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Zhou X, He J, Kuang H, Fang J, Wang H. Perinatal deaths attributable to congenital heart defects in Hunan Province, China, 2016-2020. PLoS One 2024; 19:e0304615. [PMID: 38870227 PMCID: PMC11175501 DOI: 10.1371/journal.pone.0304615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/15/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVE To explore the association between demographic characteristics and perinatal deaths attributable to congenital heart defects (CHDs). METHODS Data were obtained from the Birth Defects Surveillance System of Hunan Province, China, 2016-2020. The surveillance population included fetuses and infants from 28 weeks of gestation to 7 days after birth whose mothers delivered in the surveillance hospitals. Surveillance data included demographic characteristics such as sex, residence, maternal age, and other key information, and were used to calculate the prevalence of CHDs and perinatal mortality rates (PMR) with 95% confidence intervals (CI). Multivariable logistic regression analysis (method: Forward, Wald, α = 0.05) and adjusted odds ratios (ORs) were used to identify factors associated with perinatal deaths attributable to CHDs. RESULTS This study included 847755 fetuses, and 4161 CHDs were identified, with a prevalence of 0.49% (95%CI: 0.48-0.51). A total of 976 perinatal deaths attributable to CHDs were identified, including 16 (1.64%) early neonatal deaths and 960 (98.36%) stillbirths, with a PMR of 23.46% (95%CI: 21.98-24.93). In stepwise logistic regression analysis, perinatal deaths attributable to CHDs were more common in rural areas than urban areas (OR = 2.21, 95%CI: 1.76-2.78), more common in maternal age <20 years (OR = 2.40, 95%CI: 1.05-5.47), 20-24 years (OR = 2.13, 95%CI: 1.46-3.11) than maternal age of 25-29 years, more common in 2 (OR = 1.60, 95%CI: 1.18-2.18) or 3 (OR = 1.43, 95%CI: 1.01-2.02) or 4 (OR = 1.84, 95%CI: 1.21-2.78) or > = 5 (OR = 2.02, 95%CI: 1.28-3.18) previous pregnancies than the first pregnancy, and more common in CHDs diagnosed in > = 37 gestional weeks (OR = 77.37, 95%CI: 41.37-144.67) or 33-36 gestional weeks (OR = 305.63, 95%CI: 172.61-541.15) or < = 32 gestional weeks (OR = 395.69, 95%CI: 233.23-671.33) than diagnosed in postnatal period (within 7 days), and less common in multiple births than singletons (OR = 0.48, 95%CI: 0.28-0.80). CONCLUSIONS Perinatal deaths were common in CHDs in Hunan in 2016-2020. Several demographic characteristics were associated with perinatal deaths attributable to CHDs, which may be summarized mainly as economic and medical conditions, severity of CHDs, and parental attitudes toward CHDs.
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Affiliation(s)
- Xu Zhou
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Jian He
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Haiyan Kuang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Junqun Fang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Hua Wang
- The Hunan Children’s Hospital, Changsha, Hunan Province, China
- National Health Commission Key Laboratory of Birth Defects Research, Prevention and Treatment, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
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Qu Y, Li AJ, Liu X, Lin S, Bloom MS, Wang X, Li X, Wang H, Han F, Gao X, Wu Y, Huang K, Zhuang J, Ma S, Chen J. Maternal serum neonicotinoids during early-mid pregnancy and congenital heart diseases in offspring: An exploratory study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 342:123046. [PMID: 38040186 DOI: 10.1016/j.envpol.2023.123046] [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: 09/06/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
Experimental evidence has indicated a correlation between in-utero exposure to neonicotinoid pesticides (NEOs) and adverse birth outcomes in mammals. However, the distribution of NEO exposure during human pregnancy, as well as its association with congenital heart diseases (CHDs), the most common birth defects, are unclear. Our purpose was to explore the distribution of and contributing factors to NEO exposure in pregnant women during early-mid pregnancy and to assess the associations between NEOs and CHDs. This nested case-control study was conducted within an ongoing prospective birth cohort study and enrolled 141 CHD singletons and their 282 individually matched controls. Six "parent" NEOs and three NEO metabolites were measured in maternal serum collected at an average gestational age of 16 weeks, using liquid chromatography-tandem mass spectrometry. Logistic regression was used to quantify the NEOs-CHDs associations and explore potential contributing factors to serum NEO levels in controls. N-desmethyl acetamiprid (N-dm-ACE) and imidacloprid (IMI) were the most frequently detected NEOs, found in 100% and 20% of maternal sera, respectively. We did not find a statistically significant association between total NEOs and overall CHDs. However, there was a trend towards a higher risk of septal defects with greater serum NEOs (ORs ranged from 1.80 to 2.36), especially nitro-containing NEOs represented by IMI. Pregnant women with lower education had elevated serum total NEOs compared to women with higher education (OR = 48.39, 95% CI: 23.48-99.72). Pregnant women were primarily exposed to N-dm-ACE and IMI during early-mid pregnancy. Gestational exposure to NEOs may be associated with an increased risk of septal defects, but the evidence is limited at present. Education is a potential contributing factor to NEO exposure in pregnant women. Larger and more precise studies with longitudinal biospecimen collection, are recommended to validate our exploratory findings.
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Affiliation(s)
- Yanji Qu
- Global Health Research Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Adela Jing Li
- College of Natural Recontributing Factors and Environment, South China Agricultural University, Guangzhou, China
| | - Xiaoqing Liu
- Global Health Research Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Shao Lin
- Department of Environmental Health Sciences, University at Albany State University of New York, One University Place, Rensselaer, Albany, NY, USA
| | - Michael S Bloom
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | - Ximeng Wang
- Global Health Research Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaohong Li
- Department of Medical Research, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Hui Wang
- Department of Obstetrics and Gynecology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Fengzhen Han
- Department of Obstetrics and Gynecology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Xiangmin Gao
- Global Health Research Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Yong Wu
- Global Health Research Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Kaiqin Huang
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jian Zhuang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Shengtao Ma
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jimei Chen
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China.
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Smith C, Olugbuyi O, Kaul P, Dover DC, Mackie AS, Islam S, Eckersley L, Hornberger LK. Lower Socioeconomic Status is Associated with an Increased Incidence and Spectrum of Major Congenital Heart Disease and Associated Extracardiac Pathology. Pediatr Cardiol 2024; 45:433-440. [PMID: 37870603 DOI: 10.1007/s00246-023-03310-x] [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] [Received: 07/29/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023]
Abstract
Several studies have suggested an inverse relationship between lower socioeconomic status (SES) and the incidence of congenital heart disease (CHD) among live births. We sought to examine this relationship further in a Canada-wide population study, exploring CHD subtypes, trends, and associated noncardiac abnormalities. Infants born in Canada (less Quebec) from 2008 to 2018 with CHD requiring intervention in the first year were identified using ICD-10 codes through the Canadian Institute for Health Information Discharge Abstract Database. Births of CHD patients were stratified by SES (census-based income quintiles) and compared against national birth proportions using X2 tests. Proportions with extracardiac defects (ED) and nonlethal genetic syndromes (GS) were also explored. From 2008 to 2018, 7711 infants born with CHD were included. The proportions of major CHD distributed across SES quintiles were 27.1%, 20.1%, 19.2%, 18.6%, and 15.0% from lowest to highest, with significant differences relative to national birth proportions (22.0%, 20.0%, 20.6%, 20.7%, and 16.7% from lowest (1) to highest (5)) (p < 0.0001). No temporal trends in the CHD proportions across SES categories were observed over the study period. The distribution across SES quintiles was different only for specific CHD subtypes (double-outlet right ventricle (n = 485, p = 0.03), hypoplastic left heart syndrome (n = 547, p = 0.006), heterotaxy (n = 224, p = 0.03), tetralogy of Fallot (n = 1007, p = 0.008), truncus arteriosus (n = 126, p < 0.0001), and ventricular septal defect (n = 1916, p < 0.0001)), with highest proportions observed in the lowest quintile. The proportion of the total population with ED but not GS was highest in lower SES quintiles (< 0.0001) commensurate with increased proportion of CHD. Our study suggests a negative association between SES and certain CHD lesions and ED.
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Affiliation(s)
- Christopher Smith
- School of Public Health, University of Alberta, Edmonton, Canada
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
| | - Oluwayomi Olugbuyi
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Padma Kaul
- School of Public Health, University of Alberta, Edmonton, Canada
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Douglas C Dover
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
| | - Andrew S Mackie
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Luke Eckersley
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Lisa K Hornberger
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
- Department of Obstetrics & Gynecology, Women & Children's Health Research Institute, University of Alberta, Edmonton, Canada.
- Pediatric Cardiology, Stollery Children's Hospital, 4C2, 8440 112th Street, Edmonton, AB, T6G 2B7, Canada.
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Golding MC. Teratogenesis and the epigenetic programming of congenital defects: Why paternal exposures matter. Birth Defects Res 2023; 115:1825-1834. [PMID: 37424262 PMCID: PMC10774456 DOI: 10.1002/bdr2.2215] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 07/11/2023]
Abstract
Until recently, clinicians and researchers did not realize paternal exposures could impact child developmental outcomes. Indeed, although there is growing recognition that sperm carry a large amount of non-genomic information and that paternal stressors influence the health of the next generation, toxicologists are only now beginning to explore the role paternal exposures have in dysgenesis and the incidence of congenital malformations. In this commentary, I will briefly summarize the few studies describing congenital malformations resulting from preconception paternal stressors, argue for the theoretical expansion of teratogenic perspectives into the male preconception period, and discuss some of the challenges in this newly emerging branch of toxicology. I argue that we must consider gametes the same as any other malleable precursor cell type and recognize that environmentally-induced epigenetic changes acquired during the formation of the sperm and oocyte hold equal teratogenic potential as exposures during early development. Here, I propose the term epiteratogen to reference agents acting outside of pregnancy that, through epigenetic mechanisms, induce congenital malformations. Understanding the interactions between the environment, the essential epigenetic processes intrinsic to spermatogenesis, and their cumulative influences on embryo patterning is essential to addressing a significant blind spot in the field of developmental toxicology.
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Affiliation(s)
- Michael C. Golding
- Department of Veterinary Physiology & Pharmacology, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA, 77843
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Mátrai Á, Teutsch B, Pethő B, Kaposi AD, Hegyi P, Ács N. Reducing the Risk of Birth Defects Associated with Maternal Influenza: Insights from a Hungarian Case-Control Study. J Clin Med 2023; 12:6934. [PMID: 37959399 PMCID: PMC10650197 DOI: 10.3390/jcm12216934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
Influenza viruses can cause several complications during pregnancy. Therefore, we aimed to investigate the effects of influenza on the development of congenital abnormalities (CAs) by analyzing the database of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA). In our multicenter, case-control, population-based study, we processed clinician-reported outcomes and diagnoses collected in the HCCSCA. The case group included newborns with different non-chromosomal birth defects, while the controls were newborns without CAs. Maternal influenza, as a risk factor for CAs, was analyzed by using a logistic regression model and odds ratios with 95% confidence intervals (CIs). Our results showed that maternal influenza in the first trimester was associated with increased odds of developing non-chromosomal CAs (OR: 1.41, CI: 1.28-1.55). There were increased odds of neural tube defects (OR: 2.22, CI: 1.78-2.76), orofacial clefts (OR: 2.28, CI: 1.87-2.78), and congenital heart defects (OR: 1.28, CI: 1.10-1.49) after influenza infection. In all cases, we found a protective effect of folic acid supplementation in the first trimester. In summary, the odds of non-chromosomal birth defects are higher after maternal influenza in the first trimester, and folic acid or pregnancy vitamin supplementation and antipyretic therapy may reduce the effect of maternal influenza during the first trimester.
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Affiliation(s)
- Ákos Mátrai
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (Á.M.); (B.P.)
- Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (B.T.); (P.H.)
| | - Brigitta Teutsch
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (B.T.); (P.H.)
- Institute for Translational Medicine, Medical School, University of Pécs, 7623 Pécs, Hungary
| | - Boglárka Pethő
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (Á.M.); (B.P.)
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (B.T.); (P.H.)
| | - András D. Kaposi
- Department of Biophysics and Radiation Biology, Semmelweis University School of Medicine, 1094 Budapest, Hungary;
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (B.T.); (P.H.)
- Institute for Translational Medicine, Medical School, University of Pécs, 7623 Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, 1083 Budapest, Hungary
| | - Nándor Ács
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (Á.M.); (B.P.)
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Xiao D, Li W, Zhang WH, Wen Z, Mo W, Lu C, Guo L, Yang L. Maternal periconceptional environmental exposure and offspring with congenital heart disease: a case-control study in Guangzhou, China. BMC Pregnancy Childbirth 2023; 23:57. [PMID: 36694158 PMCID: PMC9872400 DOI: 10.1186/s12884-023-05355-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/05/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Congenital heart defects (CHDs) are a major global health problem, yet their crucial environmental risk factors are still unclear. We aimed to explore the associations between maternal periconceptional environmental exposures and all CHDs, isolated and multiple CHDs and CHDs subtypes. METHOD A case-control study including 675 infants with CHDs and 1545 healthy controls was conducted. Participating mothers who delivered in Guangzhou from October 2019 to November 2021 were recruited. To examine the independent associations between maternal periconceptional environmental exposure and offspring with CHDs, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariable logistic regression model. RESULTS Maternal exposure to living near main roads [adjusted OR (aOR) = 1.94, 95% CI = 1.06-3.56] and housing renovation (aOR = 1.94, 95% CI = 1.03-3.67) during the periconceptional period were positively related to a greater risk of all CHDs, similar results were also found in isolated CHDs rather than multiple CHDs. Additionally, living near main roads was positively associated with secundum atrial septal defect/patent foramen ovale (aOR = 2.65, 95% CI = 1.03-6.81) and housing renovation was strongly positively associated with ventricular septal defect (aOR = 5.08, 95% CI = 2.05-12.60). However, no association was observed between incense burning and family relationships and all CHDs, isolated and multiple CHDs and CHDs subtypes. CONCLUSION Living near main roads and housing renovation during the periconceptional period are significantly associated with the increased risks for all CHDs and isolated CHDs. Further study is needed to extend sample size to explore the effects of time and frequency of burning incense and family relationships on CHDs in offspring.
