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Feng Y, Liu X, Zhang X, Zhao X, Chang H, Ouyang F, Yu Z, Gao Z, Zhang H. Global air pollution exposure and congenital anomalies: an updated systematic review and meta-analysis of epidemiological studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:2333-2352. [PMID: 37610216 DOI: 10.1080/09603123.2023.2246383] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
A systematic review and meta-analysis was conducted to evaluate recent epidemiological evidence on the association of air pollution with congenital anomalies (CAs). Of 11,014 records, 49 were finally included in this meta-analysis. Per 10 μg/m3 increase in air pollutant, PM10 exposure during the 1st month of pregnancy and at the first trimester (T1) was associated with increased overall CAs. Further, exposure to PM10 was associated with congenital heart disease (OR = 1.055, 95% CI: 1.035, 1.074) and patent ductus arteriosus (OR = 1.094, 95% CI: 1.020, 1.168) at T1, with chromosomal anomalies during the entire pregnancy and with nervous system anomalies when exposure occurred 3 months prior to pregnancy, during the 1st, 2nd months of pregnancy and at T1. Besides, a significant association with overall CAs was observed for a combined exposure of PM10 and SO2 during the 1st month of gestation (OR: 1.101, 95% CI: 1.023, 1.180). A combined exposure of PM10 and CO was also associated with tetralogy of Fallot during 3-8 weeks of gestation (OR: 1.016, 95% CI: 1.005, 1.027). No significant associations were observed between PM2.5, NO2, and O3 exposure and CAs.
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Affiliation(s)
- Yang Feng
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xinxin Liu
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaoan Zhang
- Clinical Nutrition Department, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Zhao
- Clinical Nutrition Department, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Chang
- Clinical Nutrition Department, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fan Ouyang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zengli Yu
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zhan Gao
- Clinical Nutrition Department, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huanhuan Zhang
- College of Public Health, Zhengzhou University, Zhengzhou, China
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Cruz-Ávila HA, Ramírez-Alatriste F, Martínez-García M, Hernández-Lemus E. Comorbidity patterns in cardiovascular diseases: the role of life-stage and socioeconomic status. Front Cardiovasc Med 2024; 11:1215458. [PMID: 38414921 PMCID: PMC10897012 DOI: 10.3389/fcvm.2024.1215458] [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: 05/02/2023] [Accepted: 01/29/2024] [Indexed: 02/29/2024] Open
Abstract
Cardiovascular diseases stand as a prominent global cause of mortality, their intricate origins often entwined with comorbidities and multimorbid conditions. Acknowledging the pivotal roles of age, sex, and social determinants of health in shaping the onset and progression of these diseases, our study delves into the nuanced interplay between life-stage, socioeconomic status, and comorbidity patterns within cardiovascular diseases. Leveraging data from a cross-sectional survey encompassing Mexican adults, we unearth a robust association between these variables and the prevalence of comorbidities linked to cardiovascular conditions. To foster a comprehensive understanding of multimorbidity patterns across diverse life-stages, we scrutinize an extensive dataset comprising 47,377 cases diagnosed with cardiovascular ailments at Mexico's national reference hospital. Extracting sociodemographic details, primary diagnoses prompting hospitalization, and additional conditions identified through ICD-10 codes, we unveil subtle yet significant associations and discuss pertinent specific cases. Our results underscore a noteworthy trend: younger patients of lower socioeconomic status exhibit a heightened likelihood of cardiovascular comorbidities compared to their older counterparts with a higher socioeconomic status. By empowering clinicians to discern non-evident comorbidities, our study aims to refine therapeutic designs. These findings offer profound insights into the intricate interplay among life-stage, socioeconomic status, and comorbidity patterns within cardiovascular diseases. Armed with data-supported approaches that account for these factors, clinical practices stand to be enhanced, and public health policies informed, ultimately advancing the prevention and management of cardiovascular disease in Mexico.
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Affiliation(s)
- Héctor A Cruz-Ávila
- Graduate Program in Complexity Sciences, Autonomous University of México City, México City, Mexico
- Immunology Department, National Institute of Cardiology 'Ignacio Chávez', México City, Mexico
| | | | - Mireya Martínez-García
- Immunology Department, National Institute of Cardiology 'Ignacio Chávez', México City, Mexico
| | - Enrique Hernández-Lemus
- Computational Genomics Division, National Institute of Genomic Medicine, México City, Mexico
- Center for Complexity Sciences, Universidad Nacional Autónoma de México, México City, Mexico
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Seiz M, Salazar L, Eremenko T. Perinatal health in Spain during and after the Great Recession: Educational selection into fertility as a protective factor in high unemployment contexts. Soc Sci Med 2024; 340:116439. [PMID: 38000176 DOI: 10.1016/j.socscimed.2023.116439] [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: 08/06/2023] [Revised: 10/16/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
Higher maternal resources have long been associated with superior birth outcomes. This study analyzes the potentially protective role of maternal educational selection into fertility in adverse macroeconomic contexts. We focus on the case of Spain, a country reaching record-high unemployment levels during the Great Recession starting in 2008. First, we examine whether selection into fertility of more educated mothers took place as province-level unemployment rates rose. Secondly, we assess whether maternal education mitigated the impact of higher unemployment levels on different birth outcomes. The analysis combines register data on the universe of live births with aggregate data on province-level unemployment. We cover the period 2007-2019 to ensure sufficient variability of unemployment rates and perform linear regression and linear probability models with fixed effects to hold constant unobserved heterogeneity across provinces. Findings indicate selection into fertility of mothers with university-level education in times of high unemployment. In addition, while unemployment rates did show an adverse impact on certain birth outcomes -birthweight, the occurrence of low and very low birthweight, and the risk of stillbirth - maternal education mitigated the observed relations. It was itself, moreover, consistently and independently associated with better perinatal health. We thus conclude that fertility selectivity by maternal education cushioned the impact of the adverse economic context derived from the Great Recession through two separate pathways.
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Affiliation(s)
- Marta Seiz
- UNED, Department of Sociology II (Social Structure), Facultad de Ciencias Políticas y Sociología, c/Obispo Trejo 2, 28040, Madrid, Spain.
| | - Leire Salazar
- UNED, Department of Sociology II (Social Structure), Facultad de Ciencias Políticas y Sociología, c/Obispo Trejo 2, 28040, Madrid, Spain.
| | - Tatiana Eremenko
- University of Salamanca, Department of Sociology and Communication, Campus Miguel de Unamuno, Edificio FES, P.° Francisco Tomás y Valiente, 37007, Salamanca, Spain
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Nicholls-Dempsey L, Badeghiesh A, Baghlaf H, Dahan MH. How does high socioeconomic status affect maternal and neonatal pregnancy outcomes? A population-based study among American women. Eur J Obstet Gynecol Reprod Biol X 2023; 20:100248. [PMID: 37876770 PMCID: PMC10590715 DOI: 10.1016/j.eurox.2023.100248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/22/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023] Open
Abstract
Objectives The purpose of this study was to evaluate the effect of high SES on multiple pregnancy outcomes, while controlling for confounding factors. Methods Using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS), the largest American medical database including 20 % of annual hospital admissions, we studied the years 2004-2014 inclusively. We conducted a population-based retrospective cohort study consisting of women from different median household income quartiles throughout the United States. Women in the highest household income quartile were compared to those in all other lower income quartiles combined. Chi-square and Fischer exact tests were used to compare demographic and baseline characteristics. Univariate and multivariate regression analyses were carried to adjust for confounding factors, including ethnicity, pre-existing conditions, smoking status, obesity, illicit drug use and insurance type. Results Among 5,448,255 deliveries during the study period with income data, 1,218,989 deliveries were to women from the wealthiest median household income. These women were more likely to be older, Caucasian, and have private medical insurance (P < 0.05, all). They were less likely to smoke, have chronic hypertension, pre-gestational diabetes, and use illicit drugs (P < 0.05, all). They were less likely to develop complications including gestational hypertension (aOR 0.87 95 %CI 0.85-0.88), preeclampsia (aOR 0.88 95 %CI 0.86-0.89), eclampsia (aOR 0.81 95 %CI 0.66-0.99), gestational diabetes (aOR 0.91 95 %CI 0.89-0.92), preterm premature rupture of membranes (PPROM) (aOR 0.92 95 %CI 0.88-0.96), preterm birth (aOR 0.90 95 %CI 0.89-0.92), and placental abruption (aOR 0.89 95 %CI 0.85-0.93). They were less likely to have an intra-uterine fetal death (IUFD) (aOR 0.80 95 %CI 0.74-0.86), but more likely to deliver neonates with congenital anomalies (aOR 1.10 95 %CI 1.04-1.20). Conclusions Higher SES predisposes to better pregnancy outcomes, even when controlled for confounding factors such as ethnicity and underlying baseline health status. Efforts are required in order to eliminate health disparities in pregnancy.
