Relationship between maternal heavy metal exposure and congenital heart defects: a systematic review and meta-analysis

• Published in: Environmental science and pollution research international Vol. 29; no. 37; pp. 55348 - 55366
• Main Authors: Li, Shimeng, Wang, Qinbo, Luo, Wenting, Jia, Shanshan, Liu, Dan, Ma, Wei, Gu, Hui, Wei, Xiaowei, He, Yiwen, Cao, Songying, Yuan, Zhengwei
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2022; Springer Nature B.V
• Subjects: Aquatic Pollution; Arsenic; Atmospheric Protection/Air Quality Control/Air Pollution; Barium; Cadmium; Defects; Earth and Environmental Science; Ecotoxicology; Environment; Environmental Chemistry; Environmental Health; Environmental science; Exposure; Heart; Heavy metals; Heterogeneity; Lead; Measurement methods; Mercury; Mercury (metal); Meta-analysis; Offspring; Pregnancy; Review Article; Risk analysis; Risk factors; Subgroups; Ventricle; Waste Water Technology; Water Management; Water Pollution Control; Cadmium; Barium; Arsenic; Gestational exposure; Lead; Copper; Mercury; Congenital heart defects
• ISSN: 0944-1344; 1614-7499
• DOI: 10.1007/s11356-022-21071-7

Congenital heart defects (CHDs) are one of the major causes of death in infants and young children, and heavy metal exposure during pregnancy is one of the possible risk factors. However, the effect of heavy metal exposure on CHDs is still controversial. We searched English (PubMed, Web of Science) and Chinese (CNKI and WanFang database) databases for relevant articles. The summarized effect sizes and 95% confidence intervals (CIs) were calculated by pooling estimates using the random-effects model. Egger’s test was used to estimate publication bias. Heterogeneity among studies was indicated by p -values and I 2 . Finally, we conducted subgroup analyses to elucidate the causes of heterogeneity. Thirteen studies were included in this meta-analysis. A positive association between maternal exposure to heavy metals and CHDs was found. Pooling odds ratios (ORs) for arsenic, cadmium, mercury, and lead were 2.12, 1.30, 1.22, and 2.30, respectively for total CHDs. Regarding CHD subtypes, arsenic was associated with an increased risk of septal defects (OR: 1.82), barium with left ventricular outflow tract obstruction (LVOTO) (OR: 1.15) and septal defects (OR: 1.21), and lead with conotruncal defects (OR: 2.34) and LVOTO (OR: 1.93). A heterogeneous relationship was found between studies using different methods of measurement, which were mainly due to differences in actual exposure levels to heavy metals. This meta-analysis suggests significant associations between arsenic, cadmium, mercury, and lead exposure during pregnancy and an increased risk of specific CHDs in offspring. These findings underscore the importance of heavy metal exposure during pregnancy in the risk of CHDs in offspring.