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Li S, Zhang Y, Yang K, Zhou W. Exploring potential causal links between air pollutants and congenital malformations: A two-sample Mendelian Randomization study. Reprod Toxicol 2024; 128:108655. [PMID: 38972362 DOI: 10.1016/j.reprotox.2024.108655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/30/2024] [Accepted: 07/02/2024] [Indexed: 07/09/2024]
Abstract
Observational studies have suggested an association between air pollutants and congenital malformations; however, conclusions are inconsistent and the causal associations have not been elucidated. In this study, based on publicly available genetic data, a two-sample Mendelian randomization (MR) was applied to explore the associations between particulate matter 2.5 (PM2.5), NOX, NO2 levels and 11 congenital malformations. Inverse variance weighted (IVW), MR-Egger and weighted median were used as analytical methods, with IVW being the main method. A series of sensitivity analyses were used to verify the robustness of the results. For significant associations, multivariable MR (MVMR) was utilized to explore possible mediating effects. The IVW results showed that PM2.5 was associated with congenital malformations of digestive system (OR = 7.72, 95 %CI = 2.33-25.54, P = 8.11E-4) and multiple systems (OR = 8.63, 95 %CI = 1.02-73.43, P = 0.048) risks; NOX was associated with circulatory system (OR = 4.65, 95 %CI = 1.15-18.86, P = 0.031) and cardiac septal defects (OR = 14.09, 95 %CI = 1.62-122.59, P = 0.017) risks; NO2 was correlated with digestive system (OR = 27.12, 95 %CI = 1.81-407.07, P = 0.017) and cardiac septal defects (OR = 22.57, 95 %CI = 2.50-203.45, P = 0.005) risks. Further MVMR analyses suggest that there may be interactions in the effects of these air pollutants on congenital malformations. In conclusion, this study demonstrated a causal association between air pollution and congenital malformations from a genetic perspective.
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Affiliation(s)
- Shufen Li
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Yanping Zhang
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Kaiyan Yang
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China.
| | - Wenbo Zhou
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China; International Genome Center, Jiangsu University, Zhenjiang, China.
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Wang Y, Ruan Y, Wan X, Wang H, Guo J, Wei J, Ma S, He Y, Zou Z, Li J. Maternal exposure to ambient ozone and fetal congenital heart defects: a national multicenter study in China. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2024:10.1038/s41370-024-00716-4. [PMID: 39217202 DOI: 10.1038/s41370-024-00716-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 08/19/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Ambient O3 has demonstrated an aggravated increasing trend in the context of global warming. The available evidence of maternal exposure to ambient O3 on fetal congenital heart defects (CHD) is still limited, especially in high polluted areas. OBJECTIVE To examine associations of maternal exposure to ambient O3 during early pregnancy with fetal CHDs. METHODS We conducted a national multicenter study in 1313 hospitals from 26 provinces in China and collected a total of 27,817 participants at high risk of CHD from 2013 to 2021. Exposure to ambient O3 during the embryonic period, preconception, the first trimester and periconception was assessed by extracting daily concentrations from a validated grid dataset at each subject's residential district. CHDs were diagnosed based on fetal echocardiography. RESULTS Each 10 µg/m3 increase of exposure to ambient O3 during the embryonic period was approximately linearly associated with a 12.7% (odds ratio [OR]: 1.127, 95% confidence interval [CI]: 1.098, 1.155) increase in odds of pooled CHD (p < 0.001). The associations remain robust after adjusting for ambient PM2.5 and NO2 exposure. The odds of different types of CHD in association with ambient O3 exposure varied greatly. We observed significant association of ambient O3 exposure with ventricular septal defect (VSD), tetralogy of Fallot (TOF); pulmonary stenosis (PS), pulmonary atresia (PA), transposition of great arteries (TGA) and persistent left superior vena cava (PLSVC), with TOF demonstrating the strongest estimates (OR: 1.194, 95% CI:1.107, 1.288). The estimates for preconception, the first trimester and periconception demonstrate consistent findings with the main analyses, indicating stronger associations of ambient O3 exposure during the periconception period. IMPACT Our study provides evidence that higher ambient O3 during early pregnancy was significantly associated with increased odds of fetal CHD. Our findings suggest that pregnant women, clinical practitioners, and policy makers need to pay more attention to the exposure to higher ambient O3 during early pregnancy to reduce the risk of developing CHD and to improve outcomes across the life span.
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Affiliation(s)
- Yaqi Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Yanping Ruan
- Department of Echocardiography, Maternal-Fetal Medicine Research Consultation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Xiaoyu Wan
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Huan Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Jianhui Guo
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, 20740, USA
| | - Sheng Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Yihua He
- Department of Echocardiography, Maternal-Fetal Medicine Research Consultation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China.
| | - Jing Li
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China.