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Affiliation(s)
| | - Ahmad Badeghiesh
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada
| | - Haitham Baghlaf
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
- Department of Obstetrics and Gynecology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Michael H. Dahan
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
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Lucas ADP, de Oliveira Ferreira M, Lucas TDP, Salari P. The intergenerational relationship between conditional cash transfers and newborn health. BMC Public Health 2022; 22:201. [PMID: 35094683 PMCID: PMC8801108 DOI: 10.1186/s12889-022-12565-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/12/2022] [Indexed: 12/17/2022] Open
Abstract
Background Lack of nutrition, inadequate housing, low education and limited access to quality care can negatively affect children’s health over their lifetime. Implemented in 2003, the Bolsa Familia (“Family Stipend”) Program (PBF) is a conditional cash transfer program targeting poor households in Brazil. This study investigates the long-term benefits of cash transfers through intergenerational transmission of health and poverty by assessing the early life exposure of the mother to the PBF. Methods We used data from the 100M SINASC-SIM cohort compiled and managed by the Center for Data and Knowledge Integration for Health (CIDACS), containing information about participation in the PBF and socioeconomic and health indicators. We analyzed five measures of newborn health: low (less than 2,500 g) and very low (less than 1,500 g) birth weight, premature (less than 37 weeks of gestation) and very premature (less than 28 weeks of gestation) birth, and the presence of some type of malformation (according to ICD-10 codes). Furthermore, we measured the early life exposure to the PBF of the mother as PBF coverage in the previous decade in the city where the mother was born. We applied multilevel logistic regression models to assess the associations between birth outcomes and PBF exposures. Results Results showed that children born in a household where the mother received BF were less likely to have low birth weight (OR 0.93, CI; 0.92-0.94), very low birth weight (0.87, CI; 0.84-0.89), as well as to be born after 37 weeks of gestation (OR 0.98, CI; 0.97-0.99) or 28 weeks of gestation (OR 0.93, CI; 0.88-0.97). There were no significant associations between households where the mother received BF and congenital malformation. On average, the higher the early life exposure to the PBF of the mother, the lower was the prevalence of low birth weight, very low birth weight and congenital malformation of the newborn. No trend was noted for preterm birth. Conclusion The PBF might have indirect intergenerational effects on children’s health. These results provide important implications for policymakers who have to decide how to effectively allocate resources to improve child health. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12565-7.
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Chan CCH, Stirling PHC, Lam WL. The impact of socioeconomic deprivation on congenital hand differences: A retrospective cohort study. HAND SURGERY & REHABILITATION 2021; 41:265-269. [PMID: 34954407 DOI: 10.1016/j.hansur.2021.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/01/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
Socioeconomic deprivation is an established risk factor for a range of adverse perinatal and infant outcomes. The primary aim of this study was to investigate any association between socioeconomic deprivation and the prevalence of Congenital Hand Differences (CHDs). This retrospective cross-sectional study was undertaken at a single tertiary referral center over a five year period (March 2015 to February 2020). The inclusion criterion was all patients referred for a review at a CHD clinic. As a measure of socioeconomic status, patients were assigned to a deprivation quintile using the Scottish Index of Multiple Deprivation (SIMD): quintile 1 indicates the most deprived area and quintile 5 indicates the least deprived area. CHDs were classified according to the Oberg-Manske-Tonkin (OMT) Classification. During the study period 259 patients were identified. The overall prevalence of CHD was 15 per 100,000 per year, mean referral age was 2.6 years (Standard Deviation: 4 years) and 135 patients (52%) were female. Areas of greater social deprivation had a significantly higher prevalence of CHD (22 per 100,000 per year in quintile 1 vs. 13 per 100,000 per year in quintile 5; p < 0.001), surgery (75% of patients in quintile 1 vs 43% of patients in quintile 5; p = 0.003), and younger referral age (1.5 years in quintile 1 vs 4.4 years in quintile 5; p = 0.003). This study has shown a greater CHD prevalence rate amongst patients from more socially deprived areas. In the most deprived group, the patient referral age was also significantly younger and surgical intervention rate was higher.
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Affiliation(s)
- C C H Chan
- University of Edinburgh, School of Medicine, Chancellor's Building, Edinburgh, EH16 4TJ, United Kingdom.
| | - P H C Stirling
- Royal Infirmary of Edinburgh, Trauma and Orthopaedics Department, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom
| | - W L Lam
- Royal Hospital for Sick Children, Plastic Surgery Department, 50 Little France Cres, Edinburgh EH16 4TJ, United Kingdom
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Ravindra K, Chanana N, Mor S. Exposure to air pollutants and risk of congenital anomalies: A systematic review and metaanalysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 765:142772. [PMID: 33183823 DOI: 10.1016/j.scitotenv.2020.142772] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Congenital malformations are considered as one of the significant causes of preterm as well as neonatal morbidity and mortality. Literature suggests the association of diverse congenital deformities with maternal exposure to air pollutants. However, the evidence is still inconclusive on the manifestation of these during pregnancy. Thus, systematic review was done on the available epidemiological studies studying the effect of air pollutants on congenital malformations. Furthermore, the meta-analysis was conducted for several combinations of air pollutants and congenital defects. METHODS Twenty six epidemiological studies were extracted from the databases and examined for association of risk of congenital defects with air pollutant concentrations. Metaanalysis was done if the risk estimates of the same anomaly and pollutant group were reported in at least three studies. RESULTS Each study reported a statistically significant increased risk of congenital malformation with some air pollutant, amid the several tested combinations. Our meta-analysis reported that nitrogen dioxide and PM2.5 were associated with the risk of pulmonary valve stenosis with OR = 1.74 and OR = 1.42 respectively. The risk of developing tetralogy of Fallot (TOF) was observed to be associated with PM2.5 with OR = 1.52. SO2 exposure was related to a high risk of the ventricular septal defect (VSD) with OR = 1.15 and orofacial defects (OR = 1.27). CONCLUSION It is evidenced that ambient air pollutants have some effect on congenital malformations. Standard case definitions, improved methods of exposure, and better control of confounders will improve future research in this area.
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Affiliation(s)
- Khaiwal Ravindra
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Neha Chanana
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Suman Mor
- Department of Environment Sciences, Panjab University, Chandigarh 160014, India
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Ţarcă E, Roșu ST, Cojocaru E, Trandafir L, Luca AC, Rusu D, Ţarcă V. Socio-Epidemiological Factors with Negative Impact on Infant Morbidity, Mortality Rates, and the Occurrence of Birth Defects. Healthcare (Basel) 2021; 9:healthcare9040384. [PMID: 33915730 PMCID: PMC8065913 DOI: 10.3390/healthcare9040384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 12/16/2022] Open
Abstract
In the last 30-40 years, developed countries in particular, but also developing ones, have seen an increase in life expectancy and a decrease in infant mortality and morbidity rates. These factors are due to an increase in living standards, a decrease in differences between social classes, the increased accessibility of education to women, and the implementation of some public health measures. When certain basic social and medical measures are implemented on a large scale, their benefits are first reflected in lower infant mortality rates, and only in the second stage are such benefits reflected in decreasing neonatal mortality rates and a smaller number of stillbirths. In this study, we review the literature on these factors. We extrapolate and compare this literature with data recorded in our country in the hopes of finding the reasons why Romania ranks first in the European Union in terms of infant mortality rates. We found that lowering the infant morbidity, mortality, and congenital malformation rates is an absolute priority in Romania, which requires the involvement of decision makers in taking effective measures regarding food supplementation or enhancement using folic acid, adequate counselling of couples, monitoring of all pregnancies, setting antenatal diagnosis, implementing optimal delivery management and therapeutic approaches to problematic pregnancies in other hospitals and by involving the population in health education, avoiding occupational or in-home exposure to toxic factors, avoiding drug use, and implementing disease and infection prevention measures for pregnant women.
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Affiliation(s)
- Elena Ţarcă
- Department of Surgery II-Pediatric Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaşi, Romania
- Correspondence: (E.Ţ.); (E.C.)
| | - Solange Tamara Roșu
- Department of Nursing, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaşi, Romania;
| | - Elena Cojocaru
- Department of Morphofunctional Sciences I—Pathology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaşi, Romania
- Correspondence: (E.Ţ.); (E.C.)
| | - Laura Trandafir
- Department of Mother and Child Medicine–Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaşi, Romania; (L.T.); (A.C.L.)
| | - Alina Costina Luca
- Department of Mother and Child Medicine–Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaşi, Romania; (L.T.); (A.C.L.)
