Risk factors for ventricular septal defect in finland

The possible effect of genetic and environmental factors during pregnancy on the occurrence of ventricular septal defect (VSD) in the offspring was studied in 150 cases and 756 controls. The cases represented all verified VSDs in Finland during 1982-1983. The controls were randomly selected from all babies born during the same period. Case and control mothers were interviewed by midwives approximately three months after delivery using a structured questionnaire. Congenital heart disease was more prevalent among parents of cases than those of controls. Maternal alcohol consumption during the first trimester of pregnancy was more common among the mothers of VSD infants (47.0%) than among those of controls (38.0%, P less than 0.05). Exposure to organic solvents at work showed in logistic regression analysis an adjusted relative odds ratio of 1.8 (95% confidence interval 1.0-3.4). The risk of VSD was not associated with any of the maternal habits monitored, e.g. smoking, or coffee, tea, cola, acetosalicylic acid or diazepam consumption. Whether the mother was employed during the first trimester of pregnancy, and her exposure to anesthetic gases, disinfectants, pecticides, wood preservatives or video display terminals were not factors associated with the risk of ventricular septal defect.     

Risk factors for cardiovascular malformations in Finland

The possible effects of genetic and environmental risk factors during pregnancy on the occurrence of cardiovascular malformations in the offspring was studied in 408 cases and 756 controls. The cases represented all registered cardiovascular malformations reported in Finland during 1982–1983. The controls were randomly selected from all babies born during the same period. Both the case and control mothers were interviewed by midwives approximately three months after delivery using a structured questionnaire. The parents of cases had more cardiovascular malformations than parents of the controls. Maternal alcohol consumption seemed to double the risk of atrial septal defect (OR =1.9, CI₉₅1.0–3.4). Maternal exposure to dyes, lacquers or paints was a significant risk factor for conal septal defects (OR = 2.9, CI₉₅ = 1.2–7.5). Maternal upper respiratory infection was twice as common among the hypoplastic left ventricle group as among the controls. Maternal smoking, coffee, tea and cola consumption and intake of acetylsalicylic acid were equally prevalent in both groups. Maternal exposure to anesthetic gases, wood preservatives or pesticides was not associated with the risk of cardiovascular malformations. The study confirms that very little is known of the etiology of congenital heart disease.     

Occupational risk factors for congenital heart disease

Summary To investigate possible associations between cardiovascular malformations and maternal occupational exposure to various factors during the first trimester of pregnancy, 406 cases and 756 controls were studied retrospectively. The cases were taken from all infants diagnosed with cardiovascular malformations born in Finland during 1982 and 1983. The controls were randomly selected from all normal births in the country during the same period. All mothers were interviewed approximately 3 months after delivery by a midwife, using a structured questionnaire. Maternal overall exposure to chemicals at work was more prevalent among the case group (35.8%) than the control group (26.2%,P < 0.01). Among the specific chemical groups, maternal exposure to dyes, lacquers, or paints was significantly associated with the risk of congenital heart disease. Exposure to organic solvents during the first trimester seemed to increase to risk of ventricular septal defect (P < 0.05). Work at video display terminals was slightly more prevalent among the case group (6.3%) than among the control group (5.0%). The mothers' education level, regular exposure to passive smoking at work, or temperature at the workplace were not risk factors for congenital heart disease in the offspring, neither was maternal exposure to microwave ovens, disinfectants, pesticides, or anesthetic gases. It is concluded that many maternal exposures at work seem not to have a teratogenic effect on the fetal heart, although the limited power of this investigation needs to be borne in mind.     

Risk factors for conal malformations of the heart

The possible effect of environmental factors during early pregnancy on the occurrence of conal malformations (CAS) in the offspring was studied in 90 cases and 756 controls. The cases represented all CAS-infants with anomalies such as transposition, Tetralogy of Fallot and truncus arteriosus verified in Finland during 1982 and 1983. The controls were randomly selected from all babies born in the same period. Case and control mothers were interviewed by midwives using a structured questionnaire approximately three months after delivery. Maternal alcohol consumption during the first trimester was more prevalent among CAS-mothers (50.0%) than controls (38.0%), as was maternal upper respiratory infection (33.0/17.7%). Maternal exposure to dyes, lacquers or paints at work during the first trimester showed an adjusted relative odds ratio of 2.9 (95% confidence interval 1.2-7.5) in logistic regression analysis. The risk of CAS was equal in urban and rural areas and not associated with maternal ABO- or Rh-blood groups, smoking, or coffee, tea, acetylsalicylic acid or diazepam consumption. Maternal exposures to plastic raw materials, disinfectants, pesticides, microwave-ovens or video display terminals at work were not factors associated with the risk of conal malformations.     