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Zhang H, Feng Y, Huang J, Zhang F, Zhuo S, Liu H. Identifying the critical windows of temperature extremes exposure and congenital heart diseases. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2024:10.1007/s00484-024-02756-9. [PMID: 39167209 DOI: 10.1007/s00484-024-02756-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 08/02/2024] [Indexed: 08/23/2024]
Abstract
The associations between atmospheric temperature and congenital heart disease (CHD) and its subtypes are still inconclusive. In this population-based retrospective case-control study, 643 CHD cases and 3,215 non-CHD controls were analyzed through distributed lag nonlinear model to estimate the effect of weekly temperature exposure on CHD risk and to identify potentially vulnerable windows. Through the binary logistic regression model, we found that elevated temperature in the first trimester was associated with an increased risk of overall CHD and ventricular septal defect (VSD) (OR: 1.059, 95% CI: 1.002-1.119; OR: 1.094, 95% CI: 1.005-1.190, respectively), while increased temperature in the second trimester was significantly positively correlated with atrial septal defect (ASD) risk. However, the results of the DLNM showed a nonlinear relationship between the weekly average temperature and the risk of total CHDs and the subtypes. Exposure to extremely, moderately, and mildly high temperatures significantly increased the risk of overall CHD, ASD and VSD, and the critical windows were mainly concentrated at the 5th-11th and 23rd-27th weeks of gestation. Low-temperature extreme exposure resulted in vulnerable windows for ASD only: 13th-14th gestational weeks. No significant positive associations were found between extreme temperature and patent ductus arteriosus or tetralogy of Fallot. In the current context of climate change, our results add new evidence to the present understanding of the effects of high- and low-temperature extreme exposure on CHD and its main subtypes.
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Affiliation(s)
- Huanhuan Zhang
- Department of Medical Genetics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yang Feng
- Shanghai Pudong New Area Zhoupu Community Health Service Center, Pudong New Area, Shanghai, China
| | - Jia Huang
- Department of Medical Genetics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Fenghua Zhang
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Sisi Zhuo
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Hongyan Liu
- Department of Medical Genetics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
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Huang Z, Zhong X, Shen T, Gu S, Chen M, Xu W, Chen R, Wu J, Yang X. Associations between PM 2.5, ambient heat exposure and congenital hydronephrosis in southeastern China. Front Public Health 2024; 12:1389969. [PMID: 39135922 PMCID: PMC11317401 DOI: 10.3389/fpubh.2024.1389969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 07/04/2024] [Indexed: 08/15/2024] Open
Abstract
Objectives This research aims to analyze how exposure to fine particulate matter (PM2.5) and ambient heat during pregnancy increases the risk of congenital hydronephrosis (CH) in newborns. Methods A case-control study was conducted to investigate the relationship between exposure to PM2.5 and ambient heat during pregnancy and the occurrence of CH in newborns. The study, which was conducted from 2015 to 2020, included 409 infants with CH as the case group and 409 infants without any abnormalities as the control group. Using spatial remote sensing technology, the exposure of each pregnant mother to PM2.5 concentration was meticulously mapped. Additionally, data on the ambient temperature of exposure for each participant were also collected. A logistics regression model was used to calculate the influence of exposure to PM2.5 and ambient heat on the occurrence of CH. Stratified analysis and interaction analysis were used to study the interaction between ambient heat exposure and PM2.5 on the occurrence of CH. Results At the 6th week of gestation, exposure to PM2.5 may increase the risk of CH. For every 10 μg/m3 increase in PM2.5 exposure, the risk of CH increased by 2% (95%CI = 0.98, 1.05) at a p-value of >0.05, indicating that there was no significant relationship between the results. Exposure to intense heat at 6th and 7th weeks of gestation increased the risk of CH. Specifically, for every 1°C increase in heat exposure, the risk of CH in offspring increased by 21% (95%CI = 1.04, 1.41) during the 6th week and 13% during the 7th week (95%CI = 1.02, 1.24). At 5th and 6th weeks of gestation, the relative excess risk due to interaction (RERI) was greater than 0 at the 50th percentile (22.58°C), 75th percentile (27.25°C), and 90th percentile (29.13°C) of daily maximum temperature (Tmax) distribution, indicating that the risk of CH was higher when exposed to both ambient heat and PM2.5 at the same time compared to exposure to a single risk factor. Conclusion Exposure to higher levels of PM2.5 and ambient heat during pregnancy increases the risk of CH in infants. There was a positive interaction between exposure to intense heat and high concentration of PM2.5 on the occurrence of CH.