| | - Daniela Rusu
- Department of Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaşi, Romania;
| | - Viorel Ţarcă
- County Statistics Department, 700115 Iaşi, Romania;
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Shehan JN, Danis DO, Bains A, Basa K, Marston AP, Levi JR. Cleft Palate in Newborns Diagnosed With Prematurity. Otolaryngol Head Neck Surg 2021; 165:887-894. [PMID: 33752517 DOI: 10.1177/01945998211002148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Cleft lip and/or palate (CLP) is the most common major congenital malformation of the head and neck. Although numerous genetic features, syndromes, nutritional deficiencies, and maternal exposures have been implicated in the etiology of CLP, the impact of prematurity on the pathogenesis remains incompletely understood. This study seeks to evaluate the associations between prematurity and the development of CLP in the United States. STUDY DESIGN Cross-sectional. SETTING Academic medical center. METHODS The Kids' Inpatient Database (2016) was used to identify weighted in-hospital births with diagnoses of prematurity or CLP. Demographic information was obtained. Odds ratios were used to determine associations between prematurity and CLP. RESULTS Among patients included in our data set, 8.653% (n = 326,147) were preterm; 0.136% (n = 5115) had CLP; and 0.021% (n = 808) were preterm and had CLP. Preterm infants had 1.90 times the odds (95% CI, 1.74-2.07) of developing CLP when compared with the nonpreterm population. The binary logistic regression model accounting for possible confounding variables produced an odds ratio of 1.83 (95% CI, 1.66-2.01) for the association between prematurity and CLP. CONCLUSION Infants who are born preterm are more likely to have CLP than full-term infants. The current results will allow for improved risk stratification, maternal counseling, and interventions in the case of prematurity. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Jennifer N Shehan
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | | | - Ashank Bains
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Krystyne Basa
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Alexander P Marston
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jessica R Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,School of Medicine, Boston University, Boston, Massachusetts, USA
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Influence of Family Income Level on Obstetric and Perinatal Outcomes in Spain. SUSTAINABILITY 2020. [DOI: 10.3390/su12145523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For pregnant women, having a low family income status is associated with late prenatal attendance and an increased risk of adverse outcomes during pregnancy, delivery, and immediately after delivery. However, the influence of the socioeconomic level on maternal and child health may be minimal as long as the health system model is able to neutralise health inequity. For this reason, the objective of this study is to determine the relationship between the socioeconomic level assessed through monthly household income and obstetric and perinatal outcomes in the Spanish Health System, where midwives play a relevant role. To meet this objective, a cross-sectional observational study aimed at women who have been mothers between 2013 and 2018 in Spain was developed. The final study population was 5942 women. No statistically significant differences with linear trend were found between income level and obstetric and perinatal outcomes after the adjustment by confounding factors (pregnancy composite morbidity, p = 0.447; delivery composite morbidity, p = 0.590; perinatal composite morbidity, p = 0.082; postpartum composite morbidity, p = 0.407). The main conclusion is that, in the current Spanish health system, household income as an indicator of socioeconomic status is not related to perinatal outcomes after the adjustment by confounding factors. These results are likely due to the public model of our health system that serves all citizens on equal footing, although other social and individual factors may have influenced these results
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Badon SE, Littman AJ, Chan KCG, Williams MA, Kirkegaard H, Nohr EA, Enquobahrie DA. Leisure Time Physical Activity, Sedentary Time in Pregnancy, and Infant Weight at Approximately 12 Months. WOMEN'S HEALTH REPORTS 2020; 1:123-131. [PMID: 32617532 PMCID: PMC7325488 DOI: 10.1089/whr.2020.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Maternal leisure time physical activity (LTPA) and sedentary time during pregnancy may influence programming of infant growth in a sex-specific manner. Materials and Methods: Participants (N = 35,212) from the Danish National Birth Cohort reported moderate/vigorous LTPA (hours/week) in early (conception to mean 16 weeks of gestation) and late pregnancy (mean 31 weeks of gestation to delivery) during interviews at 16 weeks of gestation and 6 months postpartum. Participants reported screen time at work and time spent watching television/videos (hours/day) in early pregnancy. Infant weight at 12 months of age was reported by mothers. Weight-for-length was categorized using sex-specific international standards. Results: Participants reported on average 1 hour per week of early pregnancy moderate/vigorous LTPA, 0.5 hour per week of late pregnancy LTPA, and 3 hours per day of early pregnancy sedentary time. Early pregnancy LTPA category was not associated with infant weight (p for trend = 0.62). There were suggested associations of early pregnancy sedentary time above the first quartile with greater odds of infant underweight (odds ratio = 1.15-1.27; p for trend = 0.27). Associations were similar in male and female infants. Conclusions: There is no clear relationship between early or late pregnancy LTPA and infant weight at 12 months in our study. Maternal early pregnancy sedentary time may be associated with infant underweight at 12 months.
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Affiliation(s)
- Sylvia E Badon
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Alyson J Littman
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | | | - Michelle A Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Helene Kirkegaard
- Research Unit of Obstetrics and Gynecology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ellen A Nohr
- Research Unit of Obstetrics and Gynecology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Abstract
BACKGROUND Craniofacial syndromes occur in approximately 1 in 5600 to 100,000 infants, often resulting in significant morbidity. Due to the heterogeneity of this patient population, no clear consensus consists on optimal treatment modalities and timing. The aim of this study was to analyze the craniofacial syndrome population that were treated at the University Hospital Leuven. METHODS A retrospective analysis of patients with a clinical diagnosis of a craniofacial syndrome was performed. Inclusion criteria were patients with a clinical diagnosis of a craniofacial syndrome and that received treatment between "2000-2005" and "2010-2015." Patients with nonsyndromic conditions were excluded. Data regarding patient characteristics, treatment modalities, and treatment outcomes were analyzed. RESULTS After matching the inclusion criteria, 98 eligible patients, affected by 40 different syndromes were included. In the period of "2000 to 2005," 48 patients were treated, as compared to 50 patients in the period of "2010 to 2015." A statistically significant decrease over time is seen for cleft surgery and orthodontic treatment (P = 0.0017 and P = 0.0015, respectively). No statistically significant differences were found concerning the age at which treatment was received (P = 0.42). Significant associations between treatment modalities were found for orthognathic surgery and distraction osteogenesis (P < 0.0001), orthognathic surgery and orthodontic treatment (P < 0.0001), and between orthodontic treatment and distraction osteogenesis (P = 0.03311). CONCLUSION A decline in cleft reconstruction surgery and orthodontic treatment for patients with craniofacial syndromes was seen over time. A significant association was found between distraction osteogenesis and orthognathic surgery, possibly due to higher reintervention rates for patients treated at a young age.
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Parkes B, Hansell AL, Ghosh RE, Douglas P, Fecht D, Wellesley D, Kurinczuk JJ, Rankin J, de Hoogh K, Fuller GW, Elliott P, Toledano MB. Risk of congenital anomalies near municipal waste incinerators in England and Scotland: Retrospective population-based cohort study. ENVIRONMENT INTERNATIONAL 2020; 134:104845. [PMID: 31230843 DOI: 10.1016/j.envint.2019.05.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Few studies have investigated congenital anomalies in relation to municipal waste incinerators (MWIs) and results are inconclusive. OBJECTIVES To conduct a national investigation into the risk of congenital anomalies in babies born to mothers living within 10 km of an MWI associated with: i) modelled concentrations of PM10 as a proxy for MWI emissions more generally and; ii) proximity of residential postcode to nearest MWI, in areas in England and Scotland that are covered by a congenital anomaly register. METHODS Retrospective population-based cohort study within 10 km of 10 MWIs in England and Scotland operating between 2003 and 2010. Exposure was proximity to MWI and log of daily mean modelled ground-level particulate matter ≤10 μm diameter (PM10) concentrations. RESULTS Analysis included 219,486 births, stillbirths and terminations of pregnancy for fetal anomaly of which 5154 were cases of congenital anomalies. Fully adjusted odds ratio (OR) per doubling in PM10 was: 1·00 (95% CI 0·98-1·02) for all congenital anomalies; 0·99 (0·97-1·01) for all congenital anomalies excluding chromosomal anomalies. For every 1 km closer to an MWI adjusted OR was: 1·02 (1·00-1·04) for all congenital anomalies combined; 1·02 (1·00-1·04) for all congenital anomalies excluding chromosomal anomalies; and, for specific anomaly groups, 1·04 (1·01-1·08) for congenital heart defect sand 1·07 (1·02-1·12) for genital anomalies. DISCUSSION We found no increased risk of congenital anomalies in relation to modelled PM10 emissions, but there were small excess risks associated with congenital heart defects and genital anomalies in proximity to MWIs. These latter findings may well reflect incomplete control for confounding, but a possible causal effect cannot be excluded.
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Affiliation(s)
- Brandon Parkes
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2 1PG, UK
| | - Anna L Hansell
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2 1PG, UK; Directorate of Public Health and Primary Care, Imperial College Healthcare NHS Trust, London W2 1NY, UK; Centre for Environmental Health and Sustainability, University of Leicester, Leicester LE1 7RH, UK; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, Department of Epidemiology and Biostatistics, Imperial College London, London W2 1PG, UK; MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK.
| | - Rebecca E Ghosh
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2 1PG, UK
| | - Philippa Douglas
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2 1PG, UK; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, Department of Epidemiology and Biostatistics, Imperial College London, London W2 1PG, UK; MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK; Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, SW3 6LR, UK
| | - Daniela Fecht
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2 1PG, UK; MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Diana Wellesley
- University Hospital Southampton, Faculty of Medicine and Wessex Clinical Genetics Service, Southampton, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, UK
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Gary W Fuller
- MRC-PHE Centre for Environment and Health, Environmental Research Group, School of Population Health and Environment Sciences, King's College London, London, SE1 9NH, UK
| | - Paul Elliott
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2 1PG, UK; Directorate of Public Health and Primary Care, Imperial College Healthcare NHS Trust, London W2 1NY, UK; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, Department of Epidemiology and Biostatistics, Imperial College London, London W2 1PG, UK; MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK.
| | - Mireille B Toledano
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2 1PG, UK; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, Department of Epidemiology and Biostatistics, Imperial College London, London W2 1PG, UK; MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK.
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Bilsteen JF, Andresen JB, Mortensen LH, Hansen AV, Andersen AMN. Educational disparities in perinatal health in Denmark in the first decade of the 21st century: a register-based cohort study. BMJ Open 2018; 8:e023531. [PMID: 30413512 PMCID: PMC6231602 DOI: 10.1136/bmjopen-2018-023531] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate socioeconomic differences in six perinatal health outcomes in Denmark in the first decade of the 21st century. DESIGN A population-based cohort study. SETTING Danish national registries. PARTICIPANTS A total of 646 829 live born children and 3076 stillborn children (≥22+0 weeks of gestation) born in Denmark from 2000 to 2009. We excluded children with implausible relations between birth weight and gestational age (n=644), children without information on maternal country of origin (n=138) and implausible values of maternal year of birth (n=36). MAIN OUTCOME MEASURES We investigated the following perinatal health outcomes: stillbirth, neonatal and postneonatal mortality, small-for-gestational age, preterm birth grated into moderate preterm, very preterm and extremely preterm, and congenital anomalies registered in the first year of life. RESULTS Maternal educational level was inversely associated with all adverse perinatal outcomes. For all examined outcomes, the risk association displayed a clear gradient across the educational levels. The associations remained after adjustment for maternal age, maternal country of origin and maternal year of birth. Compared with mothers with vocational education, mothers with more than 15 years of education had an adjusted risk ratio for stillbirth of 0.64(95% CI 0.56 to 0.72). The corresponding adjusted risk ratios for neonatal mortality, postneonatal mortality, congenital anomalies, moderate preterm birth and small-for-gestational age were, respectively, 0.79(95% CI 0.67 to 0.93), 0.57(95% CI 0.42 to 0.78), 0.87(95% CI 0.83 to 0.91), 0.80(95% CI 0.77 to 0.83) and 0.83(95% CI 0.81 to 0.85). CONCLUSION Substantial educational inequalities in perinatal health were still present in Denmark in the first decade of the 21st century.