Cardiovascular malformations and organic solvent exposure during pregnancy in Finland

In order to investigate the possible association between cardiovascular malformations and maternal exposure to organic solvents during the first trimester of pregnancy, 569 cases and 1,052 controls were retrospectively studied. The cases represented all infants with diagnosed cardiovascular malformations born in Finland in 1982-1984, and the controls were randomly selected from all normal births in the country during the same period. All mothers were interviewed approximately 3 months after delivery by a midwife using a structured questionnaire. Exposures to organic solvents at work during the first trimester of pregnancy were slightly more prevalent among the mothers of affected infants (10.4%) than among those of controls (7.8%). Logistic regression analysis of exposure to organic solvents showed an adjusted relative odds ratio of 1.3 (95% confidence interval, 0.8-2.2). In the analysis of ventricular septal defect, exposure to organic solvents showed an adjusted relative odds ratio of 1.5 (95% confidence interval, 1.0-3.7).     

Caffeine intake and small-for-gestational-age birth: modifying effects of xenobiotic-metabolising genes and smoking

The relationship between caffeine consumption and small-for-gestational-age (SGA) birth remains uncertain. However, factors that can influence caffeine metabolism, such as genetic polymorphisms, have not been considered, while other similar factors such as smoking and ethnicity have not always been fully accounted for in the interpretation of results. A case-control study was carried out comprising 493 cases and 472 controls. Cases were newborns whose birthweight was below the 10th percentile according to gestational age and sex, based on national norms, and controls were at or above the 10th percentile. Caffeine consumption from beverages was estimated for each pregnancy trimester. Maternal and newborn variants in the CYP1A2 and CYP2E1 genes involved in the metabolism of caffeine were determined. Contrasting consumption >or=300 mg/day with a lower level, or using caffeiwne as a continuous measure, while adjusting for smoking and nausea, showed no increased risk for SGA. However, when stratifying for cigarette smoking, caffeine odds ratios (for the continuous and dichotomous measures) in the first trimester were statistically heterogeneous, suggesting a greater risk among non-smokers. Using birthweight as the outcome and caffeine as a continuous measure, a small 38 g [95% confidence interval -68, -8] decrement for every 100 mg of daily caffeine was observed in the third trimester. The studied polymorphisms did not modify the effect of caffeine. Caffeine consumption is unlikely to be a major risk factor for SGA or low birthweight in pregnant women.     

Moderate maternal and paternal alcohol consumption and the risk of spontaneous abortion.

Maternal alcoholism can lead to the fetal alcohol syndrome in offspring, but the effect of more moderate alcohol consumption during pregnancy remains an issue of concern. Therefore, we analyzed data from a large case-control study of spontaneous abortion (626 cases, 1,300 controls) that ascertained maternal alcohol consumption before and during pregnancy, as well as paternal consumption. Asking when in pregnancy alcohol consumption changed allowed us to calculate a weighted average of the amount consumed weekly during the first trimester. The odds ratio for consumption of seven or more drinks per week was 1.9 [95% confidence interval (CI) = 1.1-3.4] when adjusted for maternal smoking, passive smoking, and maternal age. Data were too sparse to examine higher consumption levels. There was some evidence that cases may have had less opportunity than controls to decrease consumption during their shorter pregnancies, potentially biasing the odds ratio upward. The adjusted odds ratio for any paternal alcohol consumption was 1.2 (CI = 0.93-1.5), with no dose-response effect seen. Among pregnancies in which the mother did not drink, there was no association with paternal drinking.     

Air pollution exposure during pregnancy: maternal asthma and neonatal respiratory outcomes

Purpose

Maternal asthma increases adverse neonatal respiratory outcomes, and pollution may further increase risk. Air quality in relation to neonatal respiