PDF(Pubmed)
Abstract：
Evidence remains limited about the association of maternal exposure to ambient fine particulate matter (airborne particles with an aerodynamic diameter ≤2.5 µm [PM2.5]) with fetal congenital heart defects (CHDs) in highly polluted regions, and few studies have focused on preconception exposure.
Using a nationwide surveillance-based case-control design in China, we examined the association between maternal exposure to PM2.5 during periconception (defined as 3 months before conception until 3 months into pregnancy) and risk of CHD in offspring. The study included 1 434 998 births involving 7335 CHDs from 2014 through 2017 on the basis of the National Population-Based Birth Defects Surveillance System, covering 30 provinces, municipalities, or municipal districts in China. We assigned maternal PM2.5 exposure during the periconception period to each participant using satellite-based PM2.5 concentrations at 1-km spatial resolution. Multilevel logistic regression models were used to calculate the multivariable-adjusted odds ratio and 95% CI for CHDs in offspring associated with maternal PM2.5 exposure, and the exposure-response association was investigated using restricted cubic spline analysis. Subgroup or sensitivity analyses were conducted to identify factors that may modify the association.
The average maternal exposure to PM2.5 levels across all participants was 56.51 μg/m3 (range, 10.95 to 182.13 μg/m3). For each 10 μg/m³ increase in maternal PM2.5 exposure, the risk of CHDs in offspring was increased by 2% (odds ratio, 1.02 [95% CI, 1.00 to 1.05]), and septal defect was the most influenced subtype (odds ratio, 1.04 [95% CI, 1.01 to 1.08]). The effect of PM2.5 on CHD risk was more pronounced during the preconception period. Mothers <35 years of age, those living in northern China, and those living in low-income areas were more susceptible to PM2.5 exposure than their counterparts (all P<0.05). PM2.5 exposure showed a linear association with total CHDs or specific CHD types.
High maternal PM2.5 exposure, especially during the preconception period, increases risk of certain types of CHD in offspring. These findings are useful for CHD prevention and highlight the public health benefits of improving air quality in China and other highly polluted regions.
Using a nationwide surveillance-based case-control design in China, we examined the association between maternal exposure to PM2.5 during periconception (defined as 3 months before conception until 3 months into pregnancy) and risk of CHD in offspring. The study included 1 434 998 births involving 7335 CHDs from 2014 through 2017 on the basis of the National Population-Based Birth Defects Surveillance System, covering 30 provinces, municipalities, or municipal districts in China. We assigned maternal PM2.5 exposure during the periconception period to each participant using satellite-based PM2.5 concentrations at 1-km spatial resolution. Multilevel logistic regression models were used to calculate the multivariable-adjusted odds ratio and 95% CI for CHDs in offspring associated with maternal PM2.5 exposure, and the exposure-response association was investigated using restricted cubic spline analysis. Subgroup or sensitivity analyses were conducted to identify factors that may modify the association.
The average maternal exposure to PM2.5 levels across all participants was 56.51 μg/m3 (range, 10.95 to 182.13 μg/m3). For each 10 μg/m³ increase in maternal PM2.5 exposure, the risk of CHDs in offspring was increased by 2% (odds ratio, 1.02 [95% CI, 1.00 to 1.05]), and septal defect was the most influenced subtype (odds ratio, 1.04 [95% CI, 1.01 to 1.08]). The effect of PM2.5 on CHD risk was more pronounced during the preconception period. Mothers <35 years of age, those living in northern China, and those living in low-income areas were more susceptible to PM2.5 exposure than their counterparts (all P<0.05). PM2.5 exposure showed a linear association with total CHDs or specific CHD types.
High maternal PM2.5 exposure, especially during the preconception period, increases risk of certain types of CHD in offspring. These findings are useful for CHD prevention and highlight the public health benefits of improving air quality in China and other highly polluted regions.
摘要：
关于孕妇暴露于环境细颗粒物（空气动力学直径≤2.5µm[PM2.5]的空气传播颗粒）与高污染地区胎儿先天性心脏缺陷（CHD）之间的关系的证据仍然有限。很少有研究关注孕前暴露。
在中国使用基于全国性监测的病例控制设计，我们研究了孕妇在怀孕期间(定义为怀孕前3个月至怀孕后3个月)暴露于PM2.5与后代CHD风险之间的关系.根据国家基于人口的出生缺陷监测系统，该研究包括2014年至2017年的1434998例新生儿，涉及7335例CHD。覆盖30个省，市政当局,或中国的市辖区。我们使用基于卫星的PM2.5浓度以1公里的空间分辨率将每个参与者在感知周期期间的母体PM2.5暴露量分配给每个参与者。使用多水平逻辑回归模型来计算与母亲PM2.5暴露相关的后代CHD的多变量调整比值比和95％CI，并使用受限三次样条分析研究了暴露-反应关联。进行亚组或敏感性分析以确定可能改变关联的因素。
所有参与者的母亲平均PM2.5暴露水平为56.51μg/m3（范围，10.95至182.13μg/m3)。母体PM2.5暴露量每增加10μg/m3，后代患冠心病的风险增加了2%(比值比，1.02[95%CI，1.00至1.05])，间隔缺损是受影响最大的亚型(比值比，1.04[95%CI，1.01至1.08]）。在孕前阶段，PM2.5对冠心病风险的影响更为明显。母亲年龄<35岁，那些生活在中国北方的人，生活在低收入地区的人比他们的人更容易受到PM2.5的影响(均P<0.05)。PM2.5暴露与总CHD或特定CHD类型呈线性关系。
母体PM2.5高暴露，尤其是在先入期,增加后代患某些类型冠心病的风险。这些发现有助于CHD的预防，并突出了改善中国和其他高污染地区空气质量的公共卫生益处。
在中国使用基于全国性监测的病例控制设计，
所有参与者的母亲平均PM2.5暴露水平为56.51μg/m3（范围，
母体PM2.5高暴露，