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Affiliation(s)
- Josephine Funck Bilsteen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Laust Hvas Mortensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Vinkel Hansen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Benjamin Neelon SE, Morgen CS, Kamper-Jørgensen M, Oken E, Gillman MW, Gallis JA, Sørensen TIA. Childcare before age 6 and body mass index at age 7 years in a cohort of Danish children. Pediatr Obes 2018; 13:307-311. [PMID: 28299907 PMCID: PMC5599321 DOI: 10.1111/ijpo.12206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 11/30/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Previous studies show inconsistent associations between childcare and obesity. AIMS Our prior work demonstrated that childcare in infancy was associated with higher weight in a cohort of Danish children. Here, we extend this work and examine childcare through 6 years and body mass index (BMI) at age 7 years. MATERIALS AND METHODS We examined 24 714 children in the Danish National Birth Cohort who were also in the Childcare Database. We conducted multivariable linear regressions examining children prior to age 6, overall and by type (daycare, crèche, age-integrated and kindergarten), and BMI z-score at 7 years, stratifying on maternal socio-occupational status. RESULTS A total of 19 760 (80.0%) children attended childcare before age 6. Childcare prior to age 6 was associated with BMI z-score at 7 years (0.004 units per each additional 6 months of care; 95% CI: 0.001, 0.008; p = 0.01). Childcare in a kindergarten was the only type of care associated with BMI (0.009 units; 95% CI: 0.003, 0.02; p = 0.01). For children of higher socio-occupational status mothers, childcare was associated with a 0.008 unit increase in BMI (95% CI: 0.004, 0.01; p > 0.001). CONCLUSIONS Childcare was weakly associated with later BMI. This relationship was more pronounced in children from higher socio-occupational status mothers and children in kindergarten care.
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Affiliation(s)
- Sara E Benjamin Neelon
- Department of Health, Behavior and Society, Johns Hopkins University, 624 N Broadway, Baltimore, Maryland, 21205, USA
| | - Camilla Schmidt Morgen
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, Nordre fasanvej 57, Hovedvejen 5, Copenhagen, Denmark
| | - Mads Kamper-Jørgensen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, CSS, Øster Farimagsgade 5, Postbox 2099, DK-1014 Copenhagen, Denmark
| | - Emily Oken
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, Massachusetts, 02215, USA
| | - Matthew W Gillman
- Environmental influences on Child Health Outcomes (ECHO) Program, National Institutes of Health, 6011 Executive Blvd, Rockville, MD, 20852, USA
| | - John A Gallis
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Suite 1102 Hock Plaza, Box 2721, Durham, North Carolina, 27710, USA
| | - Thorkild IA Sørensen
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, Nordre fasanvej 57, Hovedvejen 5, Copenhagen, Denmark,Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,MRC Integrative Epidemiology Unit, Bristol University, Oakfield Grove Bristol, Bristol, UK BS8 2BN
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16
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Sass L, Urhoj SK, Kjærgaard J, Dreier JW, Strandberg-Larsen K, Nybo Andersen AM. Fever in pregnancy and the risk of congenital malformations: a cohort study. BMC Pregnancy Childbirth 2017; 17:413. [PMID: 29221468 PMCID: PMC5723098 DOI: 10.1186/s12884-017-1585-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 11/20/2017] [Indexed: 11/25/2022] Open
Abstract
Background In a variety of animal species, hyperthermia in pregnancy has been recognized as teratogenic. Hyperthermia interferes with protein synthesis via heat-shock proteins, which can entail membrane disruption, cell death, vascular disruption, and placental infarction. This can induce severe fetal malformations or death. Fever during pregnancy, especially during embryogenesis, has also been associated with congenital malformations in human offspring. The purpose of this large cohort study of clinically recognized pregnancies was to investigate whether fever during first trimester was associated with an increased risk of congenital malformations in the offspring. Methods The Danish National Birth Cohort is a population-based cohort of 100,418 pregnant women and their offspring recruited in 1996 to 2002. Information on fever during pregnancy was collected prospectively by means of two telephone interviews. The study population comprised the 77,344 pregnancies enrolled in the Danish National Birth Cohort where self-reported information on fever during first trimester of pregnancy was available. Pregnancy outcomes were identified through linkage with the National Patient Registry. Congenital malformations within the first three and a half years of life were categorized according to EUROCAT’s classification criteria. Logistic regression models were used to estimate the associations between fever in first trimester and overall congenital malformations and congenital malformations by subgroups. Results Eight thousand three hundred twenty-one women reported fever during first trimester (10.8%) and 2876 infants were diagnosed with a congenital malformation (3.7%). Fever during first trimester did not affect the risk of overall fetal congenital malformation (OR 0.99, 95% CI 0.88–1.12). The subgroup analyses indicated slightly higher risk of congenital anomalies in the eye, ear, face and neck (OR 1.29, 95% CI 0.78–2.12) and in the genitals (OR 1.17, 95% CI 0.79–1.12), whereas lower risk of malformations in the nervous system (OR 0.47, 95% CI 0.21–1.08), the respiratory system (OR 0.56, 95% CI 0.23–1.29) and in the urinary subgroup (OR 0.58, 95% CI 0.35–0.99) was suggested, the latter constituting the only statistically significant finding. Conclusions Overall, this study did not show any association between maternal fever in pregnancy and risk of congenital anomalies.
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Affiliation(s)
- L Sass
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, Box 2099, 1014, København K, Denmark. .,, Ulsevej 43, 2650, Hvidovre, Denmark.
| | - S K Urhoj
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, Box 2099, 1014, København K, Denmark
| | - J Kjærgaard
- Child and Adolescent Health Clinic, Juliane Marie Center, Research Unit for Women's and Children's Health, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - J W Dreier
- Department of Economics and Business Economics, Aarhus University, Fuglesangs Allé 4, DK-8210, Aarhus V, Denmark
| | - K Strandberg-Larsen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, Box 2099, 1014, København K, Denmark
| | - A-M Nybo Andersen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, Box 2099, 1014, København K, Denmark
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17
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Richardson SD, Josberger RE. Maternal Medicaid Recipient Status and Congenital Malformations among New York State Live Births in 2010. Birth Defects Res 2017; 109:1460-1470. [PMID: 28876550 DOI: 10.1002/bdr2.1107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Congenital malformations are a leading cause of infant mortality in the United States, and risk for some congenital malformations varies by socioeconomic status (SES). Medicaid provides health insurance for people with low income, and covers approximately half of all live births in the United States. Income level is one aspect of SES. Studies have shown relationships between SES and some congenital malformations. METHODS This retrospective cohort study examined associations between maternal Medicaid recipient status and 46 congenital malformations in New York State for birth year 2010. The impact of Medicaid continuous enrollment (CE) status was evaluated in a sub-analysis of Medicaid recipients. Logistic regression was used to calculate adjusted odds ratios and 95% confidence intervals. RESULTS The study cohort included 240,721 live births, 3778 infants with one or more congenital malformation of interest, and 118,631 maternal Medicaid recipients at the time of the infant's birth. Odds ratios for cleft lip with or without cleft palate and rectal atresia or stenosis were increased for Medicaid recipients compared with non-Medicaid recipients. However, odds ratios for cleft lip with or without cleft palate and rectal atresia or stenosis were decreased for CE compared with non-CE Medicaid recipients. CONCLUSION Maternal Medicaid recipient status was associated with few of the 46 congenital malformations evaluated. However, some associations found were modified by CE in Medicaid. Birth Defects Research 109:1460-1470, 2017.© 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Sandra D Richardson
- Office of Quality and Patient Safety, New York State Department of Health, Albany, New York
| | - Raina E Josberger
- Office of Quality and Patient Safety, New York State Department of Health, Albany, New York
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18
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Pei L, Zeng L, Zhao Y, Wang D, Yan H. Using latent class cluster analysis to screen high risk clusters of birth defects between 2009 and 2013 in Northwest China. Sci Rep 2017; 7:6873. [PMID: 28761054 PMCID: PMC5537369 DOI: 10.1038/s41598-017-07076-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/22/2017] [Indexed: 11/09/2022] Open
Abstract
In the study, we aimed to explore the synergistic effects of multiple risk factors on birth defects, and examine temporal trend of the synergistic effects over time. Two cross-sectional surveys conducted in 2009 and 2013 were merged and then latent class cluster analysis and generalized linear Poisson model were used. A total of 9085 and 29094 young children born within the last three years and their mothers were enrolled in 2009 and 2013 respectively. Three latent maternal exposure clusters were determined: a high-risk, a moderate-risk, and a low-risk cluster (88.97%, 1.49%, 9.54% in 2009 and 82.42%, 3.39%, 14.19% in 2013). The synthetic effects of maternal exposure to multiple risk factors could increase the risk of overall birth defects and cardiovascular system malformation among live births, and this risk is significantly higher in high-risk cluster than that in low-risk cluster. After adjusting for confounding factors using a generalized linear Poisson model, in high-risk cluster the prevalence of nervous system malformation decreased by approximately 2.71%, and the proportion of cardiovascular system malformation rose by 0.92% from 2009 to 2013. The Chinese government should make great efforts to provide primary prevention for those on high-risk cluster as a priority target population.
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Affiliation(s)
- Leilei Pei
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, P.R. China
| | - Lingxia Zeng
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, P.R. China
| | - Yaling Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, P.R. China
| | - Duolao Wang
- Biostatistics Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Hong Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, P.R. China.
