The prenatal weekly temperature exposure and neonatal congenital heart disease: a large population-based observational study in China

Abstract

We aim to explore the link between maternal weekly temperature exposure and CHD in offspring and identify the relative contributions from heat and cold and from moderate and extreme atmospheric temperature. From January 2019 to December 2020, newborns who were diagnosed with CHD by echocardiography in the Network Platform for Congenital Heart Disease (NPCHD) from 11 cities in eastern China were enrolled in the present study. We appraised the exposure lag response relationship between temperature and CHDs in the distributed lag nonlinear model and further probed the pooled estimates by multivariate meta-analysis. We further performed the exposure–response curves in extreme temperature (5 th percentile for cold and 95 th for hot events). We also delve into the cumulative risk ratios (CRRs) of temperature on CHDs in general and subgroups. In this study, 5904 of 983, 523 infants were diagnosed with CHDs. The temperature-CHD combination performed positive significance in two exposure windows, gestational weeks 10–16 and 26–31, and reached the maximum effect in the 28th week. Compared with extreme cold (5 th , 6.14℃), these effects were higher in extreme heat (95 th , 29.26℃). The cumulative exposure–response curve showed a steep nonlinear rise in the hot tail but showed non-significance at low temperatures. In this range, the CRRs of temperature showed an increment to a ceiling of 3.781 (95% CI: 1.460–10.723). The temperature- CHD curves for both sex groups showed a general growth trend. No statistical significance was observed between these two groups ( P = 0.106). The cumulative effect of the temperature related CHD was significant in regions with lower education levels (maximum CRR was 9.282 (3.019–28.535)). A degree centigrade increase in temperature exposure was associated with the increment of CHD risk in the first and second trimesters, especially in extreme heat. Neonates born in lower education regions were more vulnerable to temperature-related CHDs. Supplementary Information The online version contains supplementary material available at 10.1007/s11356-022-24396-5.

Liability, risks, and recommendations for ultrasound use in the diagnosis of obstetrics diseases

“…This is the primary risk to developing embryos and babies [ [60] , [61] , [62] , [63] ]. Animal research using both non-ultrasound and ultrasound technologies has shown that maternal heat exposure is hazardous to the developing embryo/fetus [ 60 , [64] , [65] , [66] , [67] , [68] , [69] , [70] ]. It seems to be the case if the temperature increases by more than 1.5 °C over the physiological threshold.…”

Maternal Exposure to Extreme Cold Events and Risk of Congenital Heart Defects: A Large Multicenter Study in China

“…Previous research has shown that cold environments can impact maternal blood viscosity and nutrient distribution, potentially leading to an increased occurrence of fetal growth defects. , A study based on the New York State Congenital Anomalies Registry found an association between ECEs and hypoplastic left heart syndrome and aortic stenosis . A Chinese study found minimal effects of extreme cold temperatures on neonatal prevalence, possibly as a result of the fact that the study assessed average weekly temperatures rather than ECEs . In addition, other studies have found an effect of ECEs on adverse pregnancy outcomes .…”

“…24 A Chinese study found minimal effects of extreme cold temperatures on neonatal prevalence, possibly as a result of the fact that the study assessed average weekly temperatures rather than ECEs. 15 In addition, other studies have found an effect of ECEs on adverse pregnancy outcomes. 22 Thus, given the rapidly increasing frequency of extreme temperature events and the uncertainty of the results, there is a need to further investigate the impact of maternal exposure to ECEs during the critical period of organogenesis (3−8 weeks of gestation) on the pathogenesis of CHD.…”

“…CHD and its subtypes are associated with multiple environmental exposures in pregnant women. − Previous research has identified temperature extremes as an important factor influencing adverse pregnancy outcomes . Over the past decade, extreme temperature events have become more frequent and longer in duration as a result of global warming, which will have an even greater impact on health outcomes, including maternal pregnancy outcomes. − There is sufficient evidence that extreme heat events contribute to the development of CHD. − Previous studies have found that extreme heat events can cause fetal cell death, prevent normal protein transcription and translation, and thus cause vascular destruction during organogenesis. , However, studies on the effects of extreme cold events (ECEs) on the pathogenesis of CHD are scarce and inconsistent. Previous research has shown that cold environments can impact maternal blood viscosity and nutrient distribution, potentially leading to an increased occurrence of fetal growth defects. , A study based on the New York State Congenital Anomalies Registry found an association between ECEs and hypoplastic left heart syndrome and aortic stenosis .…”