Dongyu Zhang1, Hao Cui2, Long Zhang3, Yanjie Huang4, Jun Zhu5, Xiaohong Li6. 1. a Department of Epidemiology , University of North Carolina at Chapel Hill Gillings School of Global Public Health , Chapel Hill , NC , USA. 2. b Department of Health , Zhuhai Maternity and Child Health Hospital , Zhuhai , Guangdong , China. 3. c Department of Epidemiology and. 4. d Department of Health Policy and Management , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA. 5. e National Office for Maternal and Child Health Surveillance of China, West China Second Hospital, Sichuan University , Chengdu , Sichuan , China , and. 6. f National Center for Birth Defects Monitoring of China, West China Second Hospital, Sichuan University , Chengdu , Sichuan , China.
Abstract
OBJECTIVE: To investigate the association between maternal smoking during pregnancy and risk of congenital heart defects (CHDs) among offspring. METHODS: PubMed, EMBASE, and Web of Science were searched for eligible studies. The outcomes of interest included risk of any CHD and nine subtypes. We summarized study characteristics and used a random-effects model in meta-analysis, and a two-stage dose-response model was utilized to assess the association between smoking consumption and risk. Statistical heterogeneity was assessed by a chi-squared test of the Cochrane Q statistic and I-squared value. Publication bias was assessed by funnel plots and Egger's test, and trim and fill method was utilized when publication bias existed. RESULTS: Forty-three observational epidemiologic studies were included. The pooled risk ratio (RR) of any CHD was 1.11 (95% CI: 1.04, 1.18), but it exhibited substantial statistical heterogeneity (p < 0.001, I2 = 69.0%). In sensitivity analysis, we observed significant associations for atrial septal defect (ASD) and marginally significant associations for septal defects (SPD). The two-stage dose-response analysis showed evidence to support that higher levels of tobacco smoke was associated with an increased risk of septal defects, particularly for ASD and VSD (ventricular septal defect). CONCLUSION: Our study presents evidence to support the cardiovascular teratogenic effect of maternal smoking during pregnancy, and their offspring may suffer from approximately a 10% relative increase in the risk of CHDs on average.
OBJECTIVE: To investigate the association between maternal smoking during pregnancy and risk of congenital heart defects (CHDs) among offspring. METHODS: PubMed, EMBASE, and Web of Science were searched for eligible studies. The outcomes of interest included risk of any CHD and nine subtypes. We summarized study characteristics and used a random-effects model in meta-analysis, and a two-stage dose-response model was utilized to assess the association between smoking consumption and risk. Statistical heterogeneity was assessed by a chi-squared test of the Cochrane Q statistic and I-squared value. Publication bias was assessed by funnel plots and Egger's test, and trim and fill method was utilized when publication bias existed. RESULTS: Forty-three observational epidemiologic studies were included. The pooled risk ratio (RR) of any CHD was 1.11 (95% CI: 1.04, 1.18), but it exhibited substantial statistical heterogeneity (p < 0.001, I2 = 69.0%). In sensitivity analysis, we observed significant associations for atrial septal defect (ASD) and marginally significant associations for septal defects (SPD). The two-stage dose-response analysis showed evidence to support that higher levels of tobacco smoke was associated with an increased risk of septal defects, particularly for ASD and VSD (ventricular septal defect). CONCLUSION: Our study presents evidence to support the cardiovascular teratogenic effect of maternal smoking during pregnancy, and their offspring may suffer from approximately a 10% relative increase in the risk of CHDs on average.
Authors: Sonia Hernández-Díaz; Brian T Bateman; Kristin Palmsten; Sebastian Schneeweiss; Krista F Huybrechts Journal: Pharmacoepidemiol Drug Saf Date: 2019-12-20 Impact factor: 2.890
Authors: Sumi Hoshiko; Michelle Pearl; Juan Yang; Kenneth M Aldous; April Roeseler; Martha E Dominguez; Daniel Smith; Gerald N DeLorenze; Martin Kharrazi Journal: Int J Environ Res Public Health Date: 2019-02-05 Impact factor: 3.390
Authors: Maria C Magnus; German Tapia; Sjurdur F Olsen; Charlotta Granstrom; Karl Mårild; Per M Ueland; Øivind Midttun; Jannet Svensson; Jesper Johannesen; Torild Skrivarhaug; Geir Joner; Pål R Njølstad; Ketil Størdal; Lars C Stene Journal: Epidemiology Date: 2018-11 Impact factor: 4.822