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Meta-Analysis
. 2014 Jul 31;11(8):7642-68.
doi: 10.3390/ijerph110807642.

Effects of air pollution on the risk of congenital anomalies: a systematic review and meta-analysis

Esther Kai-Chieh Chen  1 , Denis Zmirou-Navier  2 , Cindy Padilla  3 , Séverine Deguen  4
Affiliations
Meta-Analysis

Effects of air pollution on the risk of congenital anomalies: a systematic review and meta-analysis

Esther Kai-Chieh Chen et al. Int J Environ Res Public Health. .

Abstract

Congenital anomalies are the main causes of preterm and neonatal mortality and morbidity. We investigated the association between congenital anomalies and mothers' exposure to air pollution during pregnancy by combining risk estimates for a variety of air pollutants (SO2, NO2, PM10, PM2.5, CO and O3) and anomaly defect outcomes. Seventeen articles were included in the systematic review and thirteen studies were taken into account in the meta-analysis. Combined estimated were calculated separately according to whether the exposure metric was continuous or categorical. Only one significant combination was; NO2 concentrations were significantly associated with coarctation of the aorta (OR = 1.20 per 10 ppb, 95% CI, (1.02, 1.41)). This finding could stem from strong heterogeneity in study designs. Improved exposure assessment methods, in particular more accurate spatial measurements or modeling, standardized definition of cases and of better control of confounders are highly recommended for future congenital anomalies research in this area.

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Figures

Figure 1
Figure 1
Forest plots for combinations of ventricular septal defects and pollutant (as a continuous variable). The size of each square represents the weight that contributes to the combined effect, respectively for: (A) SO2; (B) PM10; (C) NO2; (D) CO; and (E) O3.
Figure 2
Figure 2
Forest plots for combinations of atrial septal defects and pollutant (as a continuous variable). The size of each square represents the weight that contributes to the combined effect, respectively for: (A) SO2; (B) PM10; (C) NO2; (D) CO and (E) O3.
Figure 3
Figure 3
Forest plots for combinations of two cardiac anomalies (coarctation of aorta and tetralogy of fallot) and pollutant. The size of each square represents the weight that contributes to the combined effect. (A), (C), (E) were combined effects of coarctation of aorta and SO2, PM10 and NO2. (B), (D) and (F) were combined effects of tetralogy of fallot and SO2, PM10 and NO2.
Figure 4
Figure 4
Forest plots for a variety of pollutants and risk of orofacial defects. (A), (B), (C) and (D) showed combined effects of PM10, NO2, CO and O3; (E) was the combined effect of NO2 and cleft lip from continuous exposure risk estimates.
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