Wang Yaqi, Ruan Yanping, Wan Xiaoyu, Wang Huan, Guo Jianhui, Wei Jing, Ma Sheng, He Yihua, Zou Zhiyong, Li Jing
Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China.
Department of Echocardiography, Maternal-Fetal Medicine Research Consultation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
J Expo Sci Environ Epidemiol. 2025 May;35(3):511-519. doi: 10.1038/s41370-024-00716-4. Epub 2024 Aug 31.
Ambient O has demonstrated an aggravated increasing trend in the context of global warming. The available evidence of maternal exposure to ambient O on fetal congenital heart defects (CHD) is still limited, especially in high polluted areas.
To examine associations of maternal exposure to ambient O during early pregnancy with fetal CHDs.
We conducted a national multicenter study in 1313 hospitals from 26 provinces in China and collected a total of 27,817 participants at high risk of CHD from 2013 to 2021. Exposure to ambient O during the embryonic period, preconception, the first trimester and periconception was assessed by extracting daily concentrations from a validated grid dataset at each subject's residential district. CHDs were diagnosed based on fetal echocardiography.
Each 10 µg/m increase of exposure to ambient O during the embryonic period was approximately linearly associated with a 12.7% (odds ratio [OR]: 1.127, 95% confidence interval [CI]: 1.098, 1.155) increase in odds of pooled CHD (p < 0.001). The associations remain robust after adjusting for ambient PM and NO exposure. The odds of different types of CHD in association with ambient O exposure varied greatly. We observed significant association of ambient O exposure with ventricular septal defect (VSD), tetralogy of Fallot (TOF); pulmonary stenosis (PS), pulmonary atresia (PA), transposition of great arteries (TGA) and persistent left superior vena cava (PLSVC), with TOF demonstrating the strongest estimates (OR: 1.194, 95% CI:1.107, 1.288). The estimates for preconception, the first trimester and periconception demonstrate consistent findings with the main analyses, indicating stronger associations of ambient O exposure during the periconception period.
Our study provides evidence that higher ambient O during early pregnancy was significantly associated with increased odds of fetal CHD. Our findings suggest that pregnant women, clinical practitioners, and policy makers need to pay more attention to the exposure to higher ambient O during early pregnancy to reduce the risk of developing CHD and to improve outcomes across the life span.
在全球变暖的背景下，环境臭氧（O₃）呈现出加剧的上升趋势。关于孕期母亲暴露于环境臭氧与胎儿先天性心脏病（CHD）之间的现有证据仍然有限，尤其是在高污染地区。
研究孕早期母亲暴露于环境臭氧与胎儿先天性心脏病之间的关联。
我们在中国26个省份的1313家医院开展了一项全国性多中心研究，在2013年至2021年期间共收集了27817名先天性心脏病高危参与者。通过从每个受试者居住地区经过验证的网格数据集中提取每日浓度，评估胚胎期、孕前、孕早期和围孕期暴露于环境臭氧的情况。先天性心脏病通过胎儿超声心动图进行诊断。
胚胎期环境臭氧暴露每增加10µg/m³，合并先天性心脏病的几率大约线性增加12.7%（优势比[OR]：1.127，95%置信区间[CI]：1.098，1.155）（p<0.001）。在调整环境细颗粒物（PM）和一氧化氮（NO）暴露后，这种关联仍然稳健。不同类型先天性心脏病与环境臭氧暴露的几率差异很大。我们观察到环境臭氧暴露与室间隔缺损（VSD）、法洛四联症（TOF）、肺动脉狭窄（PS）、肺动脉闭锁（PA）、大动脉转位（TGA）和永存左上腔静脉（PLSVC）之间存在显著关联，其中法洛四联症的估计值最强（OR：1.194，95%CI：1.107，1.288）。孕前、孕早期和围孕期的估计结果与主要分析结果一致，表明围孕期环境臭氧暴露的关联更强。
我们的研究提供了证据，表明孕早期较高的环境臭氧水平与胎儿先天性心脏病几率增加显著相关。我们的研究结果表明，孕妇、临床医生和政策制定者需要更加关注孕早期暴露于较高环境臭氧水平的情况，以降低患先天性心脏病的风险，并改善整个生命周期的结局。
