Maternal Exposure to Ambient Ozone and Fetal Critical Congenital Heart Disease in China: A Large Multicenter Retrospective Cohort Study
The relevance of O<sub>3</sub> 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<sub>3</sub> exposure during the early pregnancy perio...
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MDPI AG
2025-05-01
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| author | Yanping Ruan Yaqi Wang Zhiyong Zou Jing Li Yihua He |
| author_facet | Yanping Ruan Yaqi Wang Zhiyong Zou Jing Li Yihua He |
| author_sort | Yanping Ruan |
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| description | The relevance of O<sub>3</sub> 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<sub>3</sub> 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<sub>3</sub> concentrations from a validated grid dataset with a spatial resolution of 0.1° at each participant’s residential county to assess ambient O<sub>3</sub> 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<sup>3</sup> increase in ambient O<sub>3</sub> 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; <i>p</i> < 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<sub>3</sub> 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<sub>3</sub> exposure in the preconception and early pregnancy periods may be beneficial in reducing the risk of fetal CCHD, especially in regions with elevated O<sub>3</sub> levels. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2025-05-01 |
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| series | Toxics |
| spelling | doaj-art-b15c6dac6ace4effa6bc66dd685dfe5d2025-08-20T03:32:31ZengMDPI AGToxics2305-63042025-05-0113646310.3390/toxics13060463Maternal Exposure to Ambient Ozone and Fetal Critical Congenital Heart Disease in China: A Large Multicenter Retrospective Cohort StudyYanping Ruan0Yaqi Wang1Zhiyong Zou2Jing Li3Yihua He4Echocardiography Medical Center, Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, ChinaInstitute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, ChinaInstitute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, ChinaInstitute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, ChinaEchocardiography Medical Center, Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, ChinaThe relevance of O<sub>3</sub> 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<sub>3</sub> 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<sub>3</sub> concentrations from a validated grid dataset with a spatial resolution of 0.1° at each participant’s residential county to assess ambient O<sub>3</sub> 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<sup>3</sup> increase in ambient O<sub>3</sub> 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; <i>p</i> < 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<sub>3</sub> 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<sub>3</sub> exposure in the preconception and early pregnancy periods may be beneficial in reducing the risk of fetal CCHD, especially in regions with elevated O<sub>3</sub> levels.https://www.mdpi.com/2305-6304/13/6/463congenital heart defectscritical congenital heart defectsair pollutionozonepericonceptional period |
| spellingShingle | Yanping Ruan Yaqi Wang Zhiyong Zou Jing Li Yihua He Maternal Exposure to Ambient Ozone and Fetal Critical Congenital Heart Disease in China: A Large Multicenter Retrospective Cohort Study Toxics congenital heart defects critical congenital heart defects air pollution ozone periconceptional period |
| title | Maternal Exposure to Ambient Ozone and Fetal Critical Congenital Heart Disease in China: A Large Multicenter Retrospective Cohort Study |
| title_full | Maternal Exposure to Ambient Ozone and Fetal Critical Congenital Heart Disease in China: A Large Multicenter Retrospective Cohort Study |
| title_fullStr | Maternal Exposure to Ambient Ozone and Fetal Critical Congenital Heart Disease in China: A Large Multicenter Retrospective Cohort Study |
| title_full_unstemmed | Maternal Exposure to Ambient Ozone and Fetal Critical Congenital Heart Disease in China: A Large Multicenter Retrospective Cohort Study |
| title_short | Maternal Exposure to Ambient Ozone and Fetal Critical Congenital Heart Disease in China: A Large Multicenter Retrospective Cohort Study |
| title_sort | maternal exposure to ambient ozone and fetal critical congenital heart disease in china a large multicenter retrospective cohort study |
| topic | congenital heart defects critical congenital heart defects air pollution ozone periconceptional period |
| url | https://www.mdpi.com/2305-6304/13/6/463 |
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