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Affiliation(s)
- Di Xiao
- grid.413428.80000 0004 1757 8466Department of Comprehensive Maternal and Child Health, Guangzhou Women and Children’s Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623 China
| | - Weidong Li
- grid.413428.80000 0004 1757 8466Department of Comprehensive Maternal and Child Health, Guangzhou Women and Children’s Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623 China
| | - Wei-Hong Zhang
- grid.5342.00000 0001 2069 7798International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium ,grid.4989.c0000 0001 2348 0746School of Public Health, Université libre de Bruxelles (ULB), 1070 Bruxelles, Belgium
| | - Zihao Wen
- grid.413428.80000 0004 1757 8466Department of Comprehensive Maternal and Child Health, Guangzhou Women and Children’s Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623 China
| | - Weijian Mo
- grid.413428.80000 0004 1757 8466Department of Comprehensive Maternal and Child Health, Guangzhou Women and Children’s Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623 China
| | - Ciyong Lu
- grid.12981.330000 0001 2360 039XDepartment of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong China
| | - Lan Guo
- grid.12981.330000 0001 2360 039XDepartment of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong China
| | - Li Yang
- grid.413428.80000 0004 1757 8466Department of Comprehensive Maternal and Child Health, Guangzhou Women and Children’s Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623 China
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First-Trimester Influenza Infection Increases the Odds of Non-Chromosomal Birth Defects: A Systematic Review and Meta-Analysis. Viruses 2022; 14:v14122708. [PMID: 36560711 PMCID: PMC9781815 DOI: 10.3390/v14122708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Viral infections during pregnancy raise several clinical challenges, including birth defects in the offspring. Thus, this systematic review and meta-analysis aims to prove and highlight the risk of birth defects after first-trimester maternal influenza infection. Our systematic search was performed on 21 November 2022. Studies that reported maternal influenza infection in the first trimester and non-chromosomal congenital abnormalities were considered eligible. We used odds ratios (OR) with 95% confidence intervals (CIs) to measure the effect size. Pooled ORs were calculated with a random effects model. Heterogeneity was measured with I² and Cochran's Q tests. We found that first-trimester maternal influenza was associated with increased odds of developing any type of birth defects (OR: 1.5, CI: 1.30-1.70). Moreover, newborns were more than twice as likely to be diagnosed with neural tube defects (OR: 2.48, CI: 1.95-3.14) or cleft lip and palate (OR: 2.48, CI: 1.87-3.28). We also found increased odds of developing congenital heart defects (OR: 1.63, CI: 1.27-2.09). In conclusion, influenza increases the odds of non-chromosomal birth defects in the first trimester. The aim of the present study was to estimate the risk of CAs in the offspring of mothers affected by first-trimester influenza infection.
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Qu Y, Zhou X, Liu X, Wang X, Yang B, Chen G, Guo Y, Nie Z, Ou Y, Gao X, Wu Y, Dong G, Zhuang J, Chen J. Risk of maternal exposure to mixed air pollutants during pregnancy for congenital heart diseases in offspring. Zhejiang Da Xue Xue Bao Yi Xue Ban 2022; 51:326-333. [PMID: 36207835 PMCID: PMC9511474 DOI: 10.3724/zdxbyxb-2022-0073] [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: 02/28/2022] [Accepted: 04/30/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To explore the risk of maternal exposure to mixed air pollutants of particulate matter 1 (PM 1), particulate matter 2.5 (PM 2.5), particulate matter 10 (PM 10) and NO 2 for congenital heart disease (CHD) in offspring, and to estimate the ranked weights of the above pollutants. METHODS 6038 CHD patients and 5227 healthy controls from 40 medical institutions in 21 cities in Guangdong Registry of Congenital Heart Disease (GRCHD) from 2007 to 2016 were included. Logistic regression model was used to estimate the effect of maternal exposure to a single air pollutant on the occurrence of CHD in offspring. Spearman correlation coefficient was used to analyze the correlation between various pollutants, and Quantile g-computation was used to evaluate the joint effects of mixed exposure of air pollutants on CHD and the weights of various pollutants. RESULTS The exposure levels of PM 1, PM 2.5, PM 10 and NO 2 in the CHD group were significantly higher than those in the control group (all P<0.01). The correlation coefficients among PM 1, PM 2.5, PM 10 and NO 2 were greater than 0.80. PM 1, PM 2.5, PM 10 and NO 2 exposure were associated with a significantly increased risk of CHD in offspring. Mixed exposure of these closely correlated pollutants presented much stronger effect on CHD than exposure of any single pollutants. There was a monotonic increasing relationship between mixed exposure and CHD risk. For each quantile increase in mixed exposure, the risk of CHD increased by 47% ( OR=1.47, 95% CI: 1.34-1.61). Mixed exposure had greater effect on CHD in the early pregnancy compared with middle and late pregnancy, but the greatest effect was the exposure in the whole pregnancy. The weight of PM 10 is the highest in the mixed exposure (81.3%). CONCLUSIONS Maternal exposure to the mixture of air pollutants during pregnancy increases the risk of CHD in offspring, and the effect is much stronger than that of single exposure of various pollutants. PM 10 has the largest weights and the strongest effect in the mixed exposure.
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Affiliation(s)
- Yanji Qu
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xinli Zhou
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xiaoqing Liu
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Ximeng Wang
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Boyi Yang
- 2. Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Gongbo Chen
- 2. Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
- 3. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Yuming Guo
- 3. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Zhiqiang Nie
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yanqiu Ou
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xiangmin Gao
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yong Wu
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Guanghui Dong
- 2. Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Jian Zhuang
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Jimei Chen
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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Ou Y, Bloom MS, Mai J, Francois M, Pan W, Xiao X, Wang X, Nie Z, Qu Y, Gao X, Wu Y, Liu X, Zhuang J, Chen J. Prenatal Detection of Congenital Heart Diseases Using Echocardiography: 12-Year Results of an Improving Program With 9782 Cases. Front Public Health 2022; 10:886262. [PMID: 35646777 PMCID: PMC9136016 DOI: 10.3389/fpubh.2022.886262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/19/2022] [Indexed: 11/27/2022] Open
Abstract
Background A provincial program combining the effect of a government investment in prenatal screening and a specialized cardiac center was introduced in 2004, to improve prenatal diagnosis by echocardiography for congenital heart diseases (CHDs) in the Guangdong Registry of Congenital Heart Disease, China. Objectives To evaluate the effects of this program on the prenatal diagnosis rate (PDR) by echocardiography and termination of pregnancy (TOP). Methods A retrospective study from 2004-2015 included 9782 fetuses and infants diagnosed with CHDs. The PDR was calculated for major and minor CHDs during pre-, mid- and post-program time-intervals. Multivariable logistic regression was utilized to analyze the associations between program implementation and the timing of CHD diagnosis (prenatal vs. postnatal) by different hospital levels. The rate for TOP were also evaluated. Results The PDR increased by 44% for major CHDs in the post-program interval relative to the pre-program interval. The three most frequently diagnosed subtypes prenatally were hypoplastic left heart syndrome (84%), double outlet right ventricle (83%) and severe pulmonary stenosis (82%). Participants with a high school education experienced a greater increase in PDR than those without a high school education. The odds for a prenatal vs. a postnatal diagnosis for major CHD were greater after introduction of the program than before (adjusted odd ratio= 20.95, 95% CI:2.47, 178.06 in secondary hospitals; and adjusted odd ratio=11.65, 95% CI:6.52, 20.81 in tertiary hospitals). The TOP rate decreased from 52.3% pre-program to 19.6% post-program among minor CHD fetuses with a prenatal diagnosis (P for trend =0.041). A lower proportion of TOP were attributed to minor CHDs after the program. Conclusions The program combining the advantages of government investment and a specialized cardiac center appeared to increase the PDR by echocardiography for CHDs in an unselected population. The TOP rate among minor cases with prenatal diagnosis declined significantly after implementation of the program.
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Affiliation(s)
- Yanqiu Ou
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Michael S. Bloom
- Department of Global and Community Health, George Mason University, Fairfax, VA, United States
| | - Jinzhuang Mai
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Melissa Francois
- Department of Biomedical Sciences, University at Albany, State University of New York, Albany, NY, United States
| | - Wei Pan
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaohua Xiao
- Department of Cardiology, Boai Hospital of Zhongshan, Zhongshan, China
| | - Ximeng Wang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhiqiang Nie
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yanji Qu
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiangmin Gao
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yong Wu
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaoqing Liu
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jimei Chen
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Zhang H, Li Y, Zhang X, Chen W, Liang Q, Li C, Knibbs LD, Huang C, Wang Q. Potential occupational exposure of parents to endocrine disrupting chemicals, adverse birth outcomes, and the modification effects of multi-vitamins supplement and infant sex. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 233:113314. [PMID: 35189520 DOI: 10.1016/j.ecoenv.2022.113314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Maternal occupational exposure to endocrine disrupting chemicals (EDCs) may have adverse effect on birth outcomes. However, little is known about paternal EDCs exposure and the combined effect of parental exposure on birth outcomes. OBJECTIVES To assess the effects of both maternal and paternal occupational EDCs exposure on adverse birth outcomes, and further explore if multi-vitamins supplement and infant sex modify the association. METHODS We conducted a prospective cohort study of 5421 mother-father-newborn groups in Guangzhou, China. A questionnaire informed by a job exposure matrix (JEM) was applied to collect parental occupational EDCs exposure based on the type of work performed. We used logistic regression to estimate association between parental EDCs exposure and birth outcomes (including preterm birth (PTB), low birth weight (LBW), birth defects and congenital heart defects (CHD)). Stratified analyses and Cochran Q tests were performed to assess the modifying effect of maternal multi-vitamins supplement use and infant sex. RESULTS Compared with mothers unexposed, we found that mothers those exposed to EDCs were associated with increased odds of birth defects (aOR=1.70, 95% confidence interval (CI): 1.10-2.62), especially for those exposed for > 1.5 years (aOR= 3.00, 95% CIs: 1.78-5.03), or those with directly occupational exposed to EDCs (aOR= 2.94, 95% CIs: 1.72-5.04). Maternal exposure for > 1.5 years and direct exposure increased the risk of CHD, with aORs of 2.47 (1.21-5.02) and 2.79 (1.37-5.69), respectively. Stronger adverse effects were also observed when mothers and fathers were both exposed to EDCs. Paternal occupational EDCs exposure and exposure ≤ 1.5 years was associated with increased odds of LBW, with aORs of 2.14 (1.63-2.79) and 1.54 (1.10-2.15), respectively. When stratified by multi-vitamins supplement and infant sex, we observed slightly stronger effects for maternal exposure on birth defects/CHD as well as paternal EDCs exposure on PTB and LBW, among those without multi-vitamins supplement and among male babies, although the modification effects were not significant. CONCLUSION Maternal exposure to EDCs was associated with greater odds of birth defects and CHD, while paternal exposure was mainly associated with greater odds of LBW. These effects tend to be stronger among mothers without multi-vitamins supplement and among male babies.
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Affiliation(s)
- Huanhuan Zhang
- School of Public Health, Sun Yat-sen University, Guangzhou, China; School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yanqiu Li
- Guangzhou Panyu Maternal Child Health Hospital (Guangzhou Panyu District He Xian Memorial Hospital), Guangzhou, China
| | - Xiaoxin Zhang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Weiyi Chen
- Guangzhou Panyu Maternal Child Health Hospital (Guangzhou Panyu District He Xian Memorial Hospital), Guangzhou, China
| | - Qianhong Liang
- Guangzhou Panyu Maternal Child Health Hospital (Guangzhou Panyu District He Xian Memorial Hospital), Guangzhou, China
| | - Changchang Li
- Department of Sexually Transmitted Disease Prevention and Control, Dermatology Hospital of Southern Medical University, Guangzhou, China; Institute for Global Health and Sexually Transmitted Infections, Southern Medical University, Guangzhou, China
| | - Luke D Knibbs
- School of Public Health, The University of Sydney, NSW 2006, Australia
| | - Cunrui Huang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qiong Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China.
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Yu X, Miao H, Zeng Q, Wu H, Chen Y, Guo P, Zhu Y. Associations between ambient heat exposure early in pregnancy and risk of congenital heart defects: a large population-based study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:7627-7638. [PMID: 34476711 DOI: 10.1007/s11356-021-16237-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/25/2021] [Indexed: 02/05/2023]
Abstract
Some epidemiological studies have confirmed the association between environmental factors and congenital heart defects (CHD). While the possibility that maternal ambient heat exposures are related to CHD has received little attention. Our study aims to investigate the association between maternal ambient extreme heat exposure early in pregnancy and the risk of CHD in offspring in China. We conducted a retrospective cohort study of 1,918,105 fetuses between 2 and 8 weeks after gestation from May to October in Guangdong, China, 2015-2019. The main heat exposure was defined as extreme heat events (EHE) by using the 90th (EHE90) or 95th (EHE95) percentile of the daily maximum temperature. For each EHE definition, we further defined four indicators: having EHE or not, frequency, duration, and cumulative days. We used the log-binomial regression models to calculate the prevalence ratios (PR) of CHD with 95% confidence intervals (CI) for the associations between CHD and EHE, adjusted for potentially confounding covariates. There are 1,918,105 infants included in the study, of which 9588 had CHD, with a prevalence rate of 499.9 per 100,000 (95% CI: 489.9, 509.8). We found that all EHE indicators were positively associated with the increased risks of overall CHD, some CHD classes (congenital malformations of cardiac septa, congenital malformations of great arteries, and congenital malformations of great arteries), and some CHD subtypes (atrial septal defect and patent ductus arteriosus). In addition, the PR yielded higher estimates when exposing to EHE95. For instance, the risk of suffering congenital malformations of great arteries was 1.548 (95% CI: 1.401, 1.712) for EHE90 exposure and 1.723 (95% CI: 1.565, 1.898) for EHE95 exposure, respectively. Our study demonstrated that EHE during 2-8 weeks postconception was associated with overall CHD in offspring, particularly atrial septal defects and patent ductus arteriosus. The associations strengthened with the extent and cumulative days of maternal exposure to EHE.
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Affiliation(s)
- Xiaolin Yu
- Department of Preventive Medicine, Shantou University Medical College, Shantou, 515041, China
| | - Huazhang Miao
- Department of Healthcare, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511442, China
- School of Health Management, Southern Medical University, Guangzhou, 510515, Guangdong Province, China
| | - Qinghui Zeng
- Department of Preventive Medicine, Shantou University Medical College, Shantou, 515041, China
| | - Haisheng Wu
- Department of Preventive Medicine, Shantou University Medical College, Shantou, 515041, China
| | - Yuliang Chen
- Department of Preventive Medicine, Shantou University Medical College, Shantou, 515041, China
| | - Pi Guo
- Department of Preventive Medicine, Shantou University Medical College, Shantou, 515041, China.
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou, 515041, China
| | - Yingxian Zhu
- Department of Healthcare, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511442, China
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Suwansumrit C, Jittham W. Parental risk factors associated with congenital heart disease in a Thai population: multivariable analysis. ASIAN BIOMED 2021; 15:267-276. [PMID: 37551363 PMCID: PMC10321219 DOI: 10.2478/abm-2021-0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Congenital heart diseases (CHDs) are the most common types of birth defects and contribute to a large proportion of infant morbidities and mortalities worldwide. These defects may require multiple surgical interventions impacting the infant's quality of life. Objectives To identify risk factors associated with CHD in a population of Thai children. Methods We conducted a case-control study of patients attending the Pediatric Clinic, Naresuan University Hospital, Thailand. We included data from pediatric patients diagnosed with CHDs as cases, and patients without cardiovascular abnormalities as controls. Risk data were collected from July 2019 to April 2020 using face-to-face interviews. Multiple logistic regression was used to analyze parental factors associated with CHDs. Results We included 249 cases classified into 2 groups according to severity and 304 patients as controls. For those less-severely affected (155 patients, 62.2%), ventricular septal defect (27.7%) was the most prevalent, whereas for those with severe CHDs, tetralogy of Fallot was the most prevalent (14.0%). There was no difference in sex distribution or maternal obstetric history between the groups. In multivariable analysis, a family history of CHDs (adjusted odds ratio [AOR] 4.67, 95% confidence interval (CI) 1.61-13.57, P = 0.005) and maternal exposure to second-hand cigarette smoke (AOR 1.58, 95% CI 1.03-2.42, P = 0.002) were identified as significant risk factors for CHDs. Conclusion A family history of CHDs and maternal exposure to second-hand cigarette smoke are associated with having offspring with CHDs in the population studied. These findings help us to encourage affected parents to obtain a fetal echocardiogram.
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Affiliation(s)
- Chayamon Suwansumrit
- Department of Pediatrics, Faculty of Medicine, Naresuan University, Phitsanulok65000, Thailand
| | - Worawan Jittham
- Department of Pediatrics, Faculty of Medicine, Naresuan University, Phitsanulok65000, Thailand
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Li J, Du Y, Liu Y, Du J, Zhang R, Qu P, Yan H, Wang D, Dang S. Maternal exposure to life events during pregnancy and congenital heart disease in offspring: a case-control study in a Chinese population. BMC Pregnancy Childbirth 2021; 21:677. [PMID: 34615495 PMCID: PMC8496089 DOI: 10.1186/s12884-021-04154-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background Previous studies have suggested that maternal stress could increase the risk of some adverse pregnancy outcomes, but evidence on congenital heart disease (CHD) is limited. We aimed to explore the association between maternal exposure to life events during pregnancy and CHD in offspring. Methods The data was based on an unmatched case-control study about CHD conducted in Shaanxi province of China from 2014 to 2016. We included 2280 subjects, 699 in the case group and 1581 in the control group. The cases were infants or fetuses diagnosed with CHD, and the controls were infants without any birth defects. The life events were assessed by the Life Events Scale for Pregnant Women, and were divided into positive and negative events for synchronous analysis. A directed acyclic graph was drawn to screen the confounders. Logistic regression was employed to estimate the odds ratio and 95% confidence interval for the effects of life events on CHD. Results After controlling for the potential confounders, the pregnant women experiencing the positive events during pregnancy had lower risk of CHD in offspring than those without positive events (OR = 0.38, 95%CI: 0.30 ~ 0.48). The risk of CHD in offspring could increase by 62% among the pregnant women experiencing the negative events compared to those without (OR = 1.62, 95%CI: 1.29 ~ 2.03). Both effects showed a certain dose-response association. Besides, the positive events could weaken the risk impact of negative events on CHD. Conclusion It may suggest that maternal exposure to negative life events could increase the risk of CHD in offspring, while experiencing positive events could play a potential protective role. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04154-0.
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Affiliation(s)
- Jing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi Province, China
| | - Yujiao Du
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi Province, China
| | - Yini Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi Province, China
| | - Jiaoyang Du
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi Province, China
| | - Ruo Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Pengfei Qu
- Assisted Reproduction Center, Northwest Women's and Children's Hospital of Xi'an Jiaotong University, Xi'an, 710003, Shaanxi Province, China
| | - Hong Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi Province, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Shaonong Dang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi Province, China.
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First-Trimester Maternal Folic Acid Supplementation Modifies the Effects of Risk Factors Exposures on Congenital Heart Disease in Offspring. Life (Basel) 2021; 11:life11080724. [PMID: 34440469 PMCID: PMC8399198 DOI: 10.3390/life11080724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/14/2021] [Accepted: 07/18/2021] [Indexed: 02/06/2023] Open
Abstract
This study aimed to examine effect modification of maternal risk factor exposures and congenital heart disease (CHD) by maternal folic acid supplementation (FAS)/non-FAS. We included 8379 CHD cases and 6918 CHD-free controls from 40 clinical centers in Guangdong Province, Southern China, 2004-2016. Controls were randomly chosen from malformation-free fetuses and infants and frequency matched to the echocardiogram-confirmed cases by enrollment hospital and year of birth. We used multiple regression models to evaluate interactions between FAS/non-FAS and risk factors on CHDs and major CHD categories, adjusted for confounding variables. We detected statistically significant additive and multiplicative interactions between maternal FAS/non-FAS and first-trimester fever, viral infection, and threatened abortion on CHDs. An additive interaction on CHDs was also identified between non-FAS and living in a newly renovated home. We observed a statistically significant dose-response relationship between non-FAS and a greater number of maternal risk factors on CHDs. Non-FAS and maternal risk factors interacted additively on multiple critical CHDs, conotruncal defects, and right ventricular outflow tract obstruction. Maternal risk factor exposures may have differential associations with CHD risk in offspring, according to FAS. These findings may inform the design of targeted interventions to prevent CHDs in highly susceptible population groups.
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15
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Graham JM. Update on the gestational effects of maternal hyperthermia. Birth Defects Res 2021; 112:943-952. [PMID: 32686349 DOI: 10.1002/bdr2.1696] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVES I plan to review the types of defects caused by gestational hyperthermia. Hyperthermia-induced malformations in animals and humans involve many organs and structures, particularly the central nervous system, as well as other defects. The type of defect is related to the timing of the hyperthermic insult, and the underlying mechanisms include cell death, membrane disruption, vascular disruption, and placental infarction. METHODS Review of recent epidemiologic studies (2005-2020) has confirmed an association between gestational hyperthermia and birth defects. RESULTS There are strong associations between neural tube defects and maternal fever, and other studies have demonstrated associations between first trimester hyperthermia and an increased risk for cardiovascular defects, oral clefts, isolated congenital ear defects, cataracts, hypospadias, renal anomalies, possibly anorectal malformations, and congenital anomalies in general, suggesting that this association between maternal hyperthermia and birth defects in humans is causal. The first prospective evaluation of maternal fever was reported in 1998, and this study confirmed findings from previous case-control studies and case series regarding the magnitude and duration of elevated maternal body temperature in relation to an increased risk for neural tube defects as well as a specific pattern of malformation. CONCLUSIONS The consistency of findings across these different study designs supports the causal nature of the relationship between maternal fever and specific birth defects. This review summarizes the recent human evidence documenting the gestational effects of maternal hyperthermia.
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Affiliation(s)
- John M Graham
- Clinical Genetics and Dysmorphology, Cedars-Sinai Medical Center and Harbor-UCLA Medical Center, Professor Emeritus of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Patel J, Bircan E, Tang X, Orloff M, Hobbs CA, Browne ML, Botto LD, Finnell RH, Jenkins MM, Olshan A, Romitti PA, Shaw GM, Werler MM, Li J, Nembhard WN. Paternal genetic variants and risk of obstructive heart defects: A parent-of-origin approach. PLoS Genet 2021; 17:e1009413. [PMID: 33684136 PMCID: PMC7971842 DOI: 10.1371/journal.pgen.1009413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/18/2021] [Accepted: 02/10/2021] [Indexed: 12/17/2022] Open
Abstract
Previous research on risk factors for obstructive heart defects (OHDs) focused on maternal and infant genetic variants, prenatal environmental exposures, and their potential interaction effects. Less is known about the role of paternal genetic variants or environmental exposures and risk of OHDs. We examined parent-of-origin effects in transmission of alleles in the folate, homocysteine, or transsulfuration pathway genes on OHD occurrence in offspring. We used data on 569 families of liveborn infants with OHDs born between October 1997 and August 2008 from the National Birth Defects Prevention Study to conduct a family-based case-only study. Maternal, paternal, and infant DNA were genotyped using an Illumina Golden Gate custom single nucleotide polymorphism (SNP) panel. Relative risks (RR), 95% confidence interval (CI), and likelihood ratio tests from log-linear models were used to estimate the parent-of-origin effect of 877 SNPs in 60 candidate genes in the folate, homocysteine, and transsulfuration pathways on the risk of OHDs. Bonferroni correction was applied for multiple testing. We identified 3 SNPs in the transsulfuration pathway and 1 SNP in the folate pathway that were statistically significant after Bonferroni correction. Among infants who inherited paternally-derived copies of the G allele for rs6812588 in the RFC1 gene, the G allele for rs1762430 in the MGMT gene, and the A allele for rs9296695 and rs4712023 in the GSTA3 gene, RRs for OHD were 0.11 (95% CI: 0.04, 0.29, P = 9.16x10-7), 0.30 (95% CI: 0.17, 0.53, P = 9.80x10-6), 0.34 (95% CI: 0.20, 0.57, P = 2.28x10-5), and 0.34 (95% CI: 0.20, 0.58, P = 3.77x10-5), respectively, compared to infants who inherited maternally-derived copies of the same alleles. We observed statistically significant decreased risk of OHDs among infants who inherited paternal gene variants involved in folate and transsulfuration pathways. Obstructive heart defects are birth defects that cause obstruction to the blood flow of the developing heart. Common OHDs include coarctation of the aorta, aortic stenosis and pulmonary stenosis. While there is a fair amount of literature indicating an association between maternal genetic variants and OHDs, less is known about the role of paternal genetic variants in the etiology of OHDs. We used a genotype clustering algorithm, SNPMClust, that was developed in-house at the Arkansas Center for Birth Defects Research and Prevention to study the role of paternal genetic variants in the folate, homocysteine and transsulfuration pathways. Maternal, paternal, and infant DNA specimens were collected from participants of the National Birth Defects Prevention Study, a large population-based case-control study in the United States, and were genotyped using an Illumina Golden Gate custom single nucleotide polymorphism (SNP) panel. We identified 4 SNPs in the folate and transsulfuration pathways, rs6812588, rs1762430, rs9296695, and rs4712023, that were associated with a statistically significant decreased risk of OHDs for infants who inherited a paternally-derived copy of the variant allele compared to infants who inherited a maternal copy of the variant allele. In conclusion, we observed a significantly decreased risk and less epigenetic influence of paternal genetic variants on OHDs compared to maternally-derived variants.
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Affiliation(s)
- Jenil Patel
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, United States of America
| | - Emine Bircan
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Xinyu Tang
- Biostatistics Program, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children’s Research Institute, Little Rock, AR, United States of America
| | - Mohammed Orloff
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Charlotte A. Hobbs
- Rady Children’s Institute for Genomic Medicine, San Diego, CA, United States of America
| | - Marilyn L. Browne
- Birth Defects Research Section, New York State Department of Health, Albany, NY, United States of America
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, NY, United States of America
| | - Lorenzo D. Botto
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States of America
| | - Richard H. Finnell
- Department of Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States of America
| | - Mary M. Jenkins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Andrew Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Paul A. Romitti
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, United States of America
| | - Gary M. Shaw
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Martha M. Werler
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, United States of America
| | - Jingyun Li
- Biostatistics Program, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children’s Research Institute, Little Rock, AR, United States of America
| | - Wendy N. Nembhard
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
- * E-mail:
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Yang G, Deng X, Xiao J, Huang P, Zhang K, Li Y. Maternal fever during preconception and conception is associated with congenital heart diseases in offspring: An updated meta-analysis of observational studies. Medicine (Baltimore) 2021; 100:e24899. [PMID: 33655950 PMCID: PMC7939217 DOI: 10.1097/md.0000000000024899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 02/01/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUNDS Many studies have evaluated the effect of maternal fever on the development risk of congenital heart diseases (CHDs) in offspring, but the findings were inconsistent. Furthermore, a complete overview of the existing data was also missing. Therefore, we intend to provide updated epidemiologic evidence to estimate the association between maternal fever and the risk of overall CHDs and specific CHD phenotypes in offspring. METHODS Pubmed, Embase, and Web of Science were searched through March 2020 to identify eligible studies that assessed the association between maternal fever and CHDs risk in offspring. The summary risk estimates were calculated using random-effects models. Potential heterogeneity source was explored by subgroup analyses and potential publication bias was assessed by Begg funnel plots and Begg rank correlation test. RESULTS Sixteen studies involving 31,922 CHDs cases among 183,563 participants were included in this meta-analysis. Overall, mothers who had a fever experience during preconception and conception periods had a significantly higher risk of overall CHDs in offspring (odds ratio [OR] = 1.45, 95% confidence interval [CI]: 1.21-1.73) when compared with those who did not have a fever experience. For specific CHD phenotypes in offspring, a statistically significant association was found between maternal fever and risk of conotruncal defects (CTD) (OR = 1.38, 95%CI: 1.01-1.89), atrial septal defects (ASD) (OR = 1.48, 95% CI: 1.01-2.17), transposition of the great vessels (TGA) (OR = 1.81, 95% CI: 1.14-2.88), and right ventricular outflow tract obstruction (RVOTO) (OR = 1.66, 95% CI: 1.04-2.65). Relevant heterogeneity moderators have been identified by subgroup analyses, and sensitivity analyses yielded consistent results. CONCLUSIONS Although the role of potential bias and evidence of heterogeneity should be carefully evaluated, our review indicates that maternal fever is significantly associated with the risk of CHDs in offspring, which highlights that preventing maternal fever during the preconception and conception periods play an important role in decreasing the risk of CHDs in offspring. However, given the limited number of current case-control studies, larger-sample prospective studies are required to further confirm our results. Besides, due to the underlying mechanisms between maternal fever and the risk of specific CHD phenotypes in offspring are still unreported, more research is needed to explore the possible mechanisms.
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Affiliation(s)
- Guihong Yang
- Department of Cardiothoracic Surgery, Hunan Children's Hospital
| | - Xicheng Deng
- Department of Cardiothoracic Surgery, Hunan Children's Hospital
| | - Jianfeng Xiao
- Department of Clinical Laboratory, Geological Mining Hospital of Hunan Province, Changsha, Hunan, China
| | - Peng Huang
- Department of Cardiothoracic Surgery, Hunan Children's Hospital
| | - Kai Zhang
- Department of Cardiothoracic Surgery, Hunan Children's Hospital
| | - Yunfei Li
- Department of Cardiothoracic Surgery, Hunan Children's Hospital
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Fazekas-Pongor V, Csáky-Szunyogh M, Fekete M, Mészáros Á, Cseh K, Pénzes M. Congenital heart diseases and parental occupational exposure in a Hungarian case-control study in 1997 to 2002. Congenit Anom (Kyoto) 2021; 61:55-62. [PMID: 33140474 DOI: 10.1111/cga.12401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 12/01/2022]
Abstract
The etiology of congenital heart diseases is not fully understood yet, however, endocrine disrupting chemicals may have a causative role in their development. The purpose of our study was to examine the association between congenital heart diseases and periconceptional parental occupational exposure to endocrine disrupting chemicals. In our Hungarian population-based case-control study, we examined 2263 live born cases with any congenital heart disease and 6789 matched controls selected between years 1997 to 2002. Occupational exposure was assessed with a job-exposure matrix developed for endocrine disrupting chemicals. Conditional multiple logistic regression analyses were performed to test associations between parental occupational exposure to endocrine disrupting chemicals and congenital heart diseases of the offspring as a whole and by congenital heart disease subtypes. The prevalence of exposure to endocrine disrupting chemicals was 4.5% for both case and control mothers and 19.1% and 19.4% for case and control fathers, respectively. We found a positive association between paternal pesticide (adjusted odds ratio = 1.66, 95% confidence interval: 1.03-2.69) and alkylphenolic compound exposure (adjusted odds ratio = 1.95, 95% confidence interval: 1.30-2.93) and the development of patent ductus arteriosus in the offspring. Alkylphenolic compound exposure occurred among painters, famers, and those working in the food service industry, while pesticide exposure occurred predominantly among farm workers. We identified that certain occupations may increase the occurrence of certain congenital heart disease phenotypes in the offspring. By paying closer attention to those working in these areas, antenatal detection rates of congenital heart diseases may be improved.
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Affiliation(s)
- Vince Fazekas-Pongor
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Melinda Csáky-Szunyogh
- Hungarian Congenital Abnormalities Registry, National Public Health Center, Budapest, Hungary
| | - Mónika Fekete
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ágota Mészáros
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Károly Cseh
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Melinda Pénzes
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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Qu Y, Lin S, Bloom MS, Wang X, Ye B, Nie Z, Ou Y, Mai J, Wu Y, Gao X, Xiao X, Tan H, Liu X, Chen J, Zhuang J. Maternal folic acid supplementation mediates the associations between maternal socioeconomic status and congenital heart diseases in offspring. Prev Med 2021; 143:106319. [PMID: 33166566 DOI: 10.1016/j.ypmed.2020.106319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/23/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
Low maternal socioeconomic status (SES) is considered as a risk factor of congenital heart diseases (CHDs) in offspring. However, the pathways underpinning the SES-CHDs associations are unclear. We assessed if first trimester maternal folic acid supplementation (FAS) is a mediator of the SES-CHDs associations. This case-control study included 8379 CHD cases and 6918 CHD-free controls from 40 participating centers in Guangdong, Southern China, 2004-2016. All fetuses were screened for CHDs using ultrasound and cases were confirmed by echocardiogram. We collected SES and FAS information during face-to-face interview by obstetricians using a structured questionnaire. Low SES was defined as education attainment <12 years, household individual income <3000 Chinese Yuan/person/month or unemployment. FAS referred to at least 0.4 mg of daily folic acid intake over 5 days/week continuously. We used causal mediation analysis to estimate the direct, indirect and proportion mediated by FAS on the SES-CHDs associations adjusted for confounders. Both low maternal income and education were significantly associated with increased risks of CHDs and lower prevalence of FAS. Low maternal FAS prevalence mediated 10% [95%CI:5%,13%] and 3% [95%CI:1%,5%] of the maternal low income-CHDs and the maternal low education-CHDs associations, respectively. In addition, FAS mediated the highest proportion of the associations between income and multiple critical CHDs [46.9%, 95%CI:24.7%,77%] and conotruncal defects [31.5%, 95%CI:17.1%,52.0%], respectively. Maternal FAS partially mediated the SES-CHDs associations, especially among the most critical and common CHDs. Promoting FAS in low SES women of childbearing age may be a feasible intervention to help prevent CHDs.
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Affiliation(s)
- Yanji Qu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Shao Lin
- Department of Environmental Health Sciences, University at Albany State University of New York, One University Place, Rensselaer, Albany, NY, USA; Department of Epidemiology and Biostatistics, University at Albany State University of New York, One University Place, Rensselaer, Albany, NY, USA.
| | - Michael S Bloom
- Department of Environmental Health Sciences, University at Albany State University of New York, One University Place, Rensselaer, Albany, NY, USA; Department of Epidemiology and Biostatistics, University at Albany State University of New York, One University Place, Rensselaer, Albany, NY, USA; Department of Global and Community Health, George Mason University, Fairfax, VA, USA.
| | - Ximeng Wang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Bo Ye
- Department of Epidemiology and Biostatistics, University at Albany State University of New York, One University Place, Rensselaer, Albany, NY, USA.
| | - Zhiqiang Nie
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yanqiu Ou
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jinzhuang Mai
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yong Wu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xiangmin Gao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xiaohua Xiao
- Boai Hospital of Zhongshan, 6 Chenggui Road, East District, Zhongshan, Guangdong, China
| | - Hongzhuan Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
| | - Xiaoqing Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
| | - Jimei Chen
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jian Zhuang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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20
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Miao Q, Dunn S, Wen SW, Lougheed J, Reszel J, Lavin Venegas C, Walker M. Neighbourhood maternal socioeconomic status indicators and risk of congenital heart disease. BMC Pregnancy Childbirth 2021; 21:72. [PMID: 33478420 PMCID: PMC7819193 DOI: 10.1186/s12884-020-03512-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/21/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study aimed to examine the relationships between various maternal socioeconomic status (SES) indicators and the risk of congenital heart disease (CHD). METHODS This was a population-based retrospective cohort study, including all singleton stillbirths and live births in Ontario hospitals from April 1, 2012 to March 31, 2018. Multivariable logistic regression models were performed to examine the relationships between maternal neighbourhood household income, poverty, education level, employment and unemployment status, immigration and minority status, and population density and the risk of CHD. All SES variables were estimated at a dissemination area level and categorized into quintiles. Adjustments were made for maternal age at birth, assisted reproductive technology, obesity, pre-existing maternal health conditions, substance use during pregnancy, rural or urban residence, and infant's sex. RESULTS Of 804,292 singletons, 9731 (1.21%) infants with CHD were identified. Compared to infants whose mothers lived in the highest income neighbourhoods, infants whose mothers lived in the lowest income neighbourhoods had higher likelihood of developing CHD (adjusted OR: 1.29, 95% CI: 1.20-1.38). Compared to infants whose mothers lived in the neighbourhoods with the highest percentage of people with a university or higher degree, infants whose mothers lived in the neighbourhoods with the lowest percentage of people with university or higher degree had higher chance of CHD (adjusted OR: 1.34, 95% CI: 1.24-1.44). Compared to infants whose mothers lived in the neighbourhoods with the highest employment rate, the odds of infants whose mothers resided in areas with the lowest employment having CHD was 18% higher (adjusted OR: 1.18, 95% CI: 1.10-1.26). Compared to infants whose mothers lived in the neighbourhoods with the lowest proportion of immigrants or minorities, infants whose mothers resided in areas with the highest proportions of immigrants or minorities had 18% lower odds (adjusted OR: 0.82, 95% CI: 0.77-0.88) and 16% lower odds (adjusted OR: 0.84, 95% CI: 0.78-0.91) of CHD, respectively. CONCLUSION Lower maternal neighbourhood household income, poverty, lower educational level and unemployment status had positive associations with CHD, highlighting a significant social inequity in Ontario. The findings of lower CHD risk in immigrant and minority neighbourhoods require further investigation.
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Affiliation(s)
- Qun Miao
- BORN Ontario, Ottawa, Ontario, Canada.
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Canada.
| | - Sandra Dunn
- BORN Ontario, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Canada
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Obstetrics & Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Jane Lougheed
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Jessica Reszel
- BORN Ontario, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Carolina Lavin Venegas
- BORN Ontario, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Mark Walker
- BORN Ontario, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Canada
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Obstetrics & Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Canada
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Montagnoli C, Ruggeri S, Cinelli G, Tozzi AE, Bovo C, Bortolus R, Zanconato G. Anything New about Paternal Contribution to Reproductive Outcomes? A Review of the Evidence. World J Mens Health 2021; 39:626-644. [PMID: 33474842 PMCID: PMC8443996 DOI: 10.5534/wjmh.200147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/13/2020] [Accepted: 11/08/2020] [Indexed: 11/15/2022] Open
Abstract
Paternal health and behavioral lifestyles affect reproductive and neonatal outcomes and yet the magnitude of these effects remain underestimated. Even though these impacts have been formally recognized as a central aspect of reproductive health, health care services in Europe often neglect the involvement of fathers in their reproductive programs. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews, a literature search was carried out to assess the possible impact of paternal health on reproductive outcomes. The comprehensive strategy included cohort studies and meta-analysis available on PubMed, Web of Science, CINAHL, and Google scholar. Cross-referencing of bibliographies of the selected papers ensured wider study capture. Paternal factors were grouped into two categories respectively identified with the terms "Biological Paternal Factors" and "Lifestyle Paternal Factors". Advanced age may impair male fertility and affect early pregnancy stages. Increased body mass index, smoking, alcohol and recreational drugs, all alter seminal fluid parameters. Hazardous alcohol use correlates with low birthweight in pregnancy and harmful behavioral lifestyles have been linked to congenital heart defects, metabolic and neurodevelopmental disorders in the offspring. Measures targeting paternal health and lifestyle within the first 1,000 days' timeframe need to be implemented in couples undergoing reproductive decisions. Health professionals, as well as future fathers, must be aware of the benefits for the offspring associated with correct paternal behaviors. More research is needed to build guidelines and to implement specific programs aiming at reproductive health promotion.
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Affiliation(s)
- Caterina Montagnoli
- Department of Medical Direction, Verona University Hospital, Verona, Italy.,Department of Midwifery, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Geneva, Switzerland
| | | | - Giulia Cinelli
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto E Tozzi
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Chiara Bovo
- Department of Medical Direction, Verona University Hospital, Verona, Italy
| | - Renata Bortolus
- Directorate General for Preventive Health - Office 9, Ministry of Health, Rome, Italy
| | - Giovanni Zanconato
- Department of Surgery, Odontostomatology and Maternal and Child Health, University of Verona, Verona, Italy
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Fazekas-Pongor V, Fekete M, Csáky-Szunyogh M, Cseh K, Pénzes M. Parental occupational exposure and congenital heart diseases in a Hungarian case-control study. Int Arch Occup Environ Health 2020; 94:515-527. [PMID: 33170344 PMCID: PMC8032570 DOI: 10.1007/s00420-020-01589-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 10/06/2020] [Indexed: 11/10/2022]
Abstract
Purpose Our study aimed to explore the effect of parental occupational exposure to endocrine disrupting chemicals (EDCs) on the development of congenital heart diseases (CHDs) in the offspring, and to compare job-exposure matrix (JEM)-assessed and self-reported occupational exposures with each other. Methods Live-born infants born in 2007–2008 were selected from the population-based Hungarian Case–Control Surveillance of Congenital Abnormalities Study. 577 cases with any CHDs were compared to 1731 matched controls. Parental periconceptional occupational exposure to EDCs was assessed by a JEM and by questionnaire-based self-reporting of parents. Multivariate conditional logistic regression analyses were conducted to explore associations between parental occupational exposure to EDCs and the entire spectrum of CHDs and by CHD subtypes in the offspring. Kappa statistics were also performed to determine the consistency among JEM-assessed and self-reported occupational exposure of parents. Results JEM-assessed paternal exposure to polychlorinated organic substances, phthalates, biphenolic compounds, and solvents were significantly associated with the entire spectrum of CHDs. Ventricular septal defects were significantly associated with paternal self-reported exposure to pesticides, while atrial septal defects were significantly associated to paternal JEM-assessed phthalate exposure. Paternal solvent exposure was significantly associated with atrial septal defects and right ventricle outflow tract obstructions. JEM-assessed and self-reported exposures to pesticides, heavy metals, and solvents exhibited poor agreement for mothers and slight agreement for fathers. Conclusion Even though parental occupational exposure to EDCs seems to have a minor impact on the occurrence of CHDs, the results of biological and environmental monitoring should be taken into consideration as well.
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Affiliation(s)
- Vince Fazekas-Pongor
- Department of Public Health, Faculty of Medicine, Semmelweis University Budapest, Üllői út 26, Budapest, 1085, Hungary.
| | - Mónika Fekete
- Department of Public Health, Faculty of Medicine, Semmelweis University Budapest, Üllői út 26, Budapest, 1085, Hungary
| | - Melinda Csáky-Szunyogh
- Hungarian Congenital Abnormalities Registry, National Public Health Center, Albert Flórián út 2-6, Budapest, 1097, Hungary
| | - Károly Cseh
- Department of Public Health, Faculty of Medicine, Semmelweis University Budapest, Üllői út 26, Budapest, 1085, Hungary
| | - Melinda Pénzes
- Department of Public Health, Faculty of Medicine, Semmelweis University Budapest, Üllői út 26, Budapest, 1085, Hungary
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Lastivka IV, Pishak VP, Ryznychuk МО, Khmara ТV. Risk factor analysis for congenital heart defects in children. REGULATORY MECHANISMS IN BIOSYSTEMS 2020. [DOI: 10.15421/022080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Congenital heart defects (CHDs) are the most common malformations, occurring in almost 1.0 in 100 births. We investigated an association between risk factors and CHDs, because epidemiological studies have reported conflicting results regarding risk factors and CHDs recently. The study of CHD frequency was conducted in Chernivtsi region (Northern Bukovina) on the basis of the medical genetic center. A retrospective method of research by studying registration genetic maps was used to analyze risk factors. 91 cards of infants suffering from CHD (47 boys and 44 girls) aged 0–1 living in the territory of Northern Bukovina were selected. In order to identify risk factors, 133 cards of healthy infants (77 boys and 56 girls) were used. The analysis of risk factors revealed that the female gender of a child is a risk factor for CHD development. The analysis of the ordinal number of pregnancy revealed that the second and the third pregnancies are probable risk factors for the development of this pathology. It was found in our study that folic acid intake during the first trimester prevented CHD development (OR 2.33). The study revealed that among stressful risk factors are: unplanned pregnancy (OR 3.13); out-of-wedlock pregnancy and stress during pregnancy. Maternal CHD increased the CHD development in offspring approximately by two times. Some factors, such as a woman doing hard physical work during pregnancy, having sedentary work during pregnancy, the mother being a housewife or having an incomplete secondary education (OR 3.61), the mother’s secondary education, the father’s incomplete secondary education (OR 18.62), the father serving in the army (OR 2.15) or being a student at the time of woman’s pregnancy (OR 2.97) were significant for CHD development in the fetal stage. A young age of the father (up to 43 years) was also considered as one of the risk factors. This article is expected to provide timely information on risk factors for CHD development to a wide range of medical staff, including pediatric and adult cardiologists, pediatricians, thoracic surgeons, obstetricians, gynecologists, medical geneticists, genetic counselors and other relevant clinicians.