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Adeboye M, Abdulkadir MB, Adegboye OA, Saka AO, Oladele PD, Oladele DM, Eze EC, Adeyemi OO, Abubakar U, Grace A, Rotimi BF. A Prospective Study of Spectrum, Risk Factors and Immediate Outcome of Congenital Anomalies in Bida, North Central Nigeria. Ann Med Health Sci Res 2016; 6:380-384. [PMID: 28540107 PMCID: PMC5423339 DOI: 10.4103/amhsr.amhsr_108_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Congenital disorders are structural, metabolic, behavioral and functional disorders that are present at birth. Their manifestations are protean ranging from mild anomalies to life-threatening conditions. Aim: The objectives of this study were to describe the congenital anomalies in children seen at Federal Medical Center, Bida over a 12 month period, determine possible factors associated with these anomalies; and their short term outcome. Subjects and Methods: Children with clinically recognized congenital malformations were recruited consecutively over a 12 month period and socio-demographic, etiologic and other relevant clinical data were obtained. A detailed examination was also performed and abnormalities documented. The data was analyzed using Epi-info version 6 (Atlanta, USA). The Chi-square was used to identify significant differences for categorical variables. Mid-P and Fisher's exact tests were utilized as appropriate. A P < 0.05 was considered to be significant. Results: A total of 46 children with congenital anomalies were seen during the study period, all which were recruited into the study. The hospital based prevalence amongst neonates was 111/1000 neonates. The most common system affected was the digestive system(50.0%) followed by the central nervous system and head and neck anomalies. There was no significant difference in distribution of anomalies amongst the various ethnic groups. About 22% of families were consanguineous, all being first cousins and 8.7% of mothers were greater than 35 years of age. The case fatality rate for congenital malformations was 2.2%, while 60.9% were referred to other hospitals for further care. Conclusion: The study has demonstrated a wide variety of congenital anomalies in Bida, North-Central Nigeria with the digestive system anomalies being the most frequent. The findings of this study strengthen the need for empowerment of the institution in appropriate management of these disorders.
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Affiliation(s)
- Man Adeboye
- Department of Pediatrics, College of Health Sciences, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - M B Abdulkadir
- Department of Pediatrics, College of Health Sciences, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - O A Adegboye
- Department of Pediatrics, College of Health Sciences, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - A O Saka
- Department of Pediatrics, College of Health Sciences, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - P D Oladele
- Department of Pediatrics, College of Health Sciences, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - D M Oladele
- Department of Pediatrics, College of Health Sciences, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - E C Eze
- Department of Pediatrics, Federal Medical Centre, Bida, Niger State, Nigeria
| | - O O Adeyemi
- Department of Pediatrics, Niger Delta University, Wilberforce, Bayelsa State, Nigeria
| | - U Abubakar
- Department of Pediatrics, Federal Medical Centre, Bida, Niger State, Nigeria
| | - A Grace
- Department of Pediatrics, Federal Medical Centre, Bida, Niger State, Nigeria
| | - B F Rotimi
- Department of Pediatrics, Federal Medical Centre, Bida, Niger State, Nigeria
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Deguen S, Kihal W, Jeanjean M, Padilla C, Zmirou-Navier D. Neighborhood Deprivation and Risk of Congenital Heart Defects, Neural Tube Defects and Orofacial Clefts: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0159039. [PMID: 27783616 PMCID: PMC5082651 DOI: 10.1371/journal.pone.0159039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 06/27/2016] [Indexed: 11/22/2022] Open
Abstract
Background We conducted this systematic review and meta-analysis to address the open question of a possible association between the socioeconomic level of the neighborhoods in which pregnant women live and the risk of Congenital Heart Defects (CHDs), Neural Tube Defects (NTDs) and OroFacial Clefts (OFCs). Methods We searched MEDLINE from its inception to December 20th, 2015 for case-control, cohort and ecological studies assessing the association between neighborhood socioeconomic level and the risk of CHDs, NTDs and the specific phenotypes Cleft Lip with or without Cleft Palate (CLP) and Cleft Palate (CP). Study-specific risk estimates were pooled according to random-effect and fixed-effect models. Results Out of 245 references, a total of seven case-control studies, two cohort studies and two ecological studies were assessed in the systematic review; all studies were enrolled in the meta-analysis with the exception of the two cohort studies. No significant association has been revealed between CHDs or NTDs and neighborhood deprivation index. For CLP phenotype subgroups, we found a significantly higher rate in deprived neighborhoods (Odds Ratios (OR) = 1.22, 95% CI: 1.10, 1.36) whereas this was not significant for CP phenotype subgroups (OR = 1.20, 95%CI: 0.89, 1.61). Conclusion In spite of the small number of epidemiological studies included in the present literature review, our findings suggest that neighborhood socioeconomic level where mothers live is associated only with an increased risk of CLP phenotype subgroups. This finding has methodological limitations that impede the formulation of firm conclusions, and further investigations should confirm this association.
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Affiliation(s)
- Séverine Deguen
- EHESP School of Public Health, Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
- INSERM U1085 (IRSET), Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
- * E-mail:
| | - Wahida Kihal
- EHESP School of Public Health, Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
| | - Maxime Jeanjean
- EHESP School of Public Health, Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
- INSERM U1085 (IRSET), Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
| | - Cindy Padilla
- EHESP School of Public Health, Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
| | - Denis Zmirou-Navier
- EHESP School of Public Health, Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
- INSERM U1085 (IRSET), Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
- Lorraine University Medical School, Nancy, Cedex 54052, France
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Nybo Andersen AM, Gundlund A, Villadsen SF. Stillbirth and congenital anomalies in migrants in Europe. Best Pract Res Clin Obstet Gynaecol 2015; 32:50-9. [PMID: 26545588 DOI: 10.1016/j.bpobgyn.2015.09.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 09/16/2015] [Accepted: 09/22/2015] [Indexed: 01/07/2023]
Abstract
The risk of giving birth to a stillborn child or a child with severe congenital anomaly is higher for women who have immigrated to Europe as compared to the majority population in the receiving country. The literature, however, reveals great differences between migrant groups, even within migrants from low-income countries, although there is no clear pattern regarding refugee or non-refugee status. This heterogeneity argues against a particular migration-related explanation. There are social disparities in stillbirth risk worldwide, and it has been suggested that the demonstrated ethnic disparity is a result of the socioeconomic disadvantage most migrants face. Consanguinity has been considered as another cause for the increased stillbirth risk and the high risk of congenital anomaly observed in many migrant groups. Utilization and quality of care during pregnancy and childbirth is the third major aspect. All three factors seem to contribute to stillbirth risk, and they should be considered in clinical practice and public health.
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Affiliation(s)
| | - Anna Gundlund
- Department of Public Health, University of Copenhagen, Denmark
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Blais L, Kettani FZ, Forget A, Beauchesne MF, Lemière C. Is drug insurance status an effect modifier in epidemiologic database studies? The case of maternal asthma and major congenital malformations. ACTA ACUST UNITED AC 2015; 103:995-1002. [PMID: 25846426 DOI: 10.1002/bdra.23366] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/06/2015] [Accepted: 02/10/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Our previous work on the association between maternal asthma and congenital malformations was based on cohorts formed by women with public drug insurance, i.e., over-represented by women with lower socioeconomic status, questioning the generalizability of our findings. This study aimed to evaluate whether or not drug insurance status, as a proxy of socioeconomic status, is an effect modifier for the association between maternal asthma and major congenital malformations. METHODS A cohort of 36,587 pregnancies from asthmatic women and 198,935 pregnancies from nonasthmatic women selected independently of their drug insurance status was reconstructed with Québec administrative databases (1998-2009). Asthmatic women were identified using a validated case definition of asthma. Cases of major congenital malformations were identified using diagnostic codes recorded in the hospitalization database. Drug insurance status at the beginning of pregnancy was classified into three groups: publicly insured with social welfare, publicly insured without social welfare, and privately insured. Adjusted odds ratios were estimated with generalized estimation equations, including an interaction term between maternal asthma and drug insurance status. RESULTS The prevalence of congenital malformations was 6.8% among asthmatic women and 5.8% among nonasthmatics. The impact of asthma on the prevalence of congenital malformations was significantly greater in women publicly insured with social welfare (odds ratio = 1.42; 95% confidence interval, 1.25-1.61) than in the other two groups ([odds ratio = 1.10; 1.00-1.21] in the publicly insured without social welfare and [odds ratio = 1.13; 1.07-1.20] in the privately insured group). CONCLUSION The increased risk of major congenital malformation associated with asthma was significantly higher among pregnant women publicly insured with social welfare than among those privately insured. As a result of this effect modification by drug insurance status, findings from Québec observational studies using databases mainly formed of patients publicly insured with social welfare may not be generalized to the entire population.
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Affiliation(s)
- Lucie Blais
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada.,Research Center, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada.,Endowment pharmaceutical Chair AstraZeneca in Respiratory Health, Montréal, Québec, Canada
| | - Fatima-Zohra Kettani
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada.,Research Center, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Amélie Forget
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada.,Research Center, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Marie-France Beauchesne
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada.,Endowment pharmaceutical Chair AstraZeneca in Respiratory Health, Montréal, Québec, Canada.,Pharmacy Department, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada.,Centre de recherche Clinique Étienne-Le Bel, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Catherine Lemière
- Research Center, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada.,Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
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Knudsen TM, Hansen AV, Garne E, Andersen AMN. Increased risk of severe congenital heart defects in offspring exposed to selective serotonin-reuptake inhibitors in early pregnancy--an epidemiological study using validated EUROCAT data. BMC Pregnancy Childbirth 2014; 14:333. [PMID: 25258023 PMCID: PMC4183770 DOI: 10.1186/1471-2393-14-333] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 09/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies suggest a possible association between maternal use of selective serotonin-reuptake inhibitors (SSRIs) during early pregnancy and congenital heart defects (CHD). The purpose of this study was to verify this association by using validated data from the Danish EUROCAT Register, and secondary, to investigate whether the risk differs between various socioeconomic groups. METHODS We conducted a cohort study based on Danish administrative register data linked with the Danish EUROCAT Register, which includes all CHD diagnosed in live births, fetal deaths and in pregnancies terminated due to congenital anomalies. The study population consisted of all registered pregnancies (n = 72,280) in Funen, Denmark in the period 1995-2008. SSRI-use was assessed using The Danish National Prescription Registry, information on marital status, maternal educational level, income, and country of origin from Statistics Denmark was used as indicators of socioeconomic situation, and the CHD were studied in subgroups defined by EUROCAT. Logistic Regression was used to investigate the association between redeemed prescriptions for SSRIs and CHD. RESULTS The risk of severe CHD in the offspring of the 845 pregnant women who used SSRIs during first trimester increased four times (AOR 4.03 (95% CI 1.75-9.26)). We found no increased risk of septal defects. Socioeconomic position did not modify the association between maternal SSRI-use during pregnancy and severe CHD. CONCLUSION This study, which is based on data with high case ascertainment, suggests that maternal use of SSRIs during first trimester increases the risk of severe CHD, but does not support findings from previous studies, based on administrative register data, regarding an increased risk of septal defects. The study was unable to document an interaction between socioeconomic status and maternal SSRI-use on the risk of severe CHD.
