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Children's Health Advance Publication

Environ Health Perspect; DOI:10.1289/ehp.1307289

Maternal Exposure to Criteria Air Pollutants and Congenital Heart Defects in Offspring: Results from the National Birth Defects Prevention Study

Jeanette A. Stingone,1 Thomas J. Luben,2 Julie L. Daniels,1 Montserrat Fuentes,3 David B. Richardson,1 Arthur S. Aylsworth,4 Amy H. Herring,5 Marlene Anderka,6 Lorenzo Botto,7 Adolfo Correa,8 Suzanne M. Gilboa,9 Peter H. Langlois,10 Bridget Mosley,11 Gary M. Shaw,12 Csaba Siffel,9 Andrew F. Olshan,1 and the National Birth Defects Prevention Study
Author Affiliations close
1Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; 2National Center for Environmental Assessment, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, North Carolina, USA; 3Department of Statistics, North Carolina State University, Raleigh, North Carolina, USA; 4Departments of Pediatrics and Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; 5Department of Biostatistics, Gillings School of Global Public Health University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; 6Massachusetts Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health Boston, Massachusetts, USA; 7Department of Genetics and Pediatrics, University of Utah, Salt Lake City, Utah, USA; 8Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA; 9National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; 10Texas Center for Birth Defects Research and Prevention, Texas Department of State Health Services Austin, Texas, USA; 11Arkansas Center for Birth Defects Research and Prevention, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA; 12Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
About This Article open

This EHP Advance Publication article has been peer-reviewed, revised, and accepted for publication. EHP Advance Publication articles are completely citable using the DOI number assigned to the article. This document will be replaced with the copyedited and formatted version as soon as it is available. Through the DOI number used in the citation, you will be able to access this document at each stage of the publication process.

Citation: Stingone JA, Luben TJ, Daniels JL, Fuentes M, Richardson DB, Aylsworth AS, Herring AH, Anderka M, Botto L, Correa A, Gilboa SM, Langlois PH, Mosley B, Shaw GM, Siffel C, Olshan AF, National Birth Defects Prevention Study. Maternal Exposure to Criteria Air Pollutants and Congenital Heart Defects in Offspring: Results from the National Birth Defects Prevention Study. Environ Health Perspect; http://dx.doi.org/10.1289/ehp.1307289.

Received: 28 June 2013
Accepted: 9 April 2014
Advance Publication: 11 April 2014

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Abstract

Background: Epidemiologic literature suggests exposure to air pollutants is associated with fetal development.

Objectives: To investigate maternal exposures to air pollutants during weeks two through eight of pregnancy and congenital heart defects.

Methods: Mothers from the National Birth Defects Prevention Study, a nine-state case-control study, were assigned one-week and seven-week averages of daily maximum concentrations of carbon monoxide, nitrogen dioxide, ozone, and sulfur dioxide and 24-hour measurements of fine and coarse particulate matter using the closest air monitor within 50 km to their residence during early pregnancy. Depending upon the pollutant, a maximum of 4632 live-birth controls and 3328 live-birth, fetal-death or electively terminated cases had exposure data. Hierarchical regression models, adjusted for maternal demographics, tobacco and alcohol use, were constructed. Principal component analysis was used to assess these relationships in a multipollutant context.

Results: Positive associations were observed between exposure to nitrogen dioxide and coarctation of the aorta and pulmonary valve stenosis. Exposure to fine particulate matter was positively associated with hypoplastic left heart syndrome but inversely associated with atrial septal defects. Examining individual exposure-weeks suggested associations between pollutants and defects that were not observed using the seven-week average. Associations between left ventricular outflow tract obstructions and nitrogen dioxide and hypoplastic left heart syndrome and particulate matter were supported by findings from the multipollutant analyses, although estimates were attenuated at the highest exposure levels.

Conclusions: Utilizing daily maximum pollutant levels and exploring individual exposure-weeks revealed some positive associations between certain pollutants and defects and suggested potential windows of susceptibility during pregnancy.


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