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Affiliation(s)
- ZhiMeng Huang
- Department Pediatrics, School of Medicine, Women and Children's Hospital, Xiamen University, Xiamen, Fujian, China
| | - XiaoHong Zhong
- Department Pediatrics, School of Medicine, Women and Children's Hospital, Xiamen University, Xiamen, Fujian, China
| | - Tong Shen
- Department Pediatrics, School of Medicine, Women and Children's Hospital, Xiamen University, Xiamen, Fujian, China
| | - SongLei Gu
- Department Pediatrics, School of Medicine, Women and Children's Hospital, Xiamen University, Xiamen, Fujian, China
| | - MengNan Chen
- Department Prenatal Diagnosis, School of Medicine, Women and Children's Hospital, Xiamen University, Xiamen, Fujian, China
| | - WenLi Xu
- Department Pediatrics, School of Medicine, Women and Children's Hospital, Xiamen University, Xiamen, Fujian, China
| | - RuiQi Chen
- Department Pediatrics, School of Medicine, Women and Children's Hospital, Xiamen University, Xiamen, Fujian, China
| | - JinZhun Wu
- Department Pediatrics, School of Medicine, Women and Children's Hospital, Xiamen University, Xiamen, Fujian, China
| | - XiaoQing Yang
- Department Pediatrics, School of Medicine, Women and Children's Hospital, Xiamen University, Xiamen, Fujian, China
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Ha S, Abatzoglou JT, Adebiyi A, Ghimire S, Martinez V, Wang M, Basu R. Impacts of heat and wildfire on preterm birth. ENVIRONMENTAL RESEARCH 2024; 252:119094. [PMID: 38723988 DOI: 10.1016/j.envres.2024.119094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Climate change continues to increase the frequency, intensity, and duration of heat events and wildfires, both of which are associated with adverse pregnancy outcomes. Few studies simultaneously evaluated exposures to these increasingly common exposures. OBJECTIVES We investigated the relationship between exposure to heat and wildfire smoke and preterm birth (PTB). METHODS In this time-stratified case-crossover study, participants consisted of 85,806 California singleton PTBs (20-36 gestational weeks) from May through October of 2015-2019. Birthing parent ZIP codes were linked to high-resolution daily weather, PM2.5 from wildfire smoke, and ambient air pollution data. Heat day was defined as a day with apparent temperature >98th percentile within each ZIP code and heat wave was defined as ≥2 consecutive heat days. Wildfire-smoke day was defined as a day with any exposure to wildfire-smoke PM2.5. Conditional logistic regression was used to calculate the odds ratio (OR) and 95% confidence intervals (CI) comparing exposures during a hazard period (lags 0-6) compared to control periods. Analyses were adjusted for relative humidity, fine particles, and ozone. RESULTS Wildfire-smoke days were associated with 3.0% increased odds of PTB (ORlag0: 1.03, CI: 1.00-1.05). Compared with white participants, associations appeared stronger among Black, Hispanic, Asian, and American Indians/Alaskan Native participants. Heatwave days (ORlag2: 1.07, CI: 1.02-1.13) were positively associated with PTB, with stronger associations among those simultaneously exposed to wildfire smoke days (ORlag2: 1.19, CI: 1.11-1.27). Similar findings were observed for heat days and when other temperature metrics (e.g., maximum, minimum) were used. DISCUSSION Heat and wildfire increased PTB risk with evidence of synergism. As the occurrence and co-occurrence of these events increase, exposure reduction among pregnant people is critical, especially among racial/ethnic minorities.
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Affiliation(s)
- Sandie Ha
- Department of Public Health, School of Social Sciences, Humanities and Arts, Health Science Research Institute, University of California, 5200 N Lake Rd, 95343, Merced, CA, USA.
| | - John T Abatzoglou
- Department of Management of Complex Systems, School of Engineering, University of California, Merced, USA
| | - Adeyemi Adebiyi
- Department of Life and Environmental Sciences, School of Natural Sciences, University of California, Merced, USA
| | - Sneha Ghimire
- Department of Public Health, School of Social Sciences, Humanities and Arts, Health Science Research Institute, University of California, 5200 N Lake Rd, 95343, Merced, CA, USA
| | - Valerie Martinez
- Department of Public Health, School of Social Sciences, Humanities and Arts, Health Science Research Institute, University of California, 5200 N Lake Rd, 95343, Merced, CA, USA
| | - Meng Wang
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Rupa Basu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA
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Wang H, Ruan YP, Ma S, Wang YQ, Wan XY, He YH, Li J, Zou ZY. Interaction between ozone and paternal smoking on fetal congenital heart defects among pregnant women at high risk: a multicenter maternal-fetal medicine study. World J Pediatr 2024; 20:621-632. [PMID: 37665504 DOI: 10.1007/s12519-023-00755-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Evidence remains limited on the association between maternal ozone (O3) exposure and congenital heart defects (CHDs) in offspring, and few studies have investigated the interaction and modification of paternal smoking on this association. METHODS Using a sample including pregnant women at high risk of fetal CHD (with metabolic disease, first-trimester viral infection, family history of CHD, etc.) from a maternal-fetal medicine study covering 1313 referral hospitals in China during 2013-2021, we examined the associations between maternal O3 exposure during 3-8 weeks of gestational age and fetal CHD in offspring and investigated the interaction and modification of paternal smoking on this association. CHD was diagnosed by fetal echocardiograms, maximum daily 8-hour average O3 exposure data at a 10 km × 10 km spatial resolution came from the Tracking Air Pollution in China dataset, and paternal smoking was collected using questionnaires. Logistic regression models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Among 27,834 pregnant women at high risk of fetal CHD, 17.4% of fetuses were diagnosed with CHD. Each 10 μg/m3 increase in maternal O3 exposure was associated with a 17% increased risk of CHD in offspring (OR = 1.17, 95% CI = 1.14-1.20). Compared with paternal nonsmoking and maternal low O3 exposure, the ORs (95% CI) of CHD for smoking and low O3 exposure, nonsmoking and high O3 exposure, and smoking and high O3 exposure were 1.25 (1.08-1.45), 1.81 (1.56-2.08), and 2.23 (1.84-2.71), respectively. Paternal smoking cessation seemingly mitigated the increased risk of CHD. CONCLUSIONS Maternal O3 exposure and paternal smoking were interactively associated with an increased risk of fetal CHD in offspring, which calls for effective measures to decrease maternal exposure to O3 pollution and secondhand smoke for CHD prevention.
