The Relationship Between Air Pollutants Exposure During Pregnancy And Congenital Heart Defects

Objective:1.To understand the prevalence of birth defects in perinatal children in Wuhan,analyze and compare the monitoring data of birth defects in Wuhan during 2011-2017,provide clues for the in-depth study of the causes of birth defects,and correctly understand the occurrence of birth defects in Wuhan.Provide a scientific basis for reducing the incidence of birth defects and improving the quality of the birth population.2.Based on a population-based study,to explore the association between air pollution exposure and congenital heart defects under a high level of air pollution in Wuhan.We also explore the separate roles of different type of congenital heart diseases.This study will provide evidence for the relationship between limited atmospheric pollution exposure and congenital heart disease,and provide clues for the etiology of birth defects.Methods:1.The first part: This study was conducted based on Wuhan Maternal and Child Information system,743,290 children born in Wuhan from January 2011 to June 2017 were selected as the objects.Using the data on birth defects in the Wuhan Maternal and Child Information System from 2011 to 2017,we described the trends and priorities of the incidence of birth defects,and determined the incidence of birth defects in different categories in different maternal delivery age,education degree,gravidity,parity,and pregnancy season.2.The second part: Based on the population,maternal and newborn babies who were resident and delivered in Wuhan from January 2011 to June 2017 were selected as study subjects.After the inclusion criteria,556,788 pregnant women were included in the study.The average daily atmospheric monitoring concentration of 2010-2016 was obtained from the Wuhan Environmental Monitoring Center.The anti-distance weighted method was applied to the individual during the first trimester of pregnancy,1st month of pregnancy,2nd month of pregnancy,3rd month of pregnancy,and 0-12 of pregnancy.Weekly individual exposure concentration values are evaluated.Unconditional logistic regression models were used to explore the associations between six common air pollutants(PM2.5,PM10,SO2,NO2,CO,and O3)during pregnancy and the risk of congenital heart disease.Result:1.The first part:(1)In 2011-2017,the total birth defect rate in Wuhan was 1.15%,and the total birth defect rate was lower than the national average 1.53%;in Wuhan,the incidence of birth defects increased by 50.10% in 2011 compared to 2017.The overall incidence of birth defects continues to rise.Among birth defects,congenital heart disease has been ranked the first place in birth defects in Wuhan City,and the incidence has been increasing year by year.(2)The incidence of birth defects was higher in pregnant women group with higher age and pregnant women group with lower age group(P<0.05).The incidence of birth defects of mothers with multiple births was lower than that of newly born mothers.(P<0.05);the distribution of birth defects has obvious seasonal aggregation,pregnant women in winter are more prone to have birth defects,and the incidence of birth defects in winter pregnancy is 1.24%,which is significantly higher than those born in other seasons(P<0.05);the mothers who gave birth to female fetuses did not have a significant impact on the fertility season.The ratio of birth defects in the delivery of winter maternal births was 1.33%,which was significantly higher than that of other fertility seasons and the incidence of birth defects in birth defects in winter.(P<0.05).2.The second part:(1)PM2.5 exposure during early pregnancy increases the risk of congenital heart disease(a OR: 1.06;95% CI = 1.02-1.10).(1)Pathological classification: during the 3 months,PM2.5 exposure may increase the risk of type 3 disease by 19%(a OR: 1.19;95% CI=1.01-1.42).(2)ICD-10 classification: no significant relationship was found between PM2.5 exposure and ventricular septal defect,tetralogy of Fallot,and endocardial point defect in the first trimester(P<0.05).During 2010-2012,the East Lake Liyuan and Wujiashan two air quality monitoring stations included newborns within 10 km of the monitoring around the site,the risk of congenital heart disease was increased by 1%(a OR: 1.01;95% CI = 1.01-1.02)for every 10μg/m3 increase in PM2.5 during the second trimester of pregnancy;for every 10 μg increase in PM2.5 exposure may increase the risk of ventricular septal defect by 2%(a OR: 1.02;95% CI = 1.01-1.03).