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Nie Z, Yang B, Ou Y, Bloom MS, Han F, Qu Y, Nasca P, Matale R, Mai J, Wu Y, Gao X, Guo Y, Markevych I, Zou Y, Lin S, Dong G, Liu X. Maternal residential greenness and congenital heart defects in infants: A large case-control study in Southern China. ENVIRONMENT INTERNATIONAL 2020; 142:105859. [PMID: 32593836 DOI: 10.1016/j.envint.2020.105859] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/07/2020] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Proximity to greenness has shown protective effects on coronary heart diseases by limiting exposure to environmental hazards, encouraging physical activity, and reducing mental stress. However, no studies have previously evaluated the impacts of greenness on congenital heart defects (CHDs). We examined the association between maternal residential greenness and the risks of CHDs. METHODS We conducted a case-control study (8042 children with major CHDs and 6887 controls without malformations) in 21 cities in Southern China, 2004 - 2016. CHDs cases were diagnosed and verified by obstetrician, pediatrician, or pediatric cardiologists, within one year. We estimated maternal residential greenness using satellite-derived normalized difference vegetation index (NDVI) in zones of 500 meters (m) and 1000 m surrounding participants' residences. Logistic regression models were used to assess NDVI-CHD relationships adjusting for confounders. RESULTS Interquartile range NDVI increases within 500 m or 1000 m were associated with odds ratios (OR) of 0.95 (95% confidence interval (CI): 0.92, 0.98) and 0.94 (95%CI: 0.91, 0.97) for total CHDs respectively. Air pollutants mediated 52.1% of the association. We also identified a protective threshold at 0.21 NDVI on CHD. Similar protective effects from greenness were found in most CHDs subtypes. The protective associations were stronger for fall, urban or permanent residents, higher household income maternal age ≤35 years of age, and high maternal education (ORs: ranged from 0.85 to 0.96). CONCLUSION Our findings suggest a beneficial effect of maternal residential greenness on CHDs. Further studies are needed to confirm our findings, which will help to refine preventive health and urban design strategies.
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Affiliation(s)
- Zhiqiang Nie
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou 510080, Guangdong, China
| | - Boyi Yang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China
| | - Yanqiu Ou
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou 510080, Guangdong, China
| | - Michael S Bloom
- Departments of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY 12144, USA
| | - Fengzhen Han
- Department of Obstetrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road , Guangzhou 510080, Guangdong, China
| | - Yanji Qu
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou 510080, Guangdong, China
| | - Philip Nasca
- Departments of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY 12144, USA
| | - Rosemary Matale
- Departments of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY 12144, USA
| | - Jinzhuang Mai
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou 510080, Guangdong, China
| | - Yong Wu
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou 510080, Guangdong, China
| | - Xiangmin Gao
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou 510080, Guangdong, China
| | - Yuming Guo
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China
| | - Iana Markevych
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China
| | - Yuxuan Zou
- School of Geographical Sciences, Guangzhou University, Guangzhou 510080, China
| | - Shao Lin
- Departments of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY 12144, USA.
| | - Guanghui Dong
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China.
| | - Xiaoqing Liu
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou 510080, Guangdong, China.
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Nie Z, Qu Y, Han F, Bell EM, Zhuang J, Chen J, François M, Lipton E, Matale R, Cui W, Liang Q, Lu X, Huang H, Lv J, Ou Y, Mai J, Wu Y, Gao X, Huang Y, Lin S, Liu X. Evaluation of interactive effects between paternal alcohol consumption and paternal socioeconomic status and environmental exposures on congenital heart defects. Birth Defects Res 2020; 112:1273-1286. [PMID: 32696579 DOI: 10.1002/bdr2.1759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND While the maternal risk factors on congenital heart defects (CHDs) have often been assessed, paternal contribution to CHDs, especially the joint effects of paternal risk factors on CHDs remain unknown. This study examined the major impacts of paternal alcohol consumption and its interaction (on multiplicative and additive scales) with paternal socioeconomic status (SES) and environmental exposures on CHDs in China. METHODS A population-based case-control study involving 4,726 singleton CHDs cases and 4,726 controls (without any malformation and matched on hospital, gender, and gestational age) was conducted in Guangdong, China, 2004-2014. Information on parental demographics, behavioral patterns, disease/medication, and environmental exposures (3 months before pregnancy) was collected through face-to-face interviews. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) while controlling for all parental factors. RESULTS Paternal alcohol consumption was associated with an increased OR of CHDs (adjusted OR = 2.87, 95% CI: 2.25-3.65). Additionally, paternal smoking, industry occupation, organic solvent contact, virus infection and antibiotic use, living in rural areas, low household income, and migrant status were significantly associated with CHDs (ORs ranged: 1.42-4.44). Significant additive or multiplicative interactions were observed between paternal alcohol consumption and paternal smoking, industrial occupation, and low income on any CHDs (interaction contrast ratio [ICR] = 4.72, 95% CI: 0.96-8.47] and septal defects (ICRs ranged from 2.04 to 2.79, p < .05). CONCLUSIONS Paternal alcohol consumption and multiple paternal factors were significantly associated with CHDs in China. Paternal smoking and low SES factors modified paternal alcohol consumption-CHDs relationships. Further studies are needed to confirm these findings.
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Affiliation(s)
- Zhiqiang Nie
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yanji Qu
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Fengzhen Han
- Department of Obstetrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Erin M Bell
- Department of Environmental Health Sciences, University at Albany, State University of New York, Albany, New York, USA.,Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Albany, New York, USA
| | - Jian Zhuang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jimei Chen
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Melissa François
- Department of Environmental Health Sciences, University at Albany, State University of New York, Albany, New York, USA.,Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Albany, New York, USA
| | - Emily Lipton
- Department of Environmental Health Sciences, University at Albany, State University of New York, Albany, New York, USA.,Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Albany, New York, USA
| | - Rosemary Matale
- Department of Environmental Health Sciences, University at Albany, State University of New York, Albany, New York, USA.,Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Albany, New York, USA
| | - Weilun Cui
- Department of Neonatology, Panyu General Hospital, Guangzhou, Guangdong, China
| | - Qianhong Liang
- Department of Echocardiography, Panyu Maternal and Child Care Service Centre, Guangzhou, Guangdong, China
| | - Xiangzhang Lu
- Department of Echocardiography, Huadu Maternal and Child Care Service Centre, Guangzhou, Guangdong, China
| | - Huiwen Huang
- Department of Neonatology, Zhuhai Maternal and Child Care Service Center, Zhuhai, Guangdong, China
| | - Junfeng Lv
- Department of Neonatology, Boai Hospital of Zhongshan, Zhongshan, Guangdong, China
| | - Yanqiu Ou
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jinzhuang Mai
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yong Wu
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xiangmin Gao
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yating Huang
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Shao Lin
- Department of Environmental Health Sciences, University at Albany, State University of New York, Albany, New York, USA.,Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Albany, New York, USA
| | - Xiaoqing Liu
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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Qu Y, Lin S, Zhuang J, Bloom MS, Smith M, Nie Z, Mai J, Ou Y, Wu Y, Gao X, Tan H, Liu X. First-Trimester Maternal Folic Acid Supplementation Reduced Risks of Severe and Most Congenital Heart Diseases in Offspring: A Large Case-Control Study. J Am Heart Assoc 2020; 9:e015652. [PMID: 32613868 PMCID: PMC7670504 DOI: 10.1161/jaha.119.015652] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Maternal folic acid supplementation (FAS) reduces the risk of neural tube defects in offspring. However, its effect on congenital heart disease (CHDs), especially on the severe ones remains uncertain. This study aimed to assess the individual and joint effect of first-trimester maternal FAS and multivitamin use on CHDs in offspring. Methods and Results This is a case-control study including 8379 confirmed CHD cases and 6918 controls from 40 healthcare centers of 21 cities in Guangdong Province, China. Adjusted odds ratios (aORs) of FAS and multivitamin use between CHD cases (overall and specific CHD phenotypes) and controls were calculated by controlling for parental confounders. The multiplicative interaction effect of FAS and multivitamin use on CHDs was estimated. A significantly protective association was detected between first-trimester maternal FAS and CHDs among offspring (aOR, 0.69; 95% CI, 0.62-0.76), but not for multivitamin use alone (aOR, 1.42; 95% CI, 0.73-2.78). There was no interaction between FAS and multivitamin use on CHDs (P=0.292). Most CHD phenotypes benefited from FAS (aORs ranged from 0.03-0.85), especially the most severe categories (ie, multiple critical CHDs [aOR, 0.16; 95% CI, 0.12-0.22]) and phenotypes (ie, single ventricle [aOR, 0.03; 95% CI, 0.004-0.21]). Conclusions First-trimester maternal FAS, but not multivitamin use, was substantially associated with lower risk of CHDs, and the association was strongest for the most severe CHD phenotypes. We recommend that women of childbearing age should supplement with folic acid as early as possible, ensuring coverage of the critical window for fetal heart development to prevent CHDs.
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Affiliation(s)
- Yanji Qu
- Department of Epidemiology and Health Statistics Xiangya School of Public Health Central South University Changsha Hunan China.,Guangdong Cardiovascular Institute WHO Collaborating Center for Research and Training in Cardiovascular Diseases Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou Guangdong China
| | - Shao Lin
- Department of Environmental Health SciencesUniversity at AlbanyState University of New York Rensselaer NY.,Department of Epidemiology and Biostatistics University at Albany State University of New York Rensselaer NY
| | - Jian Zhuang
- Guangdong Cardiovascular Institute WHO Collaborating Center for Research and Training in Cardiovascular Diseases Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou Guangdong China
| | - Michael S Bloom
- Department of Environmental Health SciencesUniversity at AlbanyState University of New York Rensselaer NY.,Department of Epidemiology and Biostatistics University at Albany State University of New York Rensselaer NY
| | - Maggie Smith
- Department of Environmental Health SciencesUniversity at AlbanyState University of New York Rensselaer NY
| | - Zhiqiang Nie
- Guangdong Cardiovascular Institute WHO Collaborating Center for Research and Training in Cardiovascular Diseases Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou Guangdong China
| | - Jinzhuang Mai
- Guangdong Cardiovascular Institute WHO Collaborating Center for Research and Training in Cardiovascular Diseases Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou Guangdong China
| | - Yanqiu Ou
- Guangdong Cardiovascular Institute WHO Collaborating Center for Research and Training in Cardiovascular Diseases Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou Guangdong China
| | - Yong Wu
- Guangdong Cardiovascular Institute WHO Collaborating Center for Research and Training in Cardiovascular Diseases Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou Guangdong China
| | - Xiangmin Gao
- Guangdong Cardiovascular Institute WHO Collaborating Center for Research and Training in Cardiovascular Diseases Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou Guangdong China
| | - Hongzhuan Tan
- Department of Epidemiology and Health Statistics Xiangya School of Public Health Central South University Changsha Hunan China
| | - Xiaoqing Liu
- Guangdong Cardiovascular Institute WHO Collaborating Center for Research and Training in Cardiovascular Diseases Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou Guangdong China
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Zhou Q, Zhang S, Wang Q, Shen H, Zhang Y, Tian W, Li X. Association between preconception paternal smoking and birth defects in offspring: evidence from the database of the National Free Preconception Health Examination Project in China. BJOG 2020; 127:1358-1364. [PMID: 32339375 DOI: 10.1111/1471-0528.16277] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To clarify whether preconception paternal smoking has any adverse effects on the offspring. DESIGN Prospective, population-based study. SETTING Preconception registry data from the National Free Preconception Health Examination Project. POPULATION OR SAMPLE Couples planning pregnancy, with complete information on preconception paternal smoking behaviour and pregnancy outcomes. METHODS The effect of questionnaire-based paternal smoking behaviour during preconception and pregnancy was assessed via logistic regression. Additionally, we performed a 1:1 case-control (birth defects versus normal pregnancy) analysis, matched for maternal province, folic acid supplementation and paternal alcohol consumption. MAIN OUTCOME MEASURES Risk of birth defects in offspring. RESULTS In total, 566 439 couples with complete information on preconception paternal smoking behaviour and pregnancy outcomes were enrolled. The preconception paternal smoking rate was 28.7% (162 482) overall: 8.7% (49 303) stopped smoking, 13.3% (75 517) decreased their smoking, and 6.6% (37 662) continued smoking during early pregnancy. The risk of birth defects was higher in the continued-smoking (P < .000, odds ratio [OR] 1.87, 95% CI 1.36-2.56) and decreased-smoking groups (P = .007, OR 1.41, 95% CI 1.10-1.82). In the case-control analysis, infants whose fathers stopped (P = .003, OR 0.32, 95% CI 0.15-0.67) or decreased smoking (P = .000, OR 0.25, 95% CI 0.13-0.49) were at lower risk of congenital heart diseases, limb abnormalities, digestive tract anomalies and neural tube defects than those whose fathers continued smoking. CONCLUSION Preconception paternal smoking may be associated with congenital heart diseases, limb abnormalities and neural tube defects in the offspring. Changes in smoking behaviour may reduce this risk. TWEETABLE ABSTRACT This study suggests that preconception paternal smoking is associated with birth defects in offspring. Changes in smoking behaviour may reduce this risk.
