Non-inherited Risk Factors Of Congenital Heart Disease In Early Pregnancy: A Case-control Study

Objects: We aimed to study the association between maternal and paternal non-inherited risk factors in early pregnancy and fetal congenital heart disease(CHD) and its subtypes, providing basis for primary prevention.Methods: A hospital-based case-control study matched with 1 : 1 by age and gestational age was carried out in 200 pregnant women whose fetuses were diagnosed as CHD and 200 controls. Both groups received prenatal examination and delivery in Fujian Provincial Maternity and Child Care Center. Surveys were used to investigate the non-genetic exposure factors during 3 months before the pregnancy and the first trimester among the parents. The questionnaire included: socio-demographic characteristics, environmental exposures, occupational hazards, lifestyle, drug exposure, illnesses and conditions, maternal stress and nutrition. We also collected the information from the result of clinical examination of pregnant women and pregnancy outcome. Descriptive analysis were used to analyze maternal and paternal socio-demographic characteristics, x2 test and univariate and multivariate conditional Logistic regression analyses were used to identify associate factors for CHD and its subtypes.Results: 1. The risk factors contributing to CHD were noise exposure in early pregnancy(OR 6.375, 95% CI 2.142 to 18.971), maternal stress(OR 5.431, 95% CI 2.403 to 12.278), paternal chemical reagent exposure(OR 4.895, 95% CI 1.353 to 17.716), alcohol(OR 3.204, 95% CI 1.127 to 9.111), harmful substances exposure(OR 3.025, 95% CI 1.151 to 7.953), cigarette smoking(OR 2.131, 95% CI 1.126 to 4.035), stainless steel tableware(OR 2.662, 95% CI 1.090 to 6.496), foam dining boxes(OR 2.510, 95% CI 1.167 to 5.402). The protective factors of fetal CHD included milk(OR 0.446, 95% CI 0.215 to 0.927) and nuts intake before and after conception(OR 0.209, 95% CI 0.075 to 0.582). 2. Noise exposure(OR 8.418, 95% CI 2.007 to 35.311), foam dining boxes(OR 5.587, 95% CI 1.918 to 16.278), alcohol(OR 5.018, 95% CI 1.528 to 16.486), paternal alcohol(OR 5.266, 95% CI 1.802 to 15.393), maternal stress(OR 4.364, 95% CI 1.704 to 11.172), cigarette smoking(OR 4.101, 95% CI 1.724 to 9.755), cosmetics(OR 3.471, 95% CI 1.234 to 9.767), harmful substances exposure(OR 3.045, 95% CI 1.272 to7.288) may raise the risk of fetal septal defects. While nuts(OR 0.061, 95% CI 0.012 to 0.308) and seafood intake(OR 0.332, 95% CI 0.117 to 0.946) and living in city over a years(OR 0.223, 95% CI 0.078 to 0.640) may reduce the risk. 3. Risk factors of fetal conotruncal defects included noise exposure(OR 9.983, 95% CI 1.569 to 63.502), occupational hazards(OR 9.621, 95% CI 1.500 to 61.687), drugs(OR 9.042, 95% CI 1.579 to 51.766), cosmetics(OR 6.752, 95% CI 1.542 to 29.561), harmful substances exposure(OR 3.834, 95% CI 1.045 to 14.066). While milk intake before and after conception(OR 0.143, 95% CI 0.024 to 0.835) and paternal mental work(OR 0.181, 95% CI 0.048 to 0.685) and living in city over a years(OR 0.206, 95% CI 0.044 to 0.962) may reduce the risk. 4.Biscuit intake(OR 11.912, 95% CI 2.011 to 70.551), noise exposure(OR 9.734, 95% CI 1.521 to 62.294), harmful substances exposure(OR 9.371, 95% CI 2.391 to 36.729), maternal stress(OR 6.395, 95% CI 1.627 to 25.140) and foam dining boxes(OR 5.102, 95% CI 1.411 to 18.450) may raise the risk of other fetal cardiac malformations. 25 square meters per capita(OR 0.299, 95% CI 0.102 to 0.883) may reduce the risk.Conclusion: The risk factors contributing to CHD were noise exposure in early pregnancy, maternal stress, paternal chemical reagent exposure, alcohol, harmful substances exposure, cigarette smoking, stainless steel tableware, foam dining boxes. The protective factors of fetal CHD included milk and nuts intake before and after conception. Noise exposure, foam dining boxes, alcohol, paternal alcohol, maternal stress, cigarette smoking, cosmetics, harmful substances exposure may raise the risk of fetal septal defects. While nuts and seafood intake and living in city over a years may reduce the risk. Risk factors of fetal conotruncal defects included noise exposure, occupational hazards, drugs, cosmetics, harmful substances exposure. While milk intake and paternal mental work and living in city over a years may reduce the risk.Biscuit intake, noise exposure, harmful substances exposure, maternal stress and foam dining boxes may raise the risk of other fetal cardiac malformations. 25 square meters per capita may reduce the risk.