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Affiliation(s)
- Tanja Majbrit Knudsen
- Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1014 Copenhagen K, Denmark.
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Huang L, Zuo Z, Zhang Y, Wu M, Lin JJ, Wang C. Use of toxicogenomics to predict the potential toxic effect of Benzo(a)pyrene on zebrafish embryos: ocular developmental toxicity. CHEMOSPHERE 2014; 108:55-61. [PMID: 24875912 DOI: 10.1016/j.chemosphere.2014.02.078] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 02/12/2014] [Accepted: 02/22/2014] [Indexed: 06/03/2023]
Abstract
Benzo(a)pyrene (BaP) is a representative polycyclic aromatic hydrocarbon (PAH), which is ubiquitous in the environment. The toxic effects of BaP on fish embryos have been described in detail, but some potentially toxic effects of BaP might have been neglected owing to the limitations of traditional techniques. In the present research, global transcriptional patterns were used to study the potentially toxic effects of BaP, as well as its underlying toxicological mechanisms. The expression levels of multiple genes were significantly changed by BaP exposure. The results of ontology assignments and cluster analysis showed that BaP could affect the processes of photoreceptor maintenance and phototransduction. We also conducted an experiment on phototactic response and found that larvae exposed to BaP displayed a decreasing response to light. In addition, BaP exposure decreased the cellular density of the ganglion cell layer (GCL) significantly. These results suggested that BaP exposure induced visual system developmental defects and dysfunction by perturbation of photoreceptor development related genes. Our results were helpful for an understanding of the toxicity of BaP. This study also indicated that microarray analysis was effective for predicting the potential toxicity of chemicals with high sensitivity and accuracy.
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Affiliation(s)
- Lixing Huang
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen, PR China
| | - Zhenghong Zuo
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen, PR China; State Key Laboratory of Marine Environmental Science, Xiamen University, Xiamen, PR China
| | - Youyu Zhang
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen, PR China
| | - Meifang Wu
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen, PR China
| | | | - Chonggang Wang
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen, PR China; State Key Laboratory of Marine Environmental Science, Xiamen University, Xiamen, PR China.
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Chen EKC, Zmirou-Navier D, Padilla C, Deguen S. Effects of air pollution on the risk of congenital anomalies: a systematic review and meta-analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:7642-68. [PMID: 25089772 PMCID: PMC4143824 DOI: 10.3390/ijerph110807642] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 01/27/2023]
Abstract
Congenital anomalies are the main causes of preterm and neonatal mortality and morbidity. We investigated the association between congenital anomalies and mothers' exposure to air pollution during pregnancy by combining risk estimates for a variety of air pollutants (SO2, NO2, PM10, PM2.5, CO and O3) and anomaly defect outcomes. Seventeen articles were included in the systematic review and thirteen studies were taken into account in the meta-analysis. Combined estimated were calculated separately according to whether the exposure metric was continuous or categorical. Only one significant combination was; NO2 concentrations were significantly associated with coarctation of the aorta (OR = 1.20 per 10 ppb, 95% CI, (1.02, 1.41)). This finding could stem from strong heterogeneity in study designs. Improved exposure assessment methods, in particular more accurate spatial measurements or modeling, standardized definition of cases and of better control of confounders are highly recommended for future congenital anomalies research in this area.
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Affiliation(s)
| | - Denis Zmirou-Navier
- School of Public Health, EHESP, Sorbonne-Paris-Cité, Rennes, Cedex 35043, France.
| | - Cindy Padilla
- School of Public Health, EHESP, Sorbonne-Paris-Cité, Rennes, Cedex 35043, France.
| | - Séverine Deguen
- School of Public Health, EHESP, Sorbonne-Paris-Cité, Rennes, Cedex 35043, France.
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Canaku D, Toçi E, Roshi E, Burazeri G. Prevalence and factors associated with congenital malformations in tirana, Albania, during 2011-2013. Mater Sociomed 2014; 26:158-62. [PMID: 25126007 PMCID: PMC4130685 DOI: 10.5455/msm.2014.26.158-162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 06/15/2014] [Indexed: 11/29/2022] Open
Abstract
Aim: Congenital Malformations (CMs) represent a challenge especially for developing countries. Data about CMs in Albania are rather scarce. In this context, our aim was to assess the prevalence and factors associated with CMs in Tirana, the capital of Albania. Methods: Information on all CMs at birth during 2011-2013 was retrieved from the National CM Surveillance System. For each CM case, three controls (babies born without CM) were retrieved as well. Overall, 831 cases and 2522 controls were included in this study. The prevalence was calculated using the total number of live births in Tirana during the same period. Binary logistic regression was used to determine the factors associated with CMs adjusting for a number of covariates. Results: The three-year prevalence of CMs was 23.41 per 1,000 live births. The most affected body systems were the musculoskeletal, cardiovascular and genital systems. CMs were more prevalent among male babies. Advanced mothers’ age, lower education, unemployment status and lower gestational age were all positively associated with increased likelihood of CMs. Conclusions: Socio-demographic factors of mothers are linked to CMs in Albania. Future surveys are needed in Albania in order to establish determinants of CMs at a national level.
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Affiliation(s)
| | - Ervin Toçi
- Institute of Public Health, Tirana, Albania ; Faculty of Public Health, University of Medicine, Tirana, Albania
| | - Enver Roshi
- Institute of Public Health, Tirana, Albania ; Faculty of Public Health, University of Medicine, Tirana, Albania
| | - Genc Burazeri
- Faculty of Public Health, University of Medicine, Tirana, Albania ; Department of International Health, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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27
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Hougaard KS, Larsen AD, Hannerz H, Andersen AMN, Jørgensen KT, Toft GV, Bonde JP, Jensen MS. Socio-occupational class, region of birth and maternal age: influence on time to detection of cryptorchidism (undescended testes): a Danish nationwide register study. BMC Urol 2014; 14:23. [PMID: 24581337 PMCID: PMC4016268 DOI: 10.1186/1471-2490-14-23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 02/15/2014] [Indexed: 11/25/2022] Open
Abstract
Background Cryptorchidism (undescended testes) is associated with poor male fertility, but can be alleviated and fertility preserved to some degree by early detection and treatment. Here we assess the influence of socio-occupational class, geographical region, maternal age and birth cohort on time to detection and correction of cryptorchidism. Methods All boys born in Denmark, 1981 to 1987 or 1988 to 1994, with a diagnosis of cryptorchidism were identified in nationwide registers. The boys were followed for a diagnosis until their 16th birthday. The age at first diagnosis was noted and used as proxy for time to detection of cryptorchidism. Parental employment in the calendar year preceding birth was grouped into one of five socio-occupational classes. Geographical region was defined by place of birth in one of 15 Danish counties. Detection rate ratios of cryptorchidism were analyzed as a function of parental socio-occupational group, county, maternal age and birth cohort by use of Poisson regression. Results Some 6,059 boys in the early and 5,947 boys in the late cohort received a diagnosis of cryptorchidism. Time to detection was independent of parental socio-occupational group and maternal age but differed slightly between geographical regions. A similar pattern was obtained for surgical correction after a diagnosis. Age at diagnosis decreased by 2.7 years from the early to the late cohort. Conclusions These results indicate that childhood socio-occupational inequality in detection and correction of cryptorchidism would play a negligible role in male infertility in a life course perspective. Geographical region may have exerted some influence, especially for the oldest cohort.
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Affiliation(s)
- Karin Sørig Hougaard
- The National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen, Denmark.
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Gianicolo EAL, Mangia C, Cervino M, Bruni A, Andreassi MG, Latini G. Congenital anomalies among live births in a high environmental risk area--a case-control study in Brindisi (southern Italy). ENVIRONMENTAL RESEARCH 2014; 128:9-14. [PMID: 24407474 DOI: 10.1016/j.envres.2013.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 10/11/2013] [Accepted: 11/11/2013] [Indexed: 05/28/2023]
Abstract
Maternal exposure to ambient pollution has been increasingly linked to the risk of congenital anomalies (CAs) in the fetus and newborns. Recently, a descriptive study in the high environmental risk city of Brindisi (Italy) revealed an increased prevalence of total CAs, especially congenital heart disease (CHD) and ventricular septal defects (VSDs), both at the local level and in comparison with the pool of EUROCAT registries. This paper concerns a population-based case control study to investigate the association between maternal exposure to air pollutants - sulfur dioxide (SO2) and total suspended particulate (TSP) matter - and the risk of CA. Cases were newborns up to 28 days of age, born to mothers resident in Brindisi between 2001 and 2010, and discharged with a diagnosis of CA. Cases and controls were individually matched according to sex, socio-economic status of the census area of residence of the mother, and year of beginning of pregnancy. Up to four controls were extracted for each case. Concentration data from monitoring stations were used to estimate air pollution exposure. Each case and control was assigned pollutant concentration values as mean and 90th percentile of the daily average values during weeks 3-8 of pregnancy. Exposure as both continuous and categorical variables was considered and a conditional logistic regression model was constructed to quantify the odds ratios of exposure to air pollutants and the occurrence of total CAs, CHDs and VSDs. We found exposure to the 90th percentile of SO2 to be associated with CHDs (p for trend =0.01) and VSDs (p for trend <0.05). Findings for TSP were less consistent. In conclusion, in the studied area, maternal exposure to sulfur dioxide increased risk of CHD.