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Affiliation(s)
- Huan Wang
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, No. 38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Yan-Ping Ruan
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University; Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China
| | - Sheng Ma
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, No. 38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Ya-Qi Wang
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, No. 38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Xiao-Yu Wan
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, No. 38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Yi-Hua He
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University; Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China.
| | - Jing Li
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, No. 38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Zhi-Yong Zou
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, No. 38 Xueyuan Rd, Haidian District, Beijing, 100191, China.
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Shen Y, de Hoogh K, Schmitz O, Clinton N, Tuxen-Bettman K, Brandt J, Christensen JH, Frohn LM, Geels C, Karssenberg D, Vermeulen R, Hoek G. Monthly average air pollution models using geographically weighted regression in Europe from 2000 to 2019. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 918:170550. [PMID: 38320693 DOI: 10.1016/j.scitotenv.2024.170550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/02/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024]
Abstract
Detailed spatial models of monthly air pollution levels at a very fine spatial resolution (25 m) can help facilitate studies to explore critical time-windows of exposure at intermediate term. Seasonal changes in air pollution may affect both levels and spatial patterns of air pollution across Europe. We built Europe-wide land-use regression (LUR) models to estimate monthly concentrations of regulated air pollutants (NO2, O3, PM10 and PM2.5) between 2000 and 2019. Monthly average concentrations were collected from routine monitoring stations. Including both monthly-fixed and -varying spatial variables, we used supervised linear regression (SLR) to select predictors and geographically weighted regression (GWR) to estimate spatially-varying regression coefficients for each month. Model performance was assessed with 5-fold cross-validation (CV). We also compared the performance of the monthly LUR models with monthly adjusted concentrations. Results revealed significant monthly variations in both estimates and model structure, particularly for O3, PM10, and PM2.5. The 5-fold CV showed generally good performance of the monthly GWR models across months and years (5-fold CV R2: 0.31-0.66 for NO2, 0.4-0.79 for O3, 0.4-0.78 for PM10, 0.46-0.87 for PM2.5). Monthly GWR models slightly outperformed monthly-adjusted models. Correlations between monthly GWR model were generally moderate to high (Pearson correlation >0.6). In conclusion, we are the first to develop robust monthly LUR models for air pollution in Europe. These monthly LUR models, at a 25 m spatial resolution, enhance epidemiologists to better characterize Europe-wide intermediate-term health effects related to air pollution, facilitating investigations into critical exposure time windows in birth cohort studies.