(2)PM10 exposure during early pregnancy increased the risk of congenital heart disease(a OR: 1.04;95% CI = 1.01-1.07).Exposure to PM10 at 0,3,and 10 weeks of pregnancy increased the risk of congenital heart disease(P<0.05),which may be a potential exposure window for the development of congenital heart disease.(1)Pathological classification: exposure to PM10 increase the risk of type 1 by 5%(a OR: 1.05;95% CI = 1.01-1.08)for every 10 μg/m3 during the 3 weeko of pregnancy.(2)ICD-10 classification: exposure to PM10 increase the risk of ventricular septal defect by 4%(a OR: 1.04;95% CI = 1.01-1.09)for every 10 μg/m3 during the first trimester of pregnancy.(3)Maternal exposure to SO2 increased the risk of congenital heart disease(a OR: 1.11;95% CI = 1.06 to 1.17)during the first trimester.(1)Pathological classification: SO2 exposure increased by 10μg/m3 during the first trimester,the type 1 and type 3 risk increase by 16-36%(a OR: 1.16-1.36;P<0.05);SO2 exposure at 0-12 weeks of pregnancy increased the risk of congenital heart disease by 5-8%(a OR: 1.05-1.08;P<0.05).Specific to different gestational weeks,exposure to SO2 during 0-12 weeks increased the risk of type 1 by 8-14%(a OR: 1.08-1.14;P<0.05);the risk of type 3 increased by 28% for every 10 μg/m3 increase in SO2 exposure during 6 weeks of pregnancy(a OR: 1.28;95% CI = 1.01 to 1.63).(2)ICD-10 classification: exposure of SO2 in early pregnancy was associated with the risk of ventricular septal defect(a OR: 1.16;95% CI = 1.06-1.26).No significant association was found between early exposure to SO2 and tetralogy of Fallot and endocardial point defects(P<0.05).(4)Exposure of NO2 during early pregnancy was associated with the risk of endocardial cushion defect(a OR: 1.32;95% CI = 1.01-1.71).Specific to different gestational weeks,NO3 exposure during 3 weeks of pregnancy increased the risk of ventricular septal defect(a OR: 1.11;95% CI = 1.03-1.20;P<0.05);NO2 exposure during the first week of pregnancy increased the risk of endocardial cushion defects(a OR: 1.19;95% CI=1.01-1.40).(5)CO exposure at 11 weeks of gestation was associated with the risk of congenital heart disease(a OR: 1.31;95% CI = 1.01-1.71).No association was found between early exposure to CO and ventricular septal defects,tetralogy of Fallot,and endocardial cushion defects(P>0.05).(6)Exposure to O3 during the second month of pregnancy increased the risk of congenital heart disease(a OR: 1.04;95% CI = 1.01-1.07).O3 exposure at 0,4,5,and 7 weeks of pregnancy increased the risk of congenital heart disease(a OR: 1.02;95% CI = 1.01-1.04;a OR: 1.02;95% CI = 1.01-1.04;a OR: 1.03;95% CI = 1.01-1.05;a OR: 1.03;95% CI = 1.01-1.05).No associations was found between O3 exposure in early pregnancy and ventricular septal defect,tetralogy of Fallot,and risk of endocardial cushion defects(P>0.05)(7)The results of the two air pollutant models(PM2.5+O3,PM10+O3,SO2+O3,NO2+O3,CO+O3)are basically the same as those of the single pollutant model.Conclusions:1.The first part:The incidences of birth defects of children in Wuhan had gradually increased in recent years,there was a targeted increasing in premarital and prenatal screening rates.To strengthen health education for pregnant women,select the best age for conception,and actively avoid the harmful factors during pregnancy were very important to reduce the occurrence of birth defects.Pregnant mothers in winter were more prone to birth defects,but the etiology was not clear,which suggested that it was necessary to further carry out researches on the associations between environmental harmful factors and birth defects.2.The second part:This large population-based study showed that exposure to air pollution during pregnancy was associated with the risk of congenital heart disease.This study provided the evidence the associations between air pollution exposure during pregnancy and congenital heart disease.Wuhan’s birth defects have gradually increased in recent years.There is a targeted increase in premarital and prenatal screening rates.Health education for women of gestational age is strengthened,the best age for conception is selected,and the harmful factors are actively avoided.The influence of the fetus is very important to reduce the occurrence of birth defects.Pregnant mothers in winter are more prone to birth defects,but the etiology is not clear,which suggests that it is necessary to further carry out research on environmental harmful factors and birth defects.