Ruan Yanping, Wang Yaqi, Zou Zhiyong, Li Jing, He Yihua
Echocardiography Medical Center, Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China.
Toxics. 2025 May 31;13(6):463. doi: 10.3390/toxics13060463.
The relevance of O exposure in critical congenital heart disease (CCHD) remains uncertain and requires further investigation. The present study aims at quantitatively assessing the association between ambient O exposure during the early pregnancy period with fetal CCHD and identifying possible susceptible exposure windows. A retrospective cohort study involving 24,516 pregnant women was conducted using data from the Maternal-Fetal Medicine Consultation Network, which encompassed 1313 medical centers across China from 2013 to 2021. We extracted daily O concentrations from a validated grid dataset with a spatial resolution of 0.1° at each participant's residential county to assess ambient O exposure, followed by calculating the average exposure levels in the periconceptional period, embryonic period, first trimester, and preconception period. The diagnosis of CCHD was based on fetal echocardiography. Exposure-response analyses were carried out using logistic regression models. During the study period, a total of 1541 (17.4%) subjects were diagnosed with fetal CCHD. Each 10 µg/m increase in ambient O exposure in the periconceptional period was associated with a 26.0% increase in the odds of CCHD (odds ratio [OR]: 1.260, 95% confidence interval [CI]: 1.189, 1.335; < 0.001). Importantly, the association was not modified by factors including maternal age and occupation status, paternal age and smoking status, conception mode, and the presence of risk factors. In the sensitivity analysis, significant associations were observed between O exposure and CCHD in the embryonic period, first trimester, and preconception period, which was consistent with the results of the main analyses. These findings suggest that lowering ambient O exposure in the preconception and early pregnancy periods may be beneficial in reducing the risk of fetal CCHD, especially in regions with elevated O levels.
孕期暴露于臭氧与严重先天性心脏病（CCHD）之间的相关性仍不确定，需要进一步研究。本研究旨在定量评估孕早期环境臭氧暴露与胎儿CCHD之间的关联，并确定可能的易感暴露窗口期。利用母胎医学咨询网络的数据进行了一项回顾性队列研究，该网络涵盖了2013年至2021年中国1313个医疗中心的24516名孕妇。我们从一个经过验证的网格数据集中提取了每个参与者居住县的每日臭氧浓度，空间分辨率为0.1°，以评估环境臭氧暴露，然后计算围孕期、胚胎期、孕早期和孕前时期的平均暴露水平。CCHD的诊断基于胎儿超声心动图。使用逻辑回归模型进行暴露-反应分析。在研究期间，共有1541名（17.4%）受试者被诊断为胎儿CCHD。围孕期环境臭氧暴露每增加10μg/m，CCHD的患病几率增加26.0%（比值比[OR]：1.260，95%置信区间[CI]：1.189，1.335；P<0.001）。重要的是，该关联不受包括母亲年龄和职业状况、父亲年龄和吸烟状况、受孕方式以及危险因素的存在等因素的影响。在敏感性分析中，在胚胎期、孕早期和孕前时期观察到臭氧暴露与CCHD之间存在显著关联，这与主要分析结果一致。这些发现表明，在孕前和孕早期降低环境臭氧暴露可能有助于降低胎儿CCHD的风险，特别是在臭氧水平升高的地区。
