databases PubMed, Ovid MEDLINE, Web of Science, and Scopus, from inception through March 2018, to identify relevant cohort, case-control, cross-sectional studies, case reports, and case series. We also manually screened bibliographies and consulted with experts in the field to identify additional publications. We reviewed cross-sectional studies, case reports, and case series and provided a narrative summary of the reported potential risk factors. We evaluated methodological qualities of cohort and case-control studies, extracted relevant data, and described statistically significant associations with infant, maternal, and paternal characteristics. Quality assessment and data extraction were conducted by two reviewers independently. All discrepancies were discussed with the senior author and resolved by consensus.

RESULTS

Overall, 110 publications were included in the review, 33 of which were cohort and case-control studies. Most of these studies (n = 32) used population-based data and had either excellent (n = 31) or good (n = 2) methodological quality. Nine studies reported statistically significant associations with infant characteristics (preterm birth, low birth weight), maternal occupations and diseases during pregnancy (untreated hypertension, infections), and paternal sociodemographics (younger age, employment in sawmill industry during pregnancy).

CONCLUSIONS

This systematic literature review provided a comprehensive summary of the known nongenetic risk factors for infantile cataracts, identified gaps in the literature, and provided directions for future research. Studies identifying modifiable risk factors are warranted to design interventions aimed at primary prevention of infantile cataracts.

Risk of congenital heart disease due to exposure to common electrical appliances during early pregnancy: a case-control study

To examine the association between exposure to common electrical appliances in early pregnancy and congenital heart disease (CHD). A case-control study of 2339 participants was conducted in six hospitals in Xi'an, Shaanxi Province, Northwest China from 2014 to 2016. All infants with CHD were diagnosed according to ICD-10 classification. Selected controls consisted of newborns from the same hospital, without any birth defects, and 1:3 matched by birthdate. We conducted personal interviews with the mothers to gather information on any exposure to electrical appliances during pregnancy. Multivariate logistic regression was used to estimate the effects of exposure to common electrical appliances on CHD. We observed that the mothers exposed to computers (OR: 1.33, 95% CI: 1.03, 1.71), induction cookers (OR: 2.79, 95% CI: 2.19, 3.55), and microwave ovens (OR: 1.53, 95% CI: 1.01, 2.31) during early pregnancy were more likely to give birth to infants with CHD. Mothers who wore radiation protection suits (OR: 0.67, 95% CI: 0.52, 0.87) during early pregnancy decreased the risk of CHD in their neonate. There was an interaction for induction cooker exposure with wore radiation protection suits on CHD (RERI: - 1.44, 95% CI: - 2.48, - 0.39; S: 0.37, 95% CI: 0.16, 0.84; AP: - 0.79, 95% CI: - 1.53, - 0.05). Our study confirmed that exposure to some electrical appliances was associated with a higher risk of CHD, and wearing a radiation protection suit was associated with a lower risk of CHD. Women should therefore reduce the usage of electrical appliances before and during pregnancy.

Radiation and the Pregnant IR: Myth versus Fact

The article is part of the series of articles on radiation protection. You can find further articles in the special section of the CVIR issue. Radiation exposure during pregnancy is a source of concern for many women interventional radiologists. There are misconceptions about the actual risks and what is safe. This article will address the myths surrounding occupational radiation exposure and clarify the facts.

Maternal exposure to ambient particulate matter 10 μm or less in diameter before and after pregnancy, and anencephaly risk: A population-based case-control study in China

BACKGROUND

There is no epidemiological evidence on the effects of maternal exposure to ambient particulate matter 10 μm or less in diameter (PM₁₀) and anencephaly risk in offspring.

METHODS

We conducted a population-based case-control study in Liaoning Province, China. The case group consisted of 663 cases with anencephaly and the control group consisted of 7950 healthy infants from the Maternal and Child Health Certificate Registry of Liaoning Province that were born between 2010 and 2015. Daily PM₁₀ concentrations were obtained from 77 monitoring stations located within the study area. A multivariable logistic regression model was established to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Maternal PM₁₀ exposure was significantly associated with an increased risk of anencephaly at three months before conception (highest versus lowest tertile: OR = 1.74, 95% CI: 1.29-2.34; per 10 μg/m³ increment: OR = 1.13, 95% CI: 1.06-1.20) and three months after conception (highest versus lowest tertile: OR = 1.93, 95% CI: 1.44-2.60; per 10 μg/m³ increment: OR = 1.01, 95% CI: 0.95-1.08). The evaluation of shorter exposure windows revealed similar associations for PM₁₀ exposure from the third month before pregnancy to the third month after pregnancy.

