Hostname: page-component-6bb9c88b65-bw5xj Total loading time: 0 Render date: 2025-07-22T05:06:57.022Z Has data issue: false hasContentIssue false
  • English
  • Français

Maternal exposure factors in pregnancy that affect fetal CHD risk: a case–control study

Published online by Cambridge University Press:  19 May 2025

Jieru Lu Open the ORCID record for Jieru Lu [Opens in a new window] ,
Zhuoyan Li ,
Yu Wang ,
Jing Yang ,
Shujing Li ,
Xuehua Ruan ,
Jinping Cheng ,
Sun Chen Open the ORCID record for Sun Chen [Opens in a new window] ,
Yurong Wu  and
Xin Shi
...Show all authors
Jieru Lu
Affiliation:
Department of Pediatric Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, China Department of Children’s Cardiology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China Department of Pediatrics, Li shui People’s Hospital, The Sixth Affiliated Hospital, Wenzhou Medical University, Li shui, China
Zhuoyan Li
Affiliation:
Department of Pediatric Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, China
Yu Wang
Affiliation:
Department of Pediatric Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, China Department of Children’s Cardiology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China
Jing Yang
Affiliation:
Department of Fetal Echocardiography, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
Shujing Li
Affiliation:
Department of Pediatric Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, China
Xuehua Ruan
Affiliation:
Department of Pediatric Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, China
Jinping Cheng
Affiliation:
School of Environmental Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
Sun Chen
Affiliation:
Department of Pediatric Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, China
Yurong Wu
Affiliation:
Department of Pediatric Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, China
Xin Shi
Affiliation:
Department of Pediatric Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, China
Kun Sun*
Affiliation:
Department of Pediatric Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, China Department of Children’s Cardiology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China
Jing Sun*
Affiliation:
Department of Pediatric Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, China
*
Corresponding authors: Kun Sun; Email: sunkun@xinhuamed.com.cn; Jing Sun; Email: sunjing02@xinhuamed.com.cn
Corresponding authors: Kun Sun; Email: sunkun@xinhuamed.com.cn; Jing Sun; Email: sunjing02@xinhuamed.com.cn
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim:

We sought to assess the degree to which environmental risk factors affect CHD prevalence using a case–control study.

Methods:

A hospital-based study was conducted by collecting data from outpatients between January 2016 and January 2021, which included 31 CHD cases and 72 controls from eastern China. Risk ratios were estimated using univariate and multivariate logistic regression models and mediating effect analysis.

Results:

Residential characteristics (usage of cement flooring, odds ratio = 17.04[1.954–148.574], P = 0.01; musty smell, odds ratio = 3.105[1.198–8.051], P = 0.02) and indoor total volatile organic compound levels of participants’ room (odds ratio = 31.846[8.187–123.872, P < 0.001), benzene level (odds ratio = 7.370[2.289–23.726], P = 0.001) increased the risk of CHDs in offspring. And folic acid plays a masking effect, which mitigates the affection of the total volatile organic compound (indirect effect = -0.072[−0.138,-0.033]) and formaldehyde (indirect effect = −0.109[-0.381,-0.006]) levels on the incidence of CHDs. While food intake including milk (odds ratio = 0.396[0.16–0.977], P = 0.044), sea fish (odds ratio = 0.273[0.086–0.867], P = 0.028), and wheat (odds ratio = 0.390[0.154–0.990], P = 0.048) were all protective factors for the occurrence of CHDs. Factors including women reproductive history (history of conception control, odds ratio = 2.648[1.062–6.603], P = 0.037; history of threatened abortion, odds ratio = 2.632[1.005–6.894], P = 0.049; history of dysmenorrhoea (odds ratio = 2.720[1.075–6.878], P = 0.035); sleep status (napping habit during daytime, odds ratio = 0.856[0.355–2.063], P = 0.047; poor sleep quality, odds ratio = 3.180[1.037–9.754], P = 0.043); and work status (working time > 40h weekly, odds ratio = 2.882[1.172–7.086], P = 0.021) also influenced the CHDs incidence to differing degrees.