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Affiliation(s)
- Youchen Shen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Kees de Hoogh
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Oliver Schmitz
- Department of Physical Geography, Faculty of Geosciences, Utrecht University, Utrecht, the Netherlands
| | - Nick Clinton
- Google, Inc, Mountain View, California, United States
| | | | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | | | - Lise M Frohn
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Camilla Geels
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Derek Karssenberg
- Department of Physical Geography, Faculty of Geosciences, Utrecht University, Utrecht, the Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
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Geng L, Yang Y, Chen Y, Ye T, Qiu A, Bukulmez O, Mol BW, Norman RJ, Teng X, Xiang J, Chen M. Association between ambient temperature exposure and pregnancy outcomes in patients undergoing in vitro fertilization in Shanghai, China: a retrospective cohort study. Hum Reprod 2023; 38:2489-2498. [PMID: 37759343 DOI: 10.1093/humrep/dead192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/27/2023] [Indexed: 09/29/2023] Open
Abstract
STUDY QUESTION Does ambient temperature exposure affect outcomes including clinical pregnancy and live birth in women undergoing IVF? SUMMARY ANSWER Both extreme cold and hot ambient temperatures were significantly associated with adverse pregnancy outcomes of IVF cycles. WHAT IS KNOWN ALREADY Heat exposure has been linked to adverse pregnancy outcomes worldwide. However, the effect of ambient temperature on infertile women undergoing IVF treatment is unclear. STUDY DESIGN, SIZE, DURATION A retrospective cohort study was conducted from a database of 3452 infertile women who underwent their first fresh or frozen embryo transfer in the Shanghai First Maternity and Infant Hospital from April 2016 to December 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS Daily mean ambient temperature exposure for each patient was obtained based on their residential address. Temperature-stratified multiple logistic regression analysis was performed to investigate associations between temperature exposure and pregnancy outcomes after controlling for confounders. Vulnerable sub-groups were identified using forest plots. MAIN RESULTS AND THE ROLE OF CHANCE The clinical pregnancy rate and live birth rate were 45.7% and 37.1%, respectively. Regarding clinical pregnancy, a higher temperature during cold weather was significantly associated with a higher pregnancy rate in the period about 11 weeks before ovarian stimulation (adjusted odds ratio (aOR) = 1.102, 95% CI: 1.012-1.201). Regarding live birth, an increased temperature during cold weather was significantly related to a higher live birth rate in the period after confirmation of clinical pregnancy or biochemical pregnancy, with the aORs of 6.299 (95% CI: 3.949-10.047) or 10.486 (95% CI: 5.609-19.620), respectively. However, a higher temperature during hot weather was negatively associated with the live birth rate in the periods after confirmation of clinical pregnancy or biochemical pregnancy, with the aORs at 0.186 (95% CI: 0.121-0.285) or 0.302 (95% CI: 0.224-0.406), respectively. Moreover, the decline in live birth rates during cold and hot weather was accompanied by increased rates of early miscarriage (P < 0.05). Stratified analyses identified susceptibility characteristics among the participants. LIMITATIONS, REASONS FOR CAUTION Climate monitoring data were used to represent individual temperature exposure levels according to the patient's residential address in the study. We were not able to obtain information of personal outdoor activity and use of indoor air conditioners in this retrospective study, which may affect actual temperature exposure. WIDER IMPLICATIONS OF THE FINDINGS This study highlights that the ambient temperature exposure should be taken into account during IVF treatment and afterwards. There is a need to be alert to extremes in cold and hot ambient temperatures, especially during the period of follicle development and pregnancy. With this knowledge, clinicians can scientifically determine the timing of IVF treatment and reinforce patients' awareness of self-protection to minimize adverse pregnancy outcomes associated with extreme temperatures. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by a grant from the Clinical Research Plan of Shanghai Hospital Development Center [SHDC2020CR4080], a grant from the Science and Technology Commission of Shanghai Municipality [19411960500], and two grants from the National Natural Science Foundation of China [81871213, 81671468]. B.W.M. is supported by a NHMRC Investigator grant (GNT1176437). B.W.M. reports consultancy for ObsEva, and research grants from Merck KGaA, Ferring and Guerbet. The other authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Lulu Geng
- Centre for Assisted Reproduction, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yan Yang
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Yifeng Chen
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Tingting Ye
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andong Qiu
- Centre for Assisted Reproduction, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Orhan Bukulmez
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Melbourne, VIC, Australia
| | - Robert J Norman
- Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, SA, Australia
| | - Xiaoming Teng
- Centre for Assisted Reproduction, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jianjun Xiang
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Miaoxin Chen
- Centre for Assisted Reproduction, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
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9
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Gong Y, Zhao Y, Zhang X, Zhao X, Chang H, Huang J, Yu Z, Zhang H, Liu H. Ambient particulate matter, maternal thyroid function, and birth weight: A mediation analysis. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 264:115420. [PMID: 37660528 DOI: 10.1016/j.ecoenv.2023.115420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/31/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Birth weight (BW) is an indicator of fetal growth and development. Previous studies showed inconsistent results on the association of ambient particulate matter (PM) exposure with BW, and the role of maternal thyroid function has not been clarified. METHODS We recruited 1711 gravidas between 2017 and 2019 in Henan, China. All participants were followed up until delivery. Daily concentrations of PM, including PM2.5 and PM10, were evaluated by using the spatial-temporal model. Maternal thyroid hormone (TH) levels were quantified by electrochemiluminescent microparticle immunoassay. Linear regression models were employed to examine the association among PM, BW, and maternal TH. Mediating effects of maternal TH interrelated with PM exposure on BW were investigated by causal mediation analyses. RESULTS A total of 1049 gravidas were identified. We found that per 10 µg/m3 increase in PM2.5 and PM10 were associated with a decreased BW of 9.941 g, and 7.758 g (PM2.5: 95 %CI: -18.184, -1.698; PM10: 95 %CI: -14.436, -1.080). An inverse correlation of maternal FT4 levels with BW was found, with the pooled β of -319.983 g (95 %CI: -483.216, -156.750). We found a prominent positive correlation between gestational FT4 and PM exposure (PM2.5: β = 0.004, 95 %CI: 0.001, 0.007; PM10: β = 0.003, 95 %CI: 0.000, 0.006). Mediation analysis found that FT4 levels mediated the relationship between maternal PM exposure and BW, ranging from 5.55 % to 15.86 %. CONCLUSIONS Maternal PM exposure may induce a reduction in newborn BW by affecting the maternal TH concentrations.