CONCLUSIONS

Maternal PM₁₀ exposure is positively associated with anencephaly risk during the critical period of neural system development.

Maternal risk factors for severe microtia/atresia in China: A case-control study

OBJECTIVE

Microtia/atresia is a severe malformation of the external ear. Previous studies have reported the potential risk factors on microtia, whereas few focused on severe microtia/atresia. The aim of the study was to investigate the effects of maternal exposure to environmental risk factors in patients with severe microtia/atresia in China.

METHODS

A case-control study was conducted. Cases were patients with severe microtia/atresia who presented to PUMCH between January 2014 and October 2017. A total of 322 patients with severe microtia/atresia were enrolled and 322 normal controls matched 1:1 with the patients by sex, age and nationality were enrolled. The designed questionnaires were completed and data were gathered. Odds ratios were estimated with logistic regression models along with 95% confidence intervals in severe microtia/atresia.

RESULTS

Most cases were males(68.6%), and the cases were observed more common in unilateral(80.7%), right-sided (54.0%). Multivariate logistic regression analysis showed that threatened abortion (OR 4.066,95% CI = 2.360-7.007), NSAIDs (OR 2.576,95% CI = 1.079-6.148), virus infection (OR 1.933,95% CI = 1.148-3.256), anemia (OR 1.902,95% CI = 1.026-3.526), miscarriages (OR 1.804,95% CI = 1.425-2.285), maternal age (OR 1.079,95% CI = 1.015-1.148) and paternal age (OR 1.061,95% CI = 1.003-1.122) were associated with a higher risk of severe microtia/atresia.

CONCLUSION

These results support that some maternal risk factors could be associated with severe microtia/atresia.

Prevalence and trend of isolated and complicated congenital hydrocephalus and preventive effect of folic acid in northern China, 2005-2015

Congenital hydrocephalus (CH) was a major birth defect of the central nervous system besides neural tube defects (NTDs). Few studies have focused on both the prevalence and trend of isolated and complicated CH in China. Data were drawn from a population-based birth defects surveillance program in five rural counties in northern China from 2005 to 2015. All livebirths and pregnancy terminations at any gestational age affected with CH were recorded. The prevalence and trend of isolated and complicated CH were examined. During the 11-year period, a total of 176,223 births and 357 CH cases were recorded, resulting in a prevalence rate of 20.3 CH cases per 10,000 births. Of the CH cases, 146 were isolated CH, resulting in a prevalence rate of 8.3 per 10,000 births. The pre-perinatal prevalence (<28 gestational weeks) was higher than the perinatal prevalence for both isolated and total CH. The prevalence rates of total and isolated CH showed a similar downward trend during the 11-year period. This downward trend was statistically significant after 2009 (p < 0.05), when a massive folic acid supplementation program was introduced. Although it decreased over time, the prevalence of CH remains high in this population which has a high prevalence of neural tube defects.

Evidence for a teratogenic risk in the offspring of health personnel exposed to ionizing radiation?!

BACKGROUND

The evidence concerning safety of occupational exposure to ionizing radiation on teratogenic effects mainly relies on animal models, disaster epidemiology and experience in cancer etiology. Following an explorative result on maternal exposure in medical occupations we conducted a feasibility study, addressing congenital anomalies (CA) in the offspring of health workers potentially exposed to radiation.

METHODS

In a prospective follow-up study, we enrolled women, identified by mandatory registration at the office of radiation protection as wearing a dosimeter. The participating women answered a questionnaire and if pregnant agreed to an examination of their infant. CA were diagnosed and categorized, and demographic and anamnestic findings (including dosimeter values) were ascertained. Mainz Birth Registry data were used for comparison, and a nonresponder analysis was performed.

RESULTS

Answers were received from 286 of 604 (51%) women exposed and 183 (30.3%) of them participated in the study including 88 nonparticipants who provided exposure data only. Further sources of ionizing radiation and other factors relevant for CA did not differ between the groups. Thirty pregnancies occurred among the participants. Eight of the resulting 27 infants were diagnosed with CA (30%) compared with 6.2% of the comparison group.

CONCLUSION

Previous explorative findings were corroborated by this feasibility study. The increased prevalence for CA could not be explained by any other factor. A preferable prospective active design is achievable, and the participation rate is essential to calculate valid results and answer this important issue. Birth Defects Research (Part A) 106:475-479, 2016. © 2016 Wiley Periodicals, Inc.