Prenatal exposure to air pollutants and the risk of congenital heart disease: a Korean national health insurance database-based study

Abstract

Air pollution and heavy metal exposure are emerging public health concerns. Prenatal exposure to air pollutants and heavy metals has been implicated in the development of congenital heart disease (CHD). However, the relationship between exposure to airborne heavy metals and CHD has not yet been investigated. Therefore, in this large population-based study, we investigated the association between air pollutants, including airborne heavy metals, and the risk of CHD using national health insurance claims data from South Korea. Data regarding 1,129,442 newborns and their mothers were matched with air pollutant levels during the first 8 weeks of gestation. In the five-air pollutant model, we found significant positive correlations between prenatal exposure to sulfur dioxide (SO₂; odds ratio [OR] 6.843, 95% confidence interval [CI] 5.746-8.149) and cadmium (Cd; OR 1.513, 95% CI 1.187-1.930) and the risk of ventricular septal defects in newborns. This study highlights the association between prenatal exposure to air pollutants, including airborne heavy metals, and an elevated CHD risk. Further research is essential to validate and expand these findings, with the ultimate goal of enhancing public health outcomes.

Figure 1

Flow diagram of this study.

Figure 2

The spatial distribution of the overall mean concentrations of SO₂ and Cd and the number of congenital heart diseases in South Korea. (a) SO₂ with number of total CHD; (b) SO₂ and number of VSD; (c) Cd and number of total CHD; (d) Cd and number of VSD. The mean concentration of SO₂/Cd is shown in the grey scale, and the number of patients with total CHD/VSD is indicated by the size of each circle. CHD, congenital heart disease; VSD, ventricular septal defect.