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Affiliation(s)
- Yuting Gong
- Department of Medical Genetics, Henan Provincial People's Hospital; People's Hospital of Zhengzhou University, Zhengzhou, China; School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yueshu Zhao
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoan Zhang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Zhao
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Chang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jia Huang
- Department of Medical Genetics, Henan Provincial People's Hospital; People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Zengli Yu
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Huanhuan Zhang
- School of Public Health, Zhengzhou University, Zhengzhou, China.
| | - Hongyan Liu
- Department of Medical Genetics, Henan Provincial People's Hospital; People's Hospital of Zhengzhou University, Zhengzhou, China.
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10
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Agay-Shay K. Invited Perspective: Air Pollution and Congenital Heart Defects (CHDs)-a Summary of Two Decades and Future Direction in Research. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:61305. [PMID: 37339065 DOI: 10.1289/ehp12931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Affiliation(s)
- Keren Agay-Shay
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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11
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Cheng Y, Yin J, Yang L, Xu M, Lu X, Huang W, Dai G, Sun G. Ambient air pollutants in the first trimester of pregnancy and birth defects: an observational study. BMJ Open 2023; 13:e063712. [PMID: 36948563 PMCID: PMC10040071 DOI: 10.1136/bmjopen-2022-063712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVES As current studies on the relationships between air pollutants exposure during the first trimester and birth defects were not fully elucidated, this study aimed to assess the association between selected air pollutants and birth defects. DESIGN An observational study. PARTICIPANTS We obtained 70 854 singletons with gestational age <20 weeks who were delivered at a large maternal and child healthcare centre in Wuhan, China. OUTCOME MEASURES Birth defects data and daily average concentration of ambient particulate matter ≤10 µm diameter (PM10), PM ≤2.5 µm diameter (PM2.5), sulfur dioxide (SO2) and nitrogen dioxide (NO2) were obtained. Logistic regression analysis was applied to assess the association between maternal air pollutants exposure during first trimester and total birth defects, congenital heart defects (CHDs), limb defects and orofacial clefts with adjustments of potential covariates. RESULTS There were a total of 1352 birth defect cases included in this study, with a prevalence of 19.08‰. Maternal exposed to high concentrations of PM10, PM2.5, NO2 and SO2 in the first trimester were significantly associated with elevated ORs of birth defects (ORs ranged from 1.13 to 1.23). Additionally, for male fetuses, maternal exposed to high PM2.5 concentration was associated with an elevated odd of CHDs (OR 1.27, 95% CI 1.06 to 1.52). In the cold season, the ORs of birth defects were significantly increased among women exposed to PM2.5 (OR 1.64, 95% CI 1.41 to 1.91), NO2 (OR 1.22, 95% CI 1.08 to 1.38) and SO2 (OR 1.26, 95% CI 1.07 to 1.47). CONCLUSIONS This study showed unfavourable effects of air pollutants exposure during the first trimester on birth defects. Especially, the association between maternal PM2.5 exposure and CHDs was only observed among male fetuses, and stronger effects of PM2.5, NO2 and SO2 exposure on birth defects were observed in the cold season.
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Affiliation(s)
- Yao Cheng
- Obstetrics Department, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Jieyun Yin
- Department of Epidemiology and Health Statistics, Medical College of Soochow University, Suzhou, China
| | - Lijun Yang
- Obstetrics Department, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Man Xu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Xinfeng Lu
- Medical Record Department, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Wenting Huang
- Science and Education Department, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Guohong Dai
- Health Care Department, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Guoqiang Sun
- Obstetrics Department, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
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12
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Xu W, Li D, Shao Z, You Y, Pan F, Lou H, Li J, Jin Y, Wu T, Pan L, An J, Xu J, Cheng W, Tao L, Lei Y, Huang C, Shu Q. The prenatal weekly temperature exposure and neonatal congenital heart disease: a large population-based observational study in China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:38282-38291. [PMID: 36580248 PMCID: PMC9797890 DOI: 10.1007/s11356-022-24396-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
We aim to explore the link between maternal weekly temperature exposure and CHD in offspring and identify the relative contributions from heat and cold and from moderate and extreme atmospheric temperature. From January 2019 to December 2020, newborns who were diagnosed with CHD by echocardiography in the Network Platform for Congenital Heart Disease (NPCHD) from 11 cities in eastern China were enrolled in the present study. We appraised the exposure lag response relationship between temperature and CHDs in the distributed lag nonlinear model and further probed the pooled estimates by multivariate meta-analysis. We further performed the exposure-response curves in extreme temperature (5th percentile for cold and 95th for hot events). We also delve into the cumulative risk ratios (CRRs) of temperature on CHDs in general and subgroups. In this study, 5904 of 983, 523 infants were diagnosed with CHDs. The temperature-CHD combination performed positive significance in two exposure windows, gestational weeks 10-16 and 26-31, and reached the maximum effect in the 28th week. Compared with extreme cold (5th, 6.14℃), these effects were higher in extreme heat (95th, 29.26℃). The cumulative exposure-response curve showed a steep nonlinear rise in the hot tail but showed non-significance at low temperatures. In this range, the CRRs of temperature showed an increment to a ceiling of 3.781 (95% CI: 1.460-10.723). The temperature- CHD curves for both sex groups showed a general growth trend. No statistical significance was observed between these two groups (P = 0.106). The cumulative effect of the temperature related CHD was significant in regions with lower education levels (maximum CRR was 9.282 (3.019-28.535)). A degree centigrade increase in temperature exposure was associated with the increment of CHD risk in the first and second trimesters, especially in extreme heat. Neonates born in lower education regions were more vulnerable to temperature-related CHDs.