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Affiliation(s)
- Q Zhou
- Obstetrics and Gynaecology Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - S Zhang
- National Research Institute for Family Planning, Beijing, China
| | - Q Wang
- National Research Institute for Family Planning, Beijing, China
| | - H Shen
- National Research Institute for Family Planning, Beijing, China
| | - Y Zhang
- National Research Institute for Family Planning, Beijing, China
| | - W Tian
- School of Life Sciences, Institute of Biostatistics, Fudan University, Shanghai, China
| | - X Li
- Obstetrics and Gynaecology Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
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28
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He B, Chen J, Tian M, Chen J, Zhou C, Ou Y, Wang S, Li X, Zhuang J. Adverse effects of nicotine on cardiogenic differentiation from human embryonic stem cells detected by single-cell RNA sequencing. Biochem Biophys Res Commun 2020; 526:848-855. [PMID: 32276728 DOI: 10.1016/j.bbrc.2020.03.149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/25/2020] [Indexed: 12/15/2022]
Abstract
Tobacco smoking was one of the important adverse factors for congenital heart disease. The effects of nicotine, the main component of tobacco, on human embryonic cardiogenesis and related mechanisms remain poorly understood. This work used single-cell RNA sequencing to investigate the effects of nicotine on human embryonic stem cell (hESC) line H9 and its underlying mechanisms during cardiac differentiation. H9 was cultured in feeder-free medium and differentiated in cardiac condition medium when cells reached 90% confluent. Cell viability was detected by MTT after different concentration of nicotine treatment. Different expressed genes during cardiac differentiation was analyzed by single-cell RNA sequencing (scRNA-seq). Key gene expressions were confirmed by qPCR and Western blot. Results showed that 0.1μM-10μM nicotine did not affect H9 cell proliferation. Nicotine 1 μM down-regulated cardiac progenitor cell, mesoderm cell, smooth muscle cell and neural crest cell relatively. Snail1/2 regulating endocardial cushion development were downregulated apparently at differention day 6. Nicotine didn't affect bry-1 and mesp-1 but inhibited cardiac transcript factors. Consequently, the expression of cTnI, a marker of cardiomyocytes was decreased significantly. The data suggest direct adverse effects of nicotine on heart development at the single-cell level and offer a new approach for estimate drug and environmental toxicity on the pathogenesis of the embryonic cardiovascular system development.
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Affiliation(s)
- Biaochuan He
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Jing Chen
- Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Miao Tian
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Chengbin Zhou
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yanqiu Ou
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Sheng Wang
- Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Xiaohong Li
- Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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29
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Parental non-hereditary teratogenic exposure factors on the occurrence of congenital heart disease in the offspring in the northeastern Sichuan, China. Sci Rep 2020; 10:3905. [PMID: 32127562 PMCID: PMC7054293 DOI: 10.1038/s41598-020-60798-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/14/2020] [Indexed: 11/09/2022] Open
Abstract
Nonhereditary factors play an important role in the occurrence of congenital heart disease (CHD). This study was to explore the possible parental nonhereditary exposure factors relevant to the occurrence of CHD in the northeastern Sichuan area. A total of 367 children with CHD and 367 children without congenital malformations aged 0 to 14 years old were recruited from the Affiliated Hospital of North Sichuan Medical College and Nanchong Central Hospital between March 2016 and November 2018. This study was designed as a case-control study with 1:1 frequency matching, in which the parents of cases and controls were interviewed with the same questionnaire according to the gestational age of the child, maternal age during pregnancy and the same maternal race/ethnicity. Then, 322 matched case-control pairs were analysed by SPSS 22. Thirty-one suspicious factors were entered into the binary logistic regression analysis after univariate regression analysis of 55 factors (alpha = 0.05). The analysis results showed that 7 factors were significantly associated with the occurrence of CHD. Thus, augmenting maternal mental healthcare, improving the quality of drinking water, obtaining adequate nutrition, maintaining a healthy physical condition during pregnancy, enhancing parents’ level of knowledge and maintaining a healthy lifestyle may lower the occurrence of CHD.
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30
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Nicotine Suppresses the Invasiveness of Human Trophoblasts by Downregulation of CXCL12 Expression through the Alpha-7 Subunit of the Nicotinic Acetylcholine Receptor. Reprod Sci 2020; 27:916-924. [PMID: 31933163 PMCID: PMC7077928 DOI: 10.1007/s43032-019-00095-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/07/2019] [Indexed: 12/20/2022]
Abstract
Smoke exposure during pregnancy has detrimental effects upon numerous fetal and neonatal outcomes. Nicotine (the main component of tobacco) has been suggested to affect placental development. During placental development, efficient invasion by trophoblasts is required for establishment of the fetus–maternal circulation. In this study we explored the regulation of trophoblast invasion by nicotine. An immortalized first trimester extravillous trophoblast cell line (HTR-8/SVneo cells) was used for all the experiments, which were treated by nicotine, methyllycaconitine, and C-X-C motif chemokine ligand 12 (CXCL12). Total RNA and protein were used to study the expressions of nicotinic acetylcholine receptors (nAChRs), and transwell assay was used to study invasiveness. Changes of RNA expression due to nicotine treatment were detected by RNA sequence. Level of CXCL12 mRNA was verified by quantitative PCR. We showed that HTR-8/SVneo expressed subunits α2–4, α7, α9, β1, and β2 of nAChRs. Nicotine downregulated CXCL12 expression and inhibited trophoblast invasion. Methyllycaconitine, as an antagonist of the α7 homopolymer, blocked the inhibitory effect of nicotine. CXCL12 could rescue the nicotine-induced inhibitory effect on invasion of HTR-8/SVneo cells. These results suggest that the α7 subunit of the nAChR has important roles in modulating trophoblast invasion through CXCL12.
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31
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Chen L, Yang T, Chen L, Wang L, Wang T, Zhao L, Ye Z, Zhang S, Luo L, Zheng Z, Qin J. Risk of congenital heart defects in offspring exposed to maternal diabetes mellitus: an updated systematic review and meta-analysis. Arch Gynecol Obstet 2019; 300:1491-1506. [PMID: 31713644 DOI: 10.1007/s00404-019-05376-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 10/25/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE A systematic review and meta-analysis was performed to assess the risk of congenital heart defects (CHDs) and its specific phenotypes associated with maternal diabetes mellitus (DM) including pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM). METHODS PubMed, Embase, Medline, Google Scholar, Cochrane Libraries, China National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journals Fulltext Database and China Biology Medicine disc were searched from the inception dates to 15 December 2018, to identify case-control or cohort studies assessing the association between maternal DM and risk of CHDs. The exposure of interest was maternal DM; the outcomes of interest were CHDs and its specific phenotypes. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates. Subgroup analyses were performed to explore potential heterogeneity moderators. RESULTS Total 52 studies, which involved 259,917 patients with CHDs among 16,929,835 participants, were included for analysis. Overall, mothers with DM compared with those without DM had a significantly higher risk of CHDs in offspring [odds ratios (OR) = 2.71, 95% confidence intervals (CI) 2.28-3.23]. When data were restricted to different types of DM, a significantly increased risk of CHDs was observed among mothers with PGDM (OR = 3.18, 95% CI 2.77-3.65) and GDM (OR = 1.98, 95% CI 1.66-2.36). Our study suggested the risk of CHDs was significantly higher among mothers with PGDM than those with GDM. Additionally, this study suggested maternal DM was significantly associated with most phenotypes of CHDs; of these, double outlet of the right ventricle (OR = 10.89; 95% CI 8.77-13.53), atrioventricular septal defect (OR = 5.74; 95% CI 3.20-10.27) and truncus arteriosus (OR = 5.06; 95% CI 2.65-9.65) were identified as the first three of the most common phenotypes of CHDs associated with maternal DM. CONCLUSIONS The maternal DM including PGDM and GDM are significantly associated with risk of CHDs and its most phenotypes. The PGDM seems to be more likely to cause CHDs in offspring than GDM. Further studies are needed to clarify the underlying mechanisms.
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Affiliation(s)
- Letao Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Tubao Yang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Lesan Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Tingting Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Lijuan Zhao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Ziwei Ye
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Senmao Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Liu Luo
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Zan Zheng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Jiabi Qin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China.
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32
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Zhang S, Wang L, Yang T, Chen L, Zhao L, Wang T, Chen L, Ye Z, Zheng Z, Qin J. Parental alcohol consumption and the risk of congenital heart diseases in offspring: An updated systematic review and meta-analysis. Eur J Prev Cardiol 2019; 27:410-421. [PMID: 31578093 DOI: 10.1177/2047487319874530] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to provide updated evidence to assess the association between parental alcohol consumption and the risk of total congenital heart diseases (CHDs) and specific CHD phenotypes in offspring, and explore the possible dose-response pattern. METHODS PubMed, Embase and Chinese databases were searched with an end-date parameter of July 24, 2019 to identify studies meeting pre-stated inclusion criteria. A random-effects model was used to calculate the overall combined risk estimates. A meta-analysis of the dose-response relationship was performed. Subgroup analysis, sensitivity analysis, and Galbraith plot were conducted to explore potential heterogeneity moderators. RESULTS A total of 55 studies involving 41,747 CHD cases and 297,587 controls were identified. Overall, both maternal (odds ratio (OR) = 1.16; 95% confidence interval (CI): 1.05-1.27) and paternal (OR = 1.44; 95% CI: 1.19-1.74) alcohol exposures were significantly associated with risk of total CHDs in offspring. Additionally, a nonlinear dose-response relationship between parental alcohol exposure and risk of total CHDs was observed. With an increase in parental alcohol consumption, the risk of total CHDs in offspring also gradually increases. For specific CHD phenotypes, a statistically significant association was found between maternal alcohol consumption and risk of tetralogy of fallot (OR = 1.20; 95% CI: 1.08-1.33). Relevant heterogeneity moderators have been identified by subgroup analysis, and sensitivity analysis yielded consistent results. CONCLUSIONS Although the role of potential bias and evidence of heterogeneity should be carefully evaluated, our review indicates that parental alcohol exposures are significantly associated with the risk of CHDs in offspring, which highlights the necessity of improving health awareness to prevent alcohol exposure during preconception and conception periods.
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Affiliation(s)
- Senmao Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Lesan Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Tubao Yang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Lijuan Zhao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Tingting Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Letao Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Ziwei Ye
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Zan Zheng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Jiabi Qin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
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33
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Liu S, Li Y, Zhou M. Addressing the Cardiovascular Disease Burden in China-Is It Possible Without Surgery?-Reply. JAMA Cardiol 2019; 4:953. [PMID: 31339507 DOI: 10.1001/jamacardio.2019.2436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Shiwei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yichong Li
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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34
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Sugrue KF, Zohn IE. Reduced maternal vitamin A status increases the incidence of normal aortic arch variants. Genesis 2019; 57:e23326. [PMID: 31299141 DOI: 10.1002/dvg.23326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/25/2022]
Abstract
While common in the general population, the developmental origins of "normal" anatomic variants of the aortic arch remain unknown. Aortic arch development begins with the establishment of the second heart field (SHF) that contributes to the pharyngeal arch arteries (PAAs). The PAAs remodel during subsequent development to form the mature aortic arch and arch vessels. Retinoic acid signaling involving the biologically active metabolite of vitamin A, plays a key role in multiple steps of this process. Recent work from our laboratory indicates that the E3 ubiquitin ligase Hectd1 is required for full activation of retinoic acid signaling during cardiac development. Furthermore, our study suggested that mild alterations in retinoic acid signaling combined with reduced gene dosage of Hectd1, results in a benign aortic arch variant where the transverse aortic arch is shortened between the brachiocephalic and left common carotid arteries. These abnormalities are preceded by hypoplasia of the fourth PAA. To further explore this interaction, we investigate whether reduced maternal dietary vitamin A intake can similarly influence aortic arch development. Our findings indicate that the incidence of hypoplastic fourth PAAs, as well as the incidence of shortened transverse arch are increased with reduced maternal vitamin A intake during pregnancy. These studies provide new insights as to the developmental origins of these benign aortic arch variants.
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Affiliation(s)
- Kelsey F Sugrue
- Institute for Biomedical Sciences, The George Washington University, Washington, District of Columbia.,Center for Neuroscience Research, Children's Research Institute, Children's National Medical Center, Washington, District of Columbia.,Center for Genetic Medicine, Children's Research Institute, Children's National Medical Center, Washington, District of Columbia
| | - Irene E Zohn
- Center for Neuroscience Research, Children's Research Institute, Children's National Medical Center, Washington, District of Columbia.,Center for Genetic Medicine, Children's Research Institute, Children's National Medical Center, Washington, District of Columbia
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Peng J, Meng Z, Zhou S, Zhou Y, Wu Y, Wang Q, Wang J, Sun K. The non-genetic paternal factors for congenital heart defects: A systematic review and meta-analysis. Clin Cardiol 2019; 42:684-691. [PMID: 31073996 PMCID: PMC6605632 DOI: 10.1002/clc.23194] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/03/2019] [Accepted: 05/08/2019] [Indexed: 01/22/2023] Open
Abstract
Background Advances have been made in identifying genetic etiologies and maternal risk factors of congenital heart defects (CHDs), while few literatures are available regarding paternal risk factors for CHDs. Thus, we aim to conduct a meta‐analysis and systematic review about the non‐genetic paternal risk factors for CHDs. Methods We searched the PubMed, MEDLINE, and Cochrane Library online databases and identified 31 studies published between 1990 and 2018 according to the inclusion criteria. Paternal risk factors were divided into subgroups, and summarized odd ratios (OR) were calculated. Results Paternal age between 24 and 29 years decreased the risk of CHDs in the offspring (OR = 0.90 [0.82, 0.98]), while paternal age ≥ 35 years old increased the risk of CHDs (35‐39 years old: OR = 1.14 [1.09, 1.19], and ≥ 40 years: OR = 1.27 [1.14, 1.42]). Paternal cigarette smoking increased the risk of CHDs in a dose‐dependent way. Paternal wine drinking (OR = 1.47 [1.05, 2.07]) and exposure to chemical agents or drugs (OR = 2.15 [1.53, 3.02]) also increased the risk of CHDs. Some specific paternal occupations were also associated with increased risk for CHDs or CHD subtypes including factory workers, janitors, painters, and plywood mill workers. Conclusions This meta‐analysis and systematic review suggested that advanced paternal age, cigarette smoking, wine drinking, exposure to chemical agents or drugs and some specific occupations were associated with an increased risk of CHDs. More measures should be taken to reduce occupational and environment exposures. At the same time, fertility at certain age and establishment of healthy life habits are strongly recommended.
