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


Stingone, Jeanette A.; Luben, Thomas J.; Daniels, Julie L.; Fuentes, Montserrat; Richardson, David B.; Aylsworth, Arthur S.; Herring, Amy H.; Anderka, Marlene; Botto, Lorenzo D.; & Correa, Adolfo, et al. (2014). Maternal Exposure to Criteria Air Pollutants and Congenital Heart Defects in Offspring: Results from the National Birth Defects Prevention Study. Environmental Health Perspectives, 122(8), 863-872. PMCID: PMC4123026


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.


Reference Type

Journal Article

Year Published


Journal Title

Environmental Health Perspectives


Stingone, Jeanette A.
Luben, Thomas J.
Daniels, Julie L.
Fuentes, Montserrat
Richardson, David B.
Aylsworth, Arthur S.
Herring, Amy H.
Anderka, Marlene
Botto, Lorenzo D.
Correa, Adolfo
Gilboa, Suzanne M.
Langlois, Peter H.
Mosley, Bridget S.
Shaw, Gary M.
Siffel, Csaba
Olshan, Andrew F.
the National Birth Defects Prevention Study,