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Affiliation(s)
- Emilio Antonio Luca Gianicolo
- National Research Council, Institute of Clinical Physiology, Lecce, Italy; der Johannes Gutenberg-Universität Mainz, Institut für Medizinische Biometrie, Epidemiologie und Informatik, Mainz, Germany.
| | - Cristina Mangia
- National Research Council, Institute of Atmospheric Sciences and Climate, Lecce, Italy
| | - Marco Cervino
- National Research Council, Institute of Atmospheric Sciences and Climate, Bologna, Italy
| | - Antonella Bruni
- National Research Council, Institute of Clinical Physiology, Lecce, Italy
| | | | - Giuseppe Latini
- National Research Council, Institute of Clinical Physiology, Lecce, Italy; Division of Neonatology, "A. Perrino" Hospital, Brindisi, Italy
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Huang L, Wang C, Zhang Y, Wu M, Zuo Z. Phenanthrene causes ocular developmental toxicity in zebrafish embryos and the possible mechanisms involved. JOURNAL OF HAZARDOUS MATERIALS 2013; 261:172-180. [PMID: 23921180 DOI: 10.1016/j.jhazmat.2013.07.030] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/11/2013] [Accepted: 07/13/2013] [Indexed: 06/02/2023]
Abstract
Recent studies show that polycyclic aromatic hydrocarbons (PAHs) may be a candidate cause of developmental defects of the retina, but the mechanism is still unclear. We evaluated the mechanism(s) underlying PAH-induced retinal development defects due to exposure to environmental concentrations of Phenanthrene (Phe) in zebrafish. We found that exposure to environmental concentrations of Phe caused obvious morphological changes, developmental retardation, apoptosis, and reduction of cell proliferation in the retina. Our results indicated that Phe could cause visual system developmental defects. Phe exposure up-regulated aryl hydrocarbon receptor (AhR) and microphthalmia-associated transcription factor (Mtif) expression, and down-regulated zinc finger E-box binding homeobox 1 (Zeb1) and paired box 6 (Pax6). Moreover, we demonstrated that AhR was a repressor of Zeb1. We propose that Phe's ocular toxicity is mediated by up-regulating AhR, which then down-regulates Zeb1, in turn inducing Mitf expression while inhibiting Pax6 expression.
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Affiliation(s)
- Lixing Huang
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen 361005, China
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Patel SS, Burns TL. Nongenetic risk factors and congenital heart defects. Pediatr Cardiol 2013; 34:1535-55. [PMID: 23963188 DOI: 10.1007/s00246-013-0775-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 07/31/2013] [Indexed: 11/25/2022]
Abstract
Advances have been made in identifying genetic etiologies of congenital heart defects. Through this knowledge, preventive strategies have been designed and instituted, and prospective parents are counseled regarding their risk of having an affected child. Great strides have been made in genetic variant identification, and genetic susceptibility to environmental exposures has been hypothesized as an etiology for congenital heart defects. Unfortunately, similar advances in understanding have not been made regarding strategies to prevent nongenetic risk factors. Less information is available regarding the potential adverse effect of modifiable risk factors on the fetal heart. This review summarizes the available literature on these modifiable exposures that may alter the risk for congenital heart disease. Information regarding paternal characteristics and conditions, maternal therapeutic drug exposures, parental nontherapeutic drug exposures, and parental environmental exposures are presented. Factors are presented in terms of risk for congenital heart defects as a group. These factors also are broken down by specific defect type. Although additional investigations are needed in this area, many of the discussed risk factors present an opportunity for prevention of potential disease.
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Affiliation(s)
- Sonali S Patel
- Department of Pediatrics, Division of Pediatric Cardiology, Carver College of Medicine, University of Iowa, Children's Hospital, 200 Hawkins Drive, Iowa City, IA, 52242, USA,
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Impact of parental ages and other characteristics at childbearing on congenital anomalies. DEMOGRAPHIC RESEARCH 2013. [DOI: 10.4054/demres.2013.28.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Gianicolo EAL, Bruni A, Rosati E, Sabina S, Guarino R, Padolecchia G, Leo C, Vigotti MA, Andreassi MG, Latini G. Congenital anomalies among live births in a polluted area. A ten-year retrospective study. BMC Pregnancy Childbirth 2012; 12:165. [PMID: 23270371 PMCID: PMC3543709 DOI: 10.1186/1471-2393-12-165] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 12/18/2012] [Indexed: 11/11/2022] Open
Abstract
Background Congenital anomalies and their primary prevention are a crucial public health issue. This work aimed to estimate the prevalence of congenital anomalies in Brindisi, a city in southeastern Italy at high risk of environmental crisis. Methods This research concerned newborns up to 28 days of age, born between 2001 and 2010 to mothers resident in Brindisi and discharged with a diagnosis of congenital anomaly. We classified cases according to the coding system adopted by the European Network for the Surveillance of Congenital Anomalies (EUROCAT). Prevalence rates of congenital anomalies in Brindisi were compared with those reported by EUROCAT. Logistic regression models were adapted to evaluate the association between congenital anomalies and municipality of residence of the mother during pregnancy. Results Out of 8,503 newborns we recorded 194 subjects with congenital anomalies (228.2/10,000 total births), 1.2 times higher than the one reported by the EUROCAT pool of registries. We observed 83 subjects with congenital heart diseases with an excess of 49.1%. Odds Ratios for congenital heart diseases significantly increased for newborns to mothers resident in Brindisi (OR 1.75 CI 95% 1.30-2.35). Conclusions Our findings indicated an increased prevalence of Congenital Anomalies (especially congenital heart diseases) in the city of Brindisi. More research is needed in order to analyze the role of factors potentially involved in the causation of congenital anomalies.
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Raza MZ, Sheikh A, Ahmed SS, Ali S, Naqvi SMA. Risk factors associated with birth defects at a tertiary care center in Pakistan. Ital J Pediatr 2012; 38:68. [PMID: 23217204 PMCID: PMC3551662 DOI: 10.1186/1824-7288-38-68] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 12/04/2012] [Indexed: 11/24/2022] Open
Abstract
Background Birth defects are defined as those conditions that are substantially determined before or during birth and which are recognizable in early life. They are an important cause of morbidity and mortality in infants. The main objective of the study was to determine the association of certain risk factors with birth defects occurring in pediatric patients seeking care in Civil Hospital, Karachi. Methods This was a prospective, cross-sectional study conducted at Department of Pediatrics: Units I, II and III of Civil Hospital Karachi, which is a tertiary care hospital located in the city center. These units provide care to pediatric patients from all over the country, with majority belonging to a low socioeconomic background. All infants with at least one birth defect were approached and their mothers interviewed. Demographics of both the mother and the infant were noted. Questions regarding possible exposure to risk factors were asked. Infants who were not accompanied by their mothers were excluded from the study. Results A total of 587 out of 669 infants completed the study successfully. Of these, defects related to urogenital system (19.9%) were the commonest, followed by those related to eye (16.9%), musculoskeletal system (12.9%), body wall defects (12.3%), oral cavity (12.1%), central nervous system (10.9%), gastrointestinal tract (3.2%), cardiovascular system (2.7%) and those related to ear, nose and throat (1.2%). Conclusion 669(4.1%) out of a total of 16,394 pediatric patients visiting the hospital during our study were identified as having at least one birth defect. The commonest ones were those related to the eye and the urogenital system. The main factors that influence the occurrence can be grouped into maternal, socioeconomic, nutritional and educational.
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Leppée M, Culig J, Eric M. Cigarette smoking during pregnancy in two regions: cross-sectional study. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2012. [DOI: 10.1016/s2305-0500(13)60079-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Leppée M, Culig J, Eric M. Cigarette smoking during pregnancy in two regions: cross-sectional study. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2012. [DOI: 10.1016/s2305-0500(13)60048-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Snijder CA, Vlot IJ, Burdorf A, Obermann-Borst SA, Helbing WA, Wildhagen MF, Steegers EAP, Steegers-Theunissen RPM. Congenital heart defects and parental occupational exposure to chemicals. Hum Reprod 2012; 27:1510-7. [DOI: 10.1093/humrep/des043] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jentink J, Zetstra-van der Woude AP, Bos J, de Jong-van den Berg LTW. Evaluation of the representativeness of a Dutch non-malformed control group for the general pregnant population: are these controls useful for EUROCAT? Pharmacoepidemiol Drug Saf 2011; 20:1217-23. [PMID: 21954020 DOI: 10.1002/pds.2254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 08/11/2011] [Accepted: 08/19/2011] [Indexed: 11/07/2022]
Abstract
PURPOSE A case-control study is the most powerful design to test the risk of specific congenital malformations associated with a specific drug. However, malformation registries often lack non-malformed controls. For the Dutch EUROCAT, we collected a non-malformed control group: the 'Healthy Pregnant'. The aim of this study was to evaluate the representativeness of this control group for the general pregnant population in the northern part of the Netherlands. METHODS The Healthy Pregnant data set includes data from two midwife practices. The baseline characteristics of mother and child including smoking status, drinking status, body mass index, maternal age, educational level, exposures to several drugs for chronic diseases and pregnancy related symptoms were evaluated. RESULTS Compared with the general population, mothers in Healthy Pregnant group (n = 556) were from either low or high education level, were more likely to have a body mass index > 25 kg/m² (26% versus 22%, p = 0.08) or to smoke (19% versus 10%, p < 0.01) but were less likely to consume alcohol (20% versus 29%, p < 0.01). The use of drugs for chronic conditions was lower in Healthy Pregnant group. Furthermore, drugs for occasional use were prescribed less frequently, and a significant underreporting of children with a low birth weight and a short duration of gestation was found. CONCLUSION The Healthy Pregnant data set was not representative of the general pregnant population in the northern part of the Netherlands. Specifically, the exposure to (chronic) drugs was underestimated, possibly a result of second-line care on the basis of medical indication. Thus, continuous investigation of options for improvement of the Healthy Pregnant database is required.
