Environmental Factors During The Periconception Period And Fetal Congenital Heart Disease:a Case-control Study

Objectives:We estimated the association between periconception environmental factors and fetal congenital heart disease(CHD),to explore the important factors of fetal CHD and provide a reference for primary prevention.Methods:This study was a retrospective case-control study.We chose the pregnant women who had undergone prenatal examination at the Fujian Matenity and Child Health Hospital from January 2016 to December 2018 as the research objects.There were124 cases and 155 controls.We used specially designed questionnaire to conduct inquiries and investigations on the subjects.The data analysis was performed by SPSS24.0 software for Person chi-square test or Fisher probabilities test,univariate and multivariate logistic regression analysis;the same type of factors were combined into comprehensive variables for multivariate logistic regression analysis and receiver operating characteristic(ROC)curve analysis,to study the association between periconception environmental factors and fetal CHD.Results:1.Living environment during periconception: pregnant women living in newly renovated rooms(OR=2.180,95%CI : 1.111-4.279),3 months before conception exposure to cockroach pesticides(OR=3.520,95%CI: 1.647-7.526),kitchen fume cleaner(OR=3.676,95%CI: 1.647-7.526)and 3 months after conception exposure to kitchen fume(OR=2.148,95%CI: 1.198-3.854)were related to the occurrence of fetal CHD.Household cleaning materials(including air fresheners,mosquito killer tablets or mosquito coils,cockroach pesticides,kitchen fume cleaner)low exposure(1-2items,OR=2.653,95%CI: 1.144-6.150)and high exposure(≥3 items,OR=4.697,95%CI: 1.968-11.209)during periconception significantly increased the risk of fetal CHD,and as the exposure level increased,the risk increased.Living in the rural areas compared to the suburbs(OR=0.219,95%CI: 0.067-0.711)and cities(OR=0.256,95%CI: 0.094-0.701)during periconception increased the risk of fetal CHD.2.Living habits during periconception: raising poultry during periconception(OR=8.202,95% CI: 1.583-42.490)contributed to fetal CHD.3.Maternal health: maternal anemia during periconception(OR=3.909,95%CI:1.467-10.421)and history of birth defects(OR=11.923,95%CI: 2.216-64.150)significantly increased the risk of fetal CHD.Maternal diseases(including infections of the upper respiratory tract,gastroenteritis,thyroid dysfunction,diabetes,allergic dermatitis,anemia)high exposure(≥3 items,OR=4.880,95%CI: 1.243-19.164)increased risk of fetal CHD.4.Protective factors of fetal CHD: maternal pre-pregnancy medical examination(OR=0.536,95% CI: 0.305-0.942)and folic acid / folic acid-containing vitamins supplementation during periconception(OR=0.551,95%CI:0.314-0.969)significantly reduced the risk of fetal CHD.Comprehensive preparations for couples before pregnancy(including women pre-pregnancy medical examination,husband medical examination before wife pregnancy,pregnancy planning,eugenics education,OR=0.515,95% CI: 0.280-0.948)was protective factors of fetal CHD.5.The area under the curve(AUC)of Receiver operating characteristic(ROC)curve evaluated Comprehensive variable logistic regression model’s value of predicting the occurrence of fetal CHD: the AUC of ROC curve of comprehensive variable regression model was 0.751,sensitivity was 86.3%,specificity was 54.8%,the best cut-off value was 0.451.Conclusions:1.The renovation of women’s rooms or workplaces,exposure of kitchen fumes,and the raising poultry during periconception were risk factors for fetal CHD,exposure to air fresheners,cockroach killers,lampblack cleaners,anti-mosquito tablets or mosquito coils and other household cleaning products,as the exposure items increased,the risk of fetal CHD increased.2.Pregnant women with anemia and 3 or more diseases(including infections of the upper respiratory tract,gastroenteritis,thyroid dysfunction,diabetes,allergic dermatitis,anemia)during periconception were all significantly associated with fetal CHD.Maternal history of birth defects had also increased the risk of fetal CHD.3.Both husband and wife attaching importance to pre-pregnancy preparations include women pre-pregnancy medical examination,husband medical examination before wife pregnancy,pregnancy planning,eugenics education,and maternal folic acid / folic acid-containing vitamins supplementation during periconception can effectively reduce the risk of fetal CHD.4.We should pay attention to the education related to eugenics,especially to strengthening the general education of rural areas and low-education people.Department of health ought to actively carry out peri-pregnancy health care work and expand prenatal care to pre-pregnancy care.Promoting pregnancy planning,making preparations before pregnancy,reducing the exposure of perinatal risk factors and implement interventions will help the primary prevention of fetal CHD.