| Background&ObjectiveCongenital heart disease is the most common congenital malformation,and mostly caused by the combination of genetic and environmental factors.This study was aimed to investigate the association of environmental and behavioral exposure during periconception period with complex CHD and simple CHD in offspring,and,therefore,to provide a scientific basis for the preventive strategies of CHD.MethodsThis study selected children who was diagnosed with CHD and simultaneously accepted surgical treatment as a case group.All children were within 2 years old(including 2 years)and recruited from Shanghai Children?s Medical Center during the period of June 1,2016 to December 1,2017.It was divided into two groups:complex CHD group and simple CHD group.Same as the case group,the children in control group were selected from the same hospital during the same recruitment period.All children were within 2 years old(including 2 years)and did not have any congenital diseases.Face-to-face investigation was conducted on children?s mothers in case and control group using the unified questionnaire.The questionnaire covers the following information,such as history of children's birth and growth,the basic information and healthy condition of their family,the living and working environment,and maternal dietary habits and nutritional supplements during periconception period,and et al.The final study sample consisted of 248 children with complex CHD,248 children with simple CHD,and 248 children in control group.Descriptive analysis was carry out on the collected data,to describe the sample characteristics in case and control group.The univariate and multivariate analyzes were carry out on using?~2 test,univariate and multivariate logistical regression model.ResultsAmong the children with complex CHD,the top three types were TOF(37%),PTA(11.7%),and SV(8.1%).Among the children with simple CHD,the top three types were VSD(44.0%),ASD(33.1%),and PDA(10.1%).The result of multivariate analysis demonstrated that the following factors were associated with both complex and simple CHD:low paternal education,low household income,maternal upper respiratory tract infection and using antibiotics/antipyretic analgesics during the first trimester,maternal stressful life events,contacting animals and contacting paint/dye,and residence near to main traffic road and smoke-emitting factories during periconception period.In addition,low maternal education(middle school and below vs.college and above OR=2.15,95%CI:1.07-4.31),maternal advanced age(?37 years vs.26-37 years OR=4.30,95%CI:1.29-14.35),maternal regular folic acid supplementation(OR=0.54,95%CI:0.31-0.93),maternal smoking/drinking during periconception period(OR=5.00,95%CI:1.03-24.33),maternal occupational exposure(OR=2.41,95%CI:1.15-5.06),paternal occupational exposure(OR=1.73,95%CI:1.01-2.98)and paternal smoking(?10 vs.0cigarettes/day OR=1.67,95%CI:1.06-2.64)were associated with complex CHD;maternal living and working environment with high temperature/pollution/noise(OR=2.50,95%CI:1.15-5.43)were associated with simple CHD.Moreover,it was found that,compared to simple CHD,low household income(<3000 vs.?5000OR=1.83,95%CI:1.02-3.29);maternal smoking/drinking during periconception period(OR=4.11,95%CI:1.08-15.62);paternal occupational exposure(OR=1.55,95%CI:1.02-2.34);maternal obesity(OR=5.37,95%CI:1.06-27.22)were associated with complex CHD.ConclusionThis study suggested that parental disadvantaged socioeconomic status,maternal high-risk biological and healthy characteristics,parental unhealthy lifestyles and harmful living and working environment during periconception period could increase the risk of complex CHD and simple CHD,while maternal regular folic acid supplementation was a protective factor for CHD.In addition,results also suggested that compared with simple CHD,more environmental and behavioral factors during periconception period were associated with complex CHD in offspring. |
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