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Racial disparities in maternal exposure to ambient air pollution during pregnancy and prevalence of congenital heart defects

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Air pollution may be a potential cause of congenital heart defects (CHDs), but racial disparities in this association are unexplored. We conducted a statewide population-based cohort study using North Carolina birth data from 2003 to 2015 (n = 1 225 285) to investigate the relationship between air pollution and CHDs (specifically pulmonary valve atresia/stenosis, tetralogy of Fallot [TOF], and atrioventricular septal defect [AVSD]). Maternal exposure to particulate matter ≤ 2.5 μm in diameter (PM2.5) and ozone during weeks 3 to 9 of pregnancy were estimated using the Environmental Protection Agency’s Downscaler Model. Single- and co-pollutant log-binomial models were created for the entire population and stratified by race to investigate disparities. Positive associations between PM2.5 and CHDs were observed. An increasing concentration-response association was found for PM2.5 and TOF in adjusted, co-pollutant models (quartile 4 prevalence ratio: 1.46; 95% CI, 1.06-2.03). Differences in the effect of PM2.5 on CHD prevalence were seen in some models stratified by race, although clear exposure-prevalence gradients were not evident. Positive associations were also seen in adjusted, co-pollutant models of ozone and AVSD. Study results suggest that prenatal PM2.5 and ozone exposure may increase the prevalence of certain CHDs. A consistent pattern of differences in association by race/ethnicity was not apparent.

Impact/Purpose

Higher levels of maternal exposure to ambient PM2.5 and ozone early in pregnancy may increase the prevalence of certain congenital heart defects. Results from our study suggest that air pollution exposure may impact non-Hispanic Black and non-Hispanic White pregnancies differently, though more epidemiologic studies are needed to confirm these findings.

Citation

Arogbokun, O., T. Luben, J. Stingone, L. Engel, C. Martin, AND A. Olshan. Racial disparities in maternal exposure to ambient air pollution during pregnancy and prevalence of congenital heart defects. Johns Hopkins Bloomberg School of Public Health, 194(3):709-721, (2025). [DOI: 10.1093/aje/kwae253]

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DOI: Racial disparities in maternal exposure to ambient air pollution during pregnancy and prevalence of congenital heart defects
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Last updated on March 07, 2025
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