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Affiliation(s)
- Janneke Jentink
- Division of Pharmacy, Department of Pharmacoepidemiology and Pharmacoeconomics, University of Groningen, Groningen, The Netherlands
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Paternal occupational exposures and the risk of congenital malformations--a case-control study. Int J Occup Med Environ Health 2011; 24:218-27. [PMID: 21590429 DOI: 10.2478/s13382-011-0019-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 03/14/2011] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES This study examined the association between certain paternal occupational exposures during the periconceptional period and the risk of congenital malformations. MATERIALS AND METHODS A case-control study was carried out from December 2009 to April 2010; on 242 congenital malformation cases and 270 controls. Paternal occupational exposure to certain workplace hazards was assessed by a detailed questionnaire to evaluate the occupational exposure for both fathers and mothers including pesticides, solvents, welding fumes, lead, working with video display terminals (VDTs) and computer monitors. In addition, the questionnaire assessed the presence of other risk factors such as consanguinity, smoking and history of any maternal diseases during the pregnancy with the child. RESULTS The results revealed that the odds of having a child with congenital malformation was higher (P < 0.01) if the father was occupationally exposed to pesticides (OR: 3.42, 95% CI: 1.97-5.92), solvents (OR: 5.63, 95% CI: 2.77-11.42), or welding fumes (OR: 2.98, 0.99-8.54) during the periconceptional period. However, consanguinity (OR: 1.91, 95% CI: 1.25-2.92) was a risk factor of developing congenital malformations among offspring. CONCLUSION Control of workplace exposures and adherence to threshold limit values of those hazards should be adopted to minimize the risk of developing congenital malformations among offspring.
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Paranaíba LMR, Miranda RTD, Ribeiro LA, Barros LMD, Martelli-Júnior H. Frequency of congenital craniofacial malformations in a Brazilian Reference Center. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2011. [DOI: 10.1590/s1415-790x2011000100014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To evaluate the frequency of craniofacial anomalies in patients treated at a Brazilian Reference Center for craniofacial deformities. METHOD: Retrospective epidemiological study evaluating the clinical records of 1,142 patients: 656 (57.4%) male and 486 (42.6%) female, between 1992 and 2008. RESULTS: Among birth defects, non-syndromic cleft lip and/or palate were the most frequent ones (778 cases; 68.1%), followed by single or multiple congenital anomalies without cleft lip and/or palate (240 cases; 21%), recognized syndromes or sequences (56 cases; 5%), syndromes with orofacial cleft as a component (41 cases; 3.5%), and orofacial clefts in association with systemic malformations (27 cases; 2.4%). CONCLUSIONS: Non-syndromic cleft lip and/or palate was the congenital defect most frequently identified, although, isolated anomalies and syndromes involving craniofacial structures were quite frequent. Furthermore, the need for studies to identify the frequency and risk factors associated with craniofacial anomalies in the Brazilian population is emphasized in order to plan comprehensive strategies and integrated actions for the development of preventive programs and treatment.
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Iszatt N, Nieuwenhuijsen MJ, Nelson P, Elliott P, Toledano MB. Water consumption and use, trihalomethane exposure, and the risk of hypospadias. Pediatrics 2011; 127:e389-97. [PMID: 21220402 DOI: 10.1542/peds.2009-3356] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Hypospadias is a congenital anomaly that affects up to 70 in 10 000 males. Ingestion of drinking-water-disinfection byproducts such as trihalomethanes (THMs) has been associated with hypospadias in a small sample. We examined risk of hypospadias and exposure to THMs through water consumption and use. METHODS Between September 2000 and March 2003, we interviewed mothers of 471 boys with hypospadias and 490 controls in southeast England about maternal water consumption, dishwashing, showering, bathing and swimming. We obtained residential THM concentrations from the water companies and linked them by using Geographical Information Systems, which provided data on 468 case-subjects and 485 controls. RESULTS THM exposures, except for ingestion of ≥ 6 μg/day of bromodichloromethane (odds ratio [OR]: 1.65 [95% confidence interval (CI): 1.02-2.69]), were not associated with risk of hypospadias. Elevated risk of hypospadias was associated with estimates of consumption of cold tap water at home (OR: 1.71 [95% CI: 1.07-2.76]), total water (OR: 1.70 [95% CI: 1.09-2.67]), bottled water (OR: 1.64 [95% CI: 1.09-2.48]), and total fluid (OR: 1.55 [95% CI: 1.01-2.39]) for the highest versus the lowest categories; the first 2 showed dose-response trends. CONCLUSIONS Evidence for an association between maternal water consumption and risk of hypospadias did not seem to be explained by THM exposure. Factors that influence maternal water consumption or other contaminants in tap or bottled water might explain this finding. It is important that women maintain an adequate fluid intake during pregnancy.
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Affiliation(s)
- Nina Iszatt
- Department of Epidemiology and Biostatistics and MRC-HPA Centre for Environment and Health, Imperial College London, London, United Kingdom
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Morales-Suárez-Varela M, Kaerlev L, Zhu JL, Llopis-González A, Gimeno-Clemente N, Nohr EA, Bonde JP, Olsen J. Risk of infection and adverse outcomes among pregnant working women in selected occupational groups: A study in the Danish National Birth Cohort. Environ Health 2010; 9:70. [PMID: 21078155 PMCID: PMC2994842 DOI: 10.1186/1476-069x-9-70] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 11/15/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND Exposure to infectious pathogens is a frequent occupational hazard for women who work with patients, children, animals or animal products. The purpose of the present study is to investigate if women working in occupations where exposure to infections agents is common have a high risk of infections and adverse pregnancy outcomes. METHODS We used data from the Danish National Birth Cohort, a population-based cohort study and studied the risk of Infection and adverse outcomes in pregnant women working with patients, with children, with food products or with animals. The regression analysis were adjusted for the following covariates: maternal age, parity, history of miscarriage, socio-occupational status, pre-pregnancy body mass index, smoking habit, alcohol consumption. RESULTS Pregnant women who worked with patients or children or food products had an excess risk of sick leave during pregnancy for more than three days. Most of negative reproductive outcomes were not increased in these occupations but the prevalence of congenital anomalies (CAs) was slightly higher in children of women who worked with patients. The prevalence of small for gestational age infants was higher among women who worked with food products. There was no association between occupation infections during pregnancy and the risk of reproductive failures in the exposed groups. However, the prevalence of CAs was slightly higher among children of women who suffered some infection during pregnancy but the numbers were small. CONCLUSION Despite preventive strategies, working in specific jobs during pregnancy may impose a higher risk of infections, and working in some of these occupations may impose a slightly higher risk of CAs in their offspring. Most other reproductive failures were not increased in these occupations.
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Affiliation(s)
- Maria Morales-Suárez-Varela
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Valencia, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Spain
- Center for Public Health Research (CSISP), Valencia, Spain
| | - Linda Kaerlev
- The Danish Epidemiology Science Centre. University of Aarhus, Aarhus, Denmark
- Centre for National Clinical Databases South, Dept. of Research and HTA, Odense University Hospital, Denmark
| | - Jin Liang Zhu
- The Danish Epidemiology Science Centre. University of Aarhus, Aarhus, Denmark
| | - Agustín Llopis-González
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Valencia, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Spain
- Center for Public Health Research (CSISP), Valencia, Spain
| | - Natalia Gimeno-Clemente
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Valencia, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Spain
- Center for Public Health Research (CSISP), Valencia, Spain
| | - Ellen A Nohr
- The Danish Epidemiology Science Centre. University of Aarhus, Aarhus, Denmark
| | - Jens P Bonde
- Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jorn Olsen
- Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Epidemiology, School of Public Health, UCLA, Los Angeles, USA
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Abstract
PURPOSE OF REVIEW Summarize recent studies exploring the relationship between paternal and maternal environmental exposures to chemicals before, at the time of and after conception to adverse developmental outcomes including preterm birth, death, structural and functional abnormalities and growth restriction. RECENT FINDINGS Recent studies have demonstrated that human pregnancy and development are vulnerable to environmental exposures of the father and mother to chemical, biological and physical agents. Exposures associated with adverse developmental outcomes include air and water pollution, chemicals in foods, occupational exposures, agricultural chemicals, metals, persistent and volatile organics. Developmental endpoints which are linked with these exposures include growth restriction, functional abnormalities, structural abnormalities, preterm delivery and death. Despite this general understanding we still have incomplete knowledge concerning most exposures and the biological interactions responsible for impaired development and preterm delivery. SUMMARY Whereas single genes and individual chemical exposures are responsible for some instances of adverse pregnancy outcome or developmental disease, gene-environment interactions are responsible for the majority. These gene-environment interactions may occur in the father, mother, placenta or fetus, suggesting that critical attention be given to maternal and paternal exposures and gene expression as they relate to the mode of action of the putative developmental toxicant both prior to and during pregnancy.
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