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Affiliation(s)
- Jiayu Peng
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhuo Meng
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of Pediatric Cardiology, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shuang Zhou
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yue Zhou
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yujian Wu
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qingjie Wang
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Wang
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kun Sun
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of Pediatric Cardiology, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Lai T, Xiang L, Liu Z, Mu Y, Li X, Li N, Li S, Chen X, Yang J, Tao J, Zhu J. Association of maternal disease and medication use with the risk of congenital heart defects in offspring: a case-control study using logistic regression with a random-effects model. J Perinat Med 2019; 47:455-463. [PMID: 30794526 DOI: 10.1515/jpm-2018-0281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 01/21/2019] [Indexed: 01/29/2023]
Abstract
Objective To examine the association between maternal diseases and congenital heart defects (CHDs) and to evaluate whether those associations vary with corresponding medication use. Methods A multi-hospital case-control study conducted from February 2010 to December 2014 analysed 916 controls and 1236 cases. Participating mothers were asked whether they suffered from influenza, common cold, herpes and threatened abortion or had used corresponding medication during the periconception period or the early pregnancy period. We used a random-effects logistic regression model to compute the odds ratios (ORs), adjusted odds ratios (AORs) and 95% confidence intervals (CIs) while controlling for potential confounders. Results Compared with the results for mothers with no exposure, there were significant associations between maternal diseases with medication non-use and CHDs in the aggregate, including influenza (AOR, 1.83; 95% CI, 1.13-2.95), common cold (AOR, 2.05; 95% CI, 1.60-2.64) and herpes (AOR, 7.00; 95% CI, 2.15-22.84). There was no significant association between medication users and offspring with any subtype of CHDs, except that maternal common cold with medication use slightly increased the risk of the specific subtype, namely, isolated cardiac defects. However, an association was observed between maternal threatened abortion and medication and isolated cardiac defects (AOR, 1.33; 95% CI, 1.01-1.75). Conclusion Maternal influenza, common cold, herpes and threatened abortion from 3 months before pregnancy through the first trimester were associated with an increased risk of congenital heart disease in offspring. The teratogenic effect of these conditions may be attenuated by medication use, except for threatened abortion.
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Affiliation(s)
- Ting Lai
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Liangcheng Xiang
- National Center for Birth Defect Monitoring, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Zhen Liu
- National Center for Birth Defect Monitoring, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sec. 3 No. 17, South RenMin Road, Chengdu, Sichuan, P.R. China
| | - Yi Mu
- National Center for Birth Defect Monitoring, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Xiaohong Li
- National Center for Birth Defect Monitoring, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Nana Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sec. 3 No. 17, South RenMin Road, Chengdu, Sichuan, P.R. China
| | - Shengli Li
- Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, P.R. China
| | - Xinlin Chen
- Department of Ultrasound, Hubei Maternity and Child Healthcare Hospital, Wuhan, Hubei, P.R. China
| | - Jiaxiang Yang
- Department of Ultrasound, Sichuan Maternity and Child Healthcare Hospital, Chengdu, P.R. China
| | - Jing Tao
- National Center for Birth Defect Monitoring, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China, Tel.: +86-028-85501362
| | - Jun Zhu
- National Center for Birth Defect Monitoring, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sec. 3 No. 17, South RenMin Road, Chengdu, Sichuan 610041, P.R. China, Tel.: +86-028-85503121
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Huang H, Wang A, Morello-Frosch R, Lam J, Sirota M, Padula A, Woodruff TJ. Cumulative Risk and Impact Modeling on Environmental Chemical and Social Stressors. Curr Environ Health Rep 2019; 5:88-99. [PMID: 29441463 DOI: 10.1007/s40572-018-0180-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to identify cumulative modeling methods used to evaluate combined effects of exposures to environmental chemicals and social stressors. The specific review question is: What are the existing quantitative methods used to examine the cumulative impacts of exposures to environmental chemical and social stressors on health? RECENT FINDINGS There has been an increase in literature that evaluates combined effects of exposures to environmental chemicals and social stressors on health using regression models; very few studies applied other data mining and machine learning techniques to this problem. The majority of studies we identified used regression models to evaluate combined effects of multiple environmental and social stressors. With proper study design and appropriate modeling assumptions, additional data mining methods may be useful to examine combined effects of environmental and social stressors.
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Affiliation(s)
- Hongtai Huang
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA.
- Institute for Computational Health Sciences, University of California, San Francisco, CA, USA.
| | - Aolin Wang
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
- Institute for Computational Health Sciences, University of California, San Francisco, CA, USA
| | - Rachel Morello-Frosch
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
- Department of Environmental Science, Policy, and Management, and the School of Public Health, University of California, Berkeley, CA, USA
| | - Juleen Lam
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Marina Sirota
- Institute for Computational Health Sciences, University of California, San Francisco, CA, USA
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Amy Padula
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Tracey J Woodruff
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
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A Matched Case-Control Study on the Association Between Colds, Depressive Symptoms during Pregnancy and Congenital Heart Disease in Northwestern China. Sci Rep 2019; 9:589. [PMID: 30679633 PMCID: PMC6345882 DOI: 10.1038/s41598-018-36968-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 11/28/2018] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study was to explore the association between colds, depressive symptoms during pregnancy and offspring congenital heart disease (CHD). A 1:2 matching case-control study was conducted in Northwest China. Information was gathered by a structured questionnaire and was reviewed by investigators on the spot. Multivariate logistic regressions and nonlinear mixed effect model were performed. 614 cases and 1228 controls were available in this study. After adjusting for potential confounders, the colds during the entire pregnancy were associated with increased risk of offspring CHD (OR = 1.44(1.12-1.85)). Similarly, there was a higher depression score in CHD group than the control group (OR = 1.89(1.48-2.41)). In addition, the women with both colds and higher depression scores had a higher risk of offspring CHD (OR = 2.72(1.87-3.93)) than their counterparts with only colds (OR = 1.48(1.04-2.09)) or with only higher depression scores (OR = 1.94(1.37-2.74)). The combined effects were significant in the multiplication model (OR = 2.04(1.47-2.83)) but not in the additive model (S = 1.40(0.70-2.81), AP = 0.19(-0.15-0.53) and RERI = 0.55(-0.54-1.64)). In conclusion, the colds and depressive symptoms during pregnancy were found associated with increased risk of offspring CHD and we found for the first time that there existed a statistically multiplying interaction effect of colds and depression on increasing risk of offspring CHD.
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Wang J, Ye Y, Xin T, Zhang X, Chen S, Wu Y, Sun K. Is echocardiography necessary for all single umbilical artery fetuses? A retrospective study in a selected Chinese population. J Obstet Gynaecol Res 2019; 45:803-809. [PMID: 30644151 DOI: 10.1111/jog.13912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 12/08/2018] [Indexed: 12/26/2022]
Abstract
AIM Previous evidence on the relationship between single umbilical artery (SUA) and congenital heart disease (CHD) is controversial. We thus conducted a retrospective study to explore the potential risk factors associated with CHD in SUA fetuses, and verify if all these SUA fetuses should be referred for detail fetal echocardiography. METHODS We reviewed medical records of SUA fetuses referred to Xinhua Hospital for fetal echocardiography between September 2009 and February 2014. All the pregnancies were divided into two groups of CHD and non-CHD according to the results of fetal echocardiography. The maternal and fetal characteristics were compared via χ2 test and Fishers' test. Furthermore, Poisson regression was used to analyze the risk factors associated with CHD in SUA pregnancies. RESULTS Nineteen CHD cases (12.5%) were detected among 152 SUA fetuses, all with abnormal cardiac views during obstetric screening ultrasound (P < 0.001). χ2 test showed that abnormal cardiac screening findings, extracardiac abnormality and infection or threatened abortion during first trimester were significantly associated with prenatal detection of CHD (P < 0.001). Multivariable Poisson regression after adjustment found that SUA fetuses with extracardiac abnormality had 4.74 (95% confidence interval: 1.89, 11.90) times higher risk of CHD. CONCLUSION Incidence of CHD was higher in SUA cases, and CHD fetuses could be screened efficiently by abnormal cardiac screening during obstetric screening ultrasound. SUA fetuses with extracardiac abnormality and maternal risk factors have higher risk of CHD, and should be strongly recommended for fetal echocardiography. In contrast, SUA fetuses without above situations might only need routine obstetric follow-up.
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Affiliation(s)
- Jian Wang
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujiao Ye
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tiantian Xin
- Department of Pediatric, Zhang Jiagang First People Hospital, Suchou University, Jiangsu, China
| | - Xi Zhang
- Clinical Research Unit, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sun Chen
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yurong Wu
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun Sun
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Lin S, Lin Z, Ou Y, Soim A, Shrestha S, Lu Y, Sheridan S, Luben TJ, Fitzgerald E, Bell E, Shaw GM, Reefhuis J, Langlois PH, Romitti P, Feldkamp ML, Malik S, Pantea C, Nayak S, Hwang SA, Browne M. Maternal ambient heat exposure during early pregnancy in summer and spring and congenital heart defects - A large US population-based, case-control study. ENVIRONMENT INTERNATIONAL 2018; 118:211-221. [PMID: 29886237 PMCID: PMC6045445 DOI: 10.1016/j.envint.2018.04.043] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/23/2018] [Accepted: 04/23/2018] [Indexed: 05/04/2023]
Abstract
BACKGROUND/OBJECTIVE Few studies have assessed the effect of ambient heat during the fetal development period on congenital heart defects (CHDs), especially in transitional seasons. We examined and compared the associations between extreme heat and CHD phenotypes in summer and spring, assessed their geographical differences, and compared different heat indicators. METHODS We identified 5848 CHD cases and 5742 controls (without major structural defects) from the National Birth Defects Prevention Study, a US multicenter, population-based case-control study. Extreme heat events (EHEs) were defined by using the 95th (EHE95) or 90th (EHE90) percentile of daily maximum temperature and its frequency and duration during postconceptional weeks 3-8. We used a two-stage Bayesian hierarchical model to examine both regional and study-wide associations. Exposure odds ratios (ORs) were calculated using multivariate logistic regression analyses, while controlling for potential confounding factors. RESULTS Overall, we observed no significant relationships between maternal EHE exposure and CHDs in most regions during summer. However, we found that 3-11 days of EHE90 during summer and spring was significantly associated with ventricular septal defects (VSDs) study-wide (ORs ranged: 2.17-3.24). EHE95 in spring was significantly associated with conotruncal defects and VSDs in the South (ORs: 1.23-1.78). Most EHE indicators in spring were significantly associated with increased septal defects (both VSDs and atrial septal defects (ASDs)) in the Northeast. CONCLUSION While generally null results were found, long duration of unseasonable heat was associated with the increased risks for VSDs and ASDs, mainly in South and Northeast of the US. Further research to confirm our findings is needed.
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Affiliation(s)
- Shao Lin
- Department of Environmental Health Sciences, University at Albany, Rensselaer, NY, United States; Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, United States.
| | - Ziqiang Lin
- Department of Mathematics, University at Albany, Albany, NY, United States
| | - Yanqiu Ou
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Aida Soim
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, United States; New York State Department of Health, Albany, NY, United States
| | - Srishti Shrestha
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, United States
| | - Yi Lu
- Department of Environmental Health Sciences, University at Albany, Rensselaer, NY, United States
| | - Scott Sheridan
- Department of Geography, Kent State University, Kent, OH, United States
| | - Thomas J Luben
- Office of Research and Development, U.S. Environmental Protection Agency, RTP, NC, United States
| | - Edward Fitzgerald
- Department of Environmental Health Sciences, University at Albany, Rensselaer, NY, United States; Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, United States
| | - Erin Bell
- Department of Environmental Health Sciences, University at Albany, Rensselaer, NY, United States; Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, United States
| | - Gary M Shaw
- Stanford School of Medicine, Stanford, CA, United States
| | - Jennita Reefhuis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Peter H Langlois
- Texas Department of State Health Services, Austin, TX, United States
| | - Paul Romitti
- Department of Epidemiology, The University of Iowa, Iowa City, IA, United States
| | - Marcia L Feldkamp
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Sadia Malik
- University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Cristian Pantea
- New York State Department of Health, Albany, NY, United States
| | - Seema Nayak
- New York State Department of Health, Albany, NY, United States
| | - Syni-An Hwang
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, United States; New York State Department of Health, Albany, NY, United States
| | - Marilyn Browne
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, United States; New York State Department of Health, Albany, NY, United States
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Xie D, Fang J, Liu Z, Wang H, Yang T, Sun Z, Wang A, Xiong L. Epidemiology and major subtypes of congenital heart defects in Hunan Province, China. Medicine (Baltimore) 2018; 97:e11770. [PMID: 30075604 PMCID: PMC6081061 DOI: 10.1097/md.0000000000011770] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Congenital heart defects (CHDs) are the most common birth defects (BDs) and account for nearly one-third of all BDs. The aim of this article was to investigate the epidemiology and major subtypes of CHDs in Hunan Province, China in the last 5 years.CHD surveillance data from 2012 to 2016 were collected from 52 registered hospitals in Hunan. The prevalence rates of CHDs, incidence rates of CHDs combined with other BDs, and rates of termination of pregnancy (TOP) for CHDs among different regions, infant sexes, and maternal ages were calculated for both early fetuses (<28 weeks of gestation) and perinatal infants (PIs) (between 28 weeks of gestation and 7 days after birth). Both the constituent ratio and prevalence rates were computed among subtypes.CHDs were found in 6289 out of 673,060 births. The overall prevalence was 93.44 per 10,000 PIs, with 19.27 and 74.17 per 10,000 in early fetuses and PIs, respectively. The risks of CHDs were higher in infants from urban areas than those from rural areas during the whole gestation and were higher in male infants than in female infants during the perinatal period. The total prevalence of CHDs increased significantly with maternal age (χ trend = 141.84, P < .05). Among fetuses in early gestation, there were 288 cases (22.21%) of CHDs combined with other BDs and 1292 cases (99.61%) of TOP for CHD. The 3 major subtypes of CHDs were ventricular septal defect (VSD) (22.06%), Tetralogy of Fallot (TOF) (9.43%), and atrioventricular septal defect (AVSD) (6.69%). Among PIs, there were 1541 cases (30.87%) of CHD diagnosed before delivery and 1184 cases (76.83%) were TOP. The 3 major subtypes were atrial septal defect (ASD) (42.81%), patent ductus arteriosus (PDA) (16.07%), and VSDs (15.21%).The total prevalence of CHD in Hunan Province and the rate of TOP for CHD was high, especially for early-gestation fetuses. Pregnancies in urban women, male PIs, and maternal age were the risk factors for CHDs. Among early-gestation fetuses, the most common types were VSD, TOF, and ASD, and among PIs, the most common types were ASD, PDA, and VSD.