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Affiliation(s)
- Weize Xu
- Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310000, China
| | - Die Li
- Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310000, China
| | - Zehua Shao
- Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, China
| | - Yanqin You
- Department of Obstetrics and Gynecology, First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Feixia Pan
- Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310000, China
| | - Hongliang Lou
- Jinhua Maternal and Child Health Care Hospital, Jinhua, 321000, China
| | - Jing Li
- Jiaxing Maternity and Child Health Care Hospital, Jiaxing, 314000, China
| | - Yueqin Jin
- Shaoxing Maternity and Child Health Care Hospital, Shaoxing, 312000, China
| | - Ting Wu
- Hangzhou Women's Hospital, Hangzhou, 310000, China
| | - Lulu Pan
- Wenzhou Guidance Center for Maternity and Child Health, Wenzhou, 325000, China
| | - Jing An
- Huzhou Maternity and Child Health Care Hospital, Huzhou, 313000, China
| | - Junqiu Xu
- Zhoushan Women and Children Hospital, Zhoushan, 316000, China
| | - Wei Cheng
- Ningbo Women and Children Hospital, Ningbo, 315000, China
| | - Linghua Tao
- Taizhou Women and Children's Hospital, Taizhou, 318000, China
| | - Yongliang Lei
- Lishui Maternity and Child Health Care Hospital, Lishui, 323000, China
| | - Chengyin Huang
- Quzhou Maternity and Child Health Care Hospital, Quzhou, 324000, China
| | - Qiang Shu
- Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310000, China.
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13
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Zhang H, Zhang X, Feng D, Gao Z, Gong Y, Zhang J, Song S, Yu Z, Huang C. Interaction effects of night-time temperature and PM 2.5 on preterm birth in Huai River Basin, China. ENVIRONMENT INTERNATIONAL 2023; 171:107729. [PMID: 36623379 DOI: 10.1016/j.envint.2023.107729] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/26/2022] [Accepted: 01/01/2023] [Indexed: 06/17/2023]
Abstract
Nocturnal temperature is observed increasing with global warming. However, evidence on night-time non-optimal temperature on the risk of preterm birth (PTB) is limited, and the potential interactions with air pollution on PTB has not been well clarified. We therefore conducted a population-based retrospective cohort study to evaluate the effect of night-time temperature extremes on the risk of PTB and its interaction with air pollution. Records of 196,780 singleton births from 4 counties in Huai River Basin (2013-2018) were obtained. Gridded data on night-time temperature were collected from a high-quality Chinese Air Quality Reanalysis dataset. We used a multivariate logistic regression to evaluate the effects of night-time heat and cold exposure on the risk of PTB as well as its subtypes. Potential interactions between night-time temperature extremes and fine particulate matter < 2.5 µm (PM2.5) were examined using the relative excess risk due to interaction (RERI). We found that the risk of PTB was positively associated with third trimester night-time extremely heat and cold exposure, with adjusted OR of 1.898 (95 %CI: 1.655-2.177) and 2.044 (95 %CI: 1.786-2.339). Similar effects were observed for PTB subtypes, moderately PTB (mPTB) and very PTB (vPTB). Synergistic effects (RERI greater than 0) of each trimester night-time temperature extremes exposure and PM2.5 on PTB were observed. We identified consistent positive interactions between night-time temperature extremes and PM2.5 on mPTB. No significant interaction of night-time temperature extremes and PM2.5 on vPTB was found. In conclusion, this large retrospective cohort study found that third trimester night-time heat and cold exposure significantly increased the risk of PTB and its subtypes. There is a synergistic effect between night-time temperature extremes and high PM2.5 levels on PTB and mPTB. In the context of climate warming, our results add new evidence to the current understanding of night-time non-optimal temperature exposure on PTB.