Conclusion:

Diet habits, nutrients intake, psychological status of pregnant women, and residential air quality were associated with fetal CHDs. Indoor total volatile organic compound content was significantly correlated with CHDs risk, and folic acid may serve as a masking factor that reduce the harmful effects of air pollutants.

Keywords

CHDsmaternal exposureenvironmental factorstotal volatile organic compound

Information

Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 10
Check for updates
Copyright
© The Author(s), 2025. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

*

These authors contributed equally to this work.

References

Rohit, M. Congenital heart disease: where are We and the way ahead! Indian J Pediatr 2022; 89: 1063–1063.10.1007/s12098-022-04343-5CrossRefGoogle ScholarPubMed
Brida, M, Gatzoulis, MA. Adult congenital heart disease: past, present and future. Acta Paediatr 2019; 108: 1757–1764.10.1111/apa.14921CrossRefGoogle ScholarPubMed
Boyd, R, McMullen, H, Beqaj, H, Kalfa, D. Environmental exposures and congenital heart disease. Pediatrics 2022; 149: e2021052151.CrossRefGoogle ScholarPubMed
Zaidi, S, Brueckner, M. Genetics and genomics of congenital heart disease. Circ Res 2017; 120: 923–940.10.1161/CIRCRESAHA.116.309140CrossRefGoogle ScholarPubMed
Zhao, D, Guo, L, Zhang, R, et al. Risk of congenital heart disease due to exposure to common electrical appliances during early pregnancy: a case-control study. Environ Sci Pollut Res Int 2021; 28: 4739–4748.CrossRefGoogle ScholarPubMed
Nie, X, Liu, X, Wang, C, et al. Assessment of evidence on reported non-genetic risk factors of congenital heart defects: the updated umbrella review. BMC Pregnancy Childbirth 2022; 22: 371.10.1186/s12884-022-04600-7CrossRefGoogle ScholarPubMed
Zhang, B, Liang, S, Zhao, J, et al. Maternal exposure to air pollutant PM2.5 and PM10 during pregnancy and risk of congenital heart defects. J Expo Sci Environ Epidemiol 2016; 26: 422–427.10.1038/jes.2016.1CrossRefGoogle ScholarPubMed
Li, R, Zhao, Y, Shi, J, et al. Effects of PM2.5 exposure in utero on heart injury, histone acetylation and GATA4 expression in offspring mice. Chemosphere 2020; 256: 127133.10.1016/j.chemosphere.2020.127133CrossRefGoogle Scholar
Qu, Y, Lin, S, Bloom, M, et al. Maternal folic acid supplementation mediates the associations between maternal socioeconomic status and congenital heart diseases in offspring. Prev Med 2020; 143: 106319.10.1016/j.ypmed.2020.106319CrossRefGoogle ScholarPubMed
Gu, J, Guan, H-B. Maternal psychological stress during pregnancy and risk of congenital heart disease in offspring: a systematic review and meta-analysis. J Affect Disord 2021; 291: 32–38.10.1016/j.jad.2021.05.002CrossRefGoogle ScholarPubMed
Verkleij-Hagoort, AC, van Driel, LMJW, Lindemans, J, et al. Genetic and lifestyle factors related to the periconception vitamin B12 status and congenital heart defects: a dutch case-control study. Mol Genet Metab 2008; 94: 112–119.CrossRefGoogle Scholar
Yang, J, Kang, Y, Cheng, Y, et al. Maternal dietary patterns during pregnancy and congenital heart defects: a case-control study. Int J Environ Res Public Health 2019; 16: 2957.10.3390/ijerph16162957CrossRefGoogle ScholarPubMed
Picot, C, Berard, A, Grenet, G, et al. Risk of malformation after ondansetron in pregnancy: An updated systematic review and meta-analysis. Birth Defects Res 2020; 112: 996–1013.10.1002/bdr2.1705CrossRefGoogle ScholarPubMed