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Affiliation(s)
| | - Junqun Fang
- Department of Health management, Maternal and Child Health Hospital of Hunan Province
| | - Zhiyu Liu
- Department of Information Management
| | - Hua Wang
- Department of Health management, Maternal and Child Health Hospital of Hunan Province
| | - Tubao Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan, P.R. China
| | - Zhenqiu Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan, P.R. China
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Kovalenko AA, Anda EE, Odland JØ, Nieboer E, Brenn T, Krettek A. Risk Factors for Ventricular Septal Defects in Murmansk County, Russia: A Registry-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071320. [PMID: 29937526 PMCID: PMC6069126 DOI: 10.3390/ijerph15071320] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/14/2018] [Accepted: 06/22/2018] [Indexed: 12/13/2022]
Abstract
Cardiovascular malformations are one of the most common birth defects among newborns and constitute a leading cause of perinatal and infant mortality. Although some risk factors are recognized, the causes of cardiovascular malformations (CVMs) remain largely unknown. In this study, we aim to identify risk factors for ventricular septal defects (VSDs) in Northwest Russia. The study population included singleton births registered in the Murmansk County Birth Registry (MCBR) between 1 January 2006 and 31 December 2011. Infants with a diagnosis of VSD in the MCBR and/or in the Murmansk Regional Congenital Defects Registry (up to two years post-delivery) constituted the study sample. Among the 52,253 infants born during the study period there were 744 cases of septal heart defects (SHDs), which corresponds to a prevalence of 14.2 [95% confidence interval (CI) of 13.2–15.3] per 1000 infants. Logistic regression analyses were carried out to identify VSD risk factors. Increased risk of VSDs was observed among infants born to mothers who abused alcohol [OR = 4.83; 95% CI 1.88–12.41], or smoked during pregnancy [OR = 1.35; 95% CI 1.02–1.80]. Maternal diabetes mellitus was also a significant risk factor [OR = 8.72; 95% CI 3.16–24.07], while maternal age, body mass index, folic acid and multivitamin intake were not associated with increased risk. Overall risks of VSDs for male babies were lower [OR = 0.67; 95% CI 0.52–0.88].
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Affiliation(s)
- Anton A Kovalenko
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway.
- International School of Public Health, Northern State Medical University, 163000 Arkhangelsk, Russia.
| | - Erik Eik Anda
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway.
| | - Jon Øyvind Odland
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway.
| | - Evert Nieboer
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, L9H 6C6 ON, Canada.
| | - Tormod Brenn
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway.
| | - Alexandra Krettek
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway.
- Department of Biomedicine and Public Health, School of Health and Education, University of Skövde, 54128 Skövde, Sweden.
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, 41390 Gothenburg, Sweden.
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Deng Y, Song L, Nie X, Shou W, Li X. Prenatal inflammation exposure-programmed cardiovascular diseases and potential prevention. Pharmacol Ther 2018; 190:159-172. [PMID: 29803628 DOI: 10.1016/j.pharmthera.2018.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In recent years, the rapid development of medical and pharmacological interventions has led to a steady decline in certain noncommunicable chronic diseases (NCDs), such as cancer. However, the overall incidence of cardiovascular diseases (CVDs) has not seemed to decline. CVDs have become even more prevalent in many countries and represent a global health threat and financial burden. An increasing number of epidemiological and experimental studies have demonstrated that maternal insults not only can result in birth defects but also can cause developmental functional defects that contribute to adult NCDs. In the current review, we provide an overview of evidence from both epidemiological investigations and experimental animal studies supporting the concept of developmental reprogramming of adult CVDs in offspring that have experienced prenatal inflammation exposure (PIE) during fetal development (PIE-programmed CVDs), a disease-causing event that has not been effectively controlled. This review describes the epidemiological observations, data from animal models, and related mechanisms for the pathogenesis of PIE-programmed CVDs. In addition, the potential therapeutic interventions of PIE-programmed CVDs are discussed. Finally, we also deliberate the need for future mechanistic studies and biomarker screenings in this important field, which creates a great opportunity to combat the global increase in CVDs by managing the adverse effects of inflammation for prepregnant and pregnant individuals who are at risk for PIE-programmed CVDs.
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Affiliation(s)
- Youcai Deng
- Institute of Materia Medica, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China; Center of Translational Medicine, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China.
| | - Liang Song
- Institute of Materia Medica, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China; Center of Translational Medicine, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China
| | - Xuqiang Nie
- Institute of Materia Medica, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China; Center of Translational Medicine, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China
| | - Weinian Shou
- Institute of Materia Medica, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China; Center of Translational Medicine, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China; Herman B Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, 1044 W. Walnut Street, R4 W302D, Indianapolis, IN 46202, USA
| | - Xiaohui Li
- Institute of Materia Medica, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China; Center of Translational Medicine, College of Pharmacy, Army Medical University (Third Military Medical University), 30# Gaotanyan Rd., Shapingba District, Chongqing 400038, China.
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Feng Y, Cai J, Tong X, Chen R, Zhu Y, Xu B, Mo X. Non-inheritable risk factors during pregnancy for congenital heart defects in offspring: A matched case-control study. Int J Cardiol 2018; 264:45-52. [PMID: 29685690 DOI: 10.1016/j.ijcard.2018.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/04/2018] [Accepted: 04/02/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Yu Feng
- Department of Thoracic Surgery, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China; Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Jun Cai
- Ministry of Education Key Laboratory for Earth System Modelling, Department of Earth System Science, Tsinghua University, Beijing 100084, China; Joint Center for Global Change Studies, Beijing 100875, China
| | - Xing Tong
- Department of Pathology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Runsen Chen
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Yu Zhu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Bing Xu
- Ministry of Education Key Laboratory for Earth System Modelling, Department of Earth System Science, Tsinghua University, Beijing 100084, China; Joint Center for Global Change Studies, Beijing 100875, China.
| | - Xuming Mo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China.
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Liu X, Nie Z, Chen J, Guo X, Ou Y, Chen G, Mai J, Gong W, Wu Y, Gao X, Qu Y, Bell EM, Lin S, Zhuang J. Does maternal environmental tobacco smoke interact with social-demographics and environmental factors on congenital heart defects? ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 234:214-222. [PMID: 29175685 DOI: 10.1016/j.envpol.2017.11.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 06/07/2023]
Abstract
Congenital heart defects (CHDs) are a major cause of death in infancy and childhood. Major risk factors for most CHDs, particularly those resulting from the combination of environmental exposures with social determinants and behaviors, are still unknown. This study evaluated the main effect of maternal environmental tobacco smoke (ETS), and its interaction with social-demographics and environmental factors on CHDs in China. A population-based, matched case-control study of 9452 live-born infants and stillborn fetuses was conducted using the Guangdong Registry of Congenital Heart Disease data (2004-2014). The CHDs were evaluated by obstetrician, pediatrician, or cardiologist, and confirmed by cardia tomography/catheterization. Controls were randomly chosen from singleton newborns without any malformation, born in the same hospital as the cases and 1:1 matched by infant sex, time of conception, and parental residence (same city and town to ensure sufficient geographical distribution for analyses). Face-to-face interviews were conducted to collect information on demographics, behavior patterns, maternal disease/medication, and environmental exposures. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals of ETS exposure on CHDs while controlling for all risk factors. Interactive effects were evaluated using a multivariate delta method for maternal demographics, behavior, and environmental exposures on the ETS-CHD relationship. Mothers exposed to ETS during the first trimester of pregnancy were more likely to have infants with CHD than mothers who did not (aOR = 1.44, 95% CI 1.25-1.66). We also observed a significant dose-response relationship when mothers were exposed to ETS and an increasing number of risk factors and CHDs. There were greater than additive interactions for maternal ETS and migrant status, low household income and paternal alcohol consumption on CHDs. Maternal low education also modified the ETS-CHD association on the multiplicative scale. These findings may help to identify high-risk populations for CHD, providing an opportunity for targeted preventive interventions.
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Affiliation(s)
- Xiaoqing Liu
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou 510100, Guangdong, China
| | - Zhiqiang Nie
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou 510100, Guangdong, China
| | - Jimei Chen
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou 510100, Guangdong, China
| | - Xiaoling Guo
- Department of Pediatric, Zhongshan Boai Hospital, 6 Chenghui Road, Zhongshan 528400, Guangdong, China
| | - Yanqiu Ou
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou 510100, Guangdong, China
| | - Guanchun Chen
- Department of Echocardiography, Dongguan Houjie Hospital, 21 Hetian Avenue, Dongguan 523945, Guangdong, China
| | - Jinzhuang Mai
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou 510100, Guangdong, China
| | - Wei Gong
- Department of Echocardiography, Panyu Maternal and Child Care Service Centre of Guangzhou, 2 Qinghe Road Ease, Guangzhou 511400, Guangdong, China
| | - Yong Wu
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou 510100, Guangdong, China
| | - Xiangmin Gao
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou 510100, Guangdong, China
| | - Yanji Qu
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou 510100, Guangdong, China
| | - Erin M Bell
- Department of Environmental Health Sciences, University at Albany, State University of New York, GEC 100, One University Place, Rensselaer, Albany, NY, USA; Department of Epidemiology and Biostatistics, University at Albany, State University of New York, GEC 100, One University Place, Rensselaer, Albany, NY, USA
| | - Shao Lin
- Department of Environmental Health Sciences, University at Albany, State University of New York, GEC 100, One University Place, Rensselaer, Albany, NY, USA; Department of Epidemiology and Biostatistics, University at Albany, State University of New York, GEC 100, One University Place, Rensselaer, Albany, NY, USA.
| | - Jian Zhuang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou 510100, Guangdong, China.
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Nembhard WN, Tang X, Li J, MacLeod SL, Levy J, Schaefer GB, Hobbs CA. A parent-of-origin analysis of paternal genetic variants and increased risk of conotruncal heart defects. Am J Med Genet A 2018; 176:609-617. [PMID: 29399948 DOI: 10.1002/ajmg.a.38611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/04/2017] [Accepted: 12/26/2017] [Indexed: 12/12/2022]
Abstract
The association between conotruncal heart defects (CTHDs) and maternal genetic and environmental exposures is well studied. However, little is known about paternal genetic or environmental exposures and risk of CTHDs. We assessed the effect of paternal genetic variants in the folate, homocysteine, and transsulfuration pathways on risk of CTHDs in offspring. We utilized National Birth Defects Prevention Study data to conduct a family-based case only study using 616 live-born infants with CTHDs, born October 1997-August 2008. Maternal, paternal and infant DNA was genotyped using an Illumina® Golden Gate custom single nucleotide polymorphism (SNP) panel. Relative risks (RR) and 95% confidence intervals (CI) from log-linear models determined parent of origin effects for 921 SNPs in 60 candidate genes involved in the folate, homocysteine, and transsulfuration pathways on risk of CTHDs. The risk of CTHD among children who inherited a paternally derived copy of the A allele on GLRX (rs17085159) or the T allele of GLRX (rs12109442) was 0.23 (95%CI: 0.12, 0.42; p = 1.09 × 10-6 ) and 0.27 (95%CI: 0.14, 0.50; p = 2.06 × 10-5 ) times the risk among children who inherited a maternal copy of the same allele. The paternally inherited copy of the GSR (rs7818511) A allele had a 0.31 (95%CI: 0.18, 0.53; p = 9.94 × 10-6 ] risk of CTHD compared to children with the maternal copy of the same allele. The risk of CTHD is less influenced by variants in paternal genes involved in the folate, homocysteine, or transsulfuration pathways than variants in maternal genes in those pathways.
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Affiliation(s)
- Wendy N Nembhard
- Division of Birth Defects Research, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, Arkansas.,Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Xinyu Tang
- Division of Biostatistics, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, Arkansas
| | - Jingyun Li
- Division of Biostatistics, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, Arkansas
| | - Stewart L MacLeod
- Division of Birth Defects Research, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, Arkansas
| | - Joseph Levy
- Division of Birth Defects Research, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, Arkansas
| | - Gerald B Schaefer
- Division of Genetics and Metabolism, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, Arkansas
| | - Charlotte A Hobbs
- Division of Birth Defects Research, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, Arkansas
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Pickardt T, Niggemeyer E, Bauer UMM, Abdul-Khaliq H. A Biobank for Long-term and Sustainable Research in the Field of Congenital Heart Disease in Germany. GENOMICS PROTEOMICS & BIOINFORMATICS 2016; 14:181-90. [PMID: 27132144 PMCID: PMC4996858 DOI: 10.1016/j.gpb.2016.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 11/17/2022]
Abstract
Congenital heart disease (CHD) is the most frequent birth defect (0.8%-1% of all live births). Due to the advance in prenatal and postnatal early diagnosis and treatment, more than 90% of these patients survive into adulthood today. However, several mid- and long-term morbidities are dominating the follow-up of these patients. Due to the rarity and heterogeneity of the phenotypes of CHD, multicenter registry-based studies are required. The CHD-Biobank was established in 2009 with the aim to collect DNA from patients and their parents (trios) or from affected families, as well as cardiovascular tissues from patients undergoing corrective heart surgery for cardiovascular malformations. Clinical/phenotype data are matched to the International Paediatric and Congenital Cardiac Code (IPCCC) and the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). The DNA collection currently comprises samples from approximately 4200 participants with a wide range of CHD phenotypes. The collection covers about 430 trios and 120 families with more than one affected member. The cardiac tissue collection comprises 1143 tissue samples from 556 patients after open heart surgery. The CHD-Biobank provides a comprehensive basis for research in the field of CHD with high standards of data privacy, IT management, and sample logistics.
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Affiliation(s)
- Thomas Pickardt
- National Register for Congenital Heart Defects, 13353 Berlin, Germany.
| | - Eva Niggemeyer
- National Register for Congenital Heart Defects, 13353 Berlin, Germany
| | - Ulrike M M Bauer
- National Register for Congenital Heart Defects, 13353 Berlin, Germany; Competence Network for Congenital Heart Defects, 13353 Berlin, Germany
| | - Hashim Abdul-Khaliq
- Saarland University Medical Center, Department of Paediatric Cardiology, 66421 Homburg, Germany; Competence Network for Congenital Heart Defects, 13353 Berlin, Germany
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