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Affiliation(s)
- Huanhuan Zhang
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China; School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaoan Zhang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Zhengzhou, China
| | - Demin Feng
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Zhengzhou, China
| | - Zhan Gao
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Yuting Gong
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Junxi Zhang
- NHC Key Laboratory of Birth Defects Prevention & Henan Key Laboratory of Population Defects Prevention, Zhengzhou, China
| | - Shuaixing Song
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zengli Yu
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China; NHC Key Laboratory of Birth Defects Prevention & Henan Key Laboratory of Population Defects Prevention, Zhengzhou, China.
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
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14
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Simmons W, Lin S, Luben TJ, Sheridan SC, Langlois PH, Shaw GM, Reefhuis J, Romitti PA, Feldkamp ML, Nembhard WN, Desrosiers TA, Browne ML, Stingone JA. Modeling complex effects of exposure to particulate matter and extreme heat during pregnancy on congenital heart defects: A U.S. population-based case-control study in the National Birth Defects Prevention Study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 808:152150. [PMID: 34864029 PMCID: PMC8758551 DOI: 10.1016/j.scitotenv.2021.152150] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/19/2021] [Accepted: 11/29/2021] [Indexed: 05/04/2023]
Abstract
BACKGROUND/OBJECTIVE Research suggests gestational exposure to particulate matter ≤2.5 μm (PM2.5) and extreme heat may independently increase risk of birth defects. We investigated whether duration of gestational extreme heat exposure modifies associations between PM2.5 exposure and specific congenital heart defects (CHDs). We also explored nonlinear exposure-outcome relationships. METHODS We identified CHD case children (n = 2824) and non-malformed live-birth control children (n = 4033) from pregnancies ending between 1999 and 2007 in the National Birth Defects Prevention Study, a U.S. population-based multicenter case-control study. We assigned mothers 6-week averages of PM2.5 exposure during the cardiac critical period (postconceptional weeks 3-8) using the closest monitor within 50 km of maternal residence. We assigned a count of extreme heat days (EHDs, days above the 90th percentile of daily maximum temperature for year, season, and weather station) during this period using the closest weather station. Using generalized additive models, we explored logit-nonlinear exposure-outcome relationships, concluding logistic models were reasonable. We estimated joint effects of PM2.5 and EHDs on six CHDs using logistic regression models adjusted for mean dewpoint and maternal age, education, and race/ethnicity. We assessed multiplicative and additive effect modification. RESULTS Conditional on the highest observed EHD count (15) and at least one critical period day during spring/summer, each 5 μg/m3 increase in average PM2.5 exposure was significantly associated with perimembranous ventricular septal defects (VSDpm; OR: 1.54 [95% CI: 1.01, 2.41]). High EHD counts (8+) in the same population were positively, but non-significantly, associated with both overall septal defects and VSDpm. Null or inverse associations were observed for lower EHD counts. Multiplicative and additive effect modification estimates were consistently positive in all septal models. CONCLUSIONS Results provide limited evidence that duration of extreme heat exposure modifies the PM2.5-septal defects relationship. Future research with enhanced exposure assessment and modeling techniques could clarify these relationships.
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Affiliation(s)
- Will Simmons
- Department of Epidemiology, Columbia University, 722 West 168(th) Street, NY, New York 10032, USA
| | - Shao Lin
- Department of Epidemiology and Biostatistics, University at Albany, 1 University Place, Rensselaer, NY 12144, USA; Department of Environmental Health Sciences, University at Albany, 1 University Place, Rensselaer, NY, 12144, USA
| | - Thomas J Luben
- Office of Research and Development, U.S. Environmental Protection Agency, 109 T.W. Alexander Drive, RTP, NC 27711, USA
| | - Scott C Sheridan
- Department of Geography, Kent State University, 325 S. Lincoln Street, Kent, OH 44242, USA
| | - Peter H Langlois
- Department of Epidemiology, Human Genetics, and Environmental Science, University of Texas School of Public Health, 1616 Guadalupe Street, Austin, TX 78701, USA
| | - Gary M Shaw
- Stanford School of Medicine, 453 Quarry Road, Stanford, CA 94305, USA
| | - Jennita Reefhuis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA
| | - Paul A Romitti
- Department of Epidemiology, The University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, USA
| | - Marcia L Feldkamp
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Wendy N Nembhard
- Departments of Pediatrics and Epidemiology, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR 72205, USA
| | - Tania A Desrosiers
- Department of Epidemiology, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Marilyn L Browne
- Department of Epidemiology and Biostatistics, University at Albany, 1 University Place, Rensselaer, NY 12144, USA; Birth Defects Registry, New York State Department of Health, Corning Tower, Empire State Plaza, Albany, NY 12237, USA
| | - Jeanette A Stingone
- Department of Epidemiology, Columbia University, 722 West 168(th) Street, NY, New York 10032, USA.
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