Inoue, K, Yan, Q, Arah, OA, et al. Air pollution and adverse pregnancy and birth outcomes: mediation anal ysis using metabolomic profiles. Curr Environ Health Rep 2020; 7: 231–242.10.1007/s40572-020-00284-3CrossRefGoogle Scholar
Yasuda, S, Okazaki, K, Nakano, H, et al. Effects of external radiation exposure on perinatal outcomes in pregnant women after the Fukushima Daiichi Nuclear Power Plant accident: the Fukushima health management survey. J Epidemiol 2022; 32: S104–S114.10.2188/jea.JE20210252CrossRefGoogle ScholarPubMed
Elizabeth, N, Michael, B, Patti, J. Time-activity patterns of pregnant women and changes during the course of pregnancy. J Expo Sci Environ Epidemiol 2009; 19: 317–324.Google Scholar
Pei, J, Yin, Y, Liu, J, Dai, X. An eight-city study of volatile organic compounds in Chinese residences: compounds, concentrations, and characteristics. Sci Total Environ 2020; 698: 134137.10.1016/j.scitotenv.2019.134137CrossRefGoogle ScholarPubMed
Liu, Z, Yin, H, Ma, S, et al. On-site assessments on variations of PM2.5, PM10, CO2 and TVOC concentrations in naturally ventilated underground parking garages with traffic volume. Environ Pollut 2019; 247: 626–637.CrossRefGoogle Scholar
Cheng, Z, Li, B, Yu, W, et al. Risk assessment of inhalation exposure to VOCs in dwellings in Chongqing, China. Toxicol Res (Camb) 2018; 7: 59–72.10.1039/C7TX00191FCrossRefGoogle ScholarPubMed
Manisalidis, I, Stavropoulou, E, Stavropoulos, A, Bezirtzoglou, E. Environmental and health impacts of air pollution: a review. Front Public Health 2020; 8: 14.CrossRefGoogle ScholarPubMed
Maroziene, L, Grazuleviciene, R. Maternal exposure to low-level air pollution and pregnancy outcomes: a population-based study. Environ Health Glob Access Sci src 2002; 1: 6.Google ScholarPubMed
Moro, AM, Brucker, N, Charão, M, et al. Evaluation of genotoxicity and oxidative damage in painters exposed to low levels of toluene. Mutat Res 2012; 746: 42–48.10.1016/j.mrgentox.2012.02.007CrossRefGoogle ScholarPubMed
Jiang, Y, Li, J, Ren, F, et al. PM2.5-induced extensive DNA methylation changes in the heart of zebrafish embryos and the protective effect of folic acid. Environ Pollut 2019; 255: 113331.10.1016/j.envpol.2019.113331CrossRefGoogle ScholarPubMed
Duong, A, Steinmaus, C, McHale, CM, Vaughan, CP, Zhang, L. Reproductive and developmental toxicity of formaldehyde: a systematic review. Mutat Res 2011; 728: 118–138.10.1016/j.mrrev.2011.07.003CrossRefGoogle ScholarPubMed
Slama, R, Thiebaugeorges, O, Goua, V, et al. Maternal personal exposure to airborne benzene and intrauterine growth. Environ Health Persp 2009; 117: 1313–1321.10.1289/ehp.0800465CrossRefGoogle ScholarPubMed
Chang, M, Park, H, Ha, M, et al. The effect of prenatal TVOC exposure on birth and infantile weight: th e mothers and children’s environmental health study. Pediatr Res 2017; 82: 423–428.10.1038/pr.2017.55CrossRefGoogle Scholar
Madureira, J, Slezakova, K, Costa, C, Pereira, MC, Teixeira, JP. Assessment of indoor air exposure among newborns and their mothers: Le vels and sources of PM10, PM2.5 and ultrafine particles at 65 home environments. Environ Pollut (Barking, Essex 1987) 1987; 264: 114746.10.1016/j.envpol.2020.114746CrossRefGoogle Scholar
Supplementary material: File

Lu et al. supplementary material

Lu et al. supplementary material
Download Lu et al. supplementary material(File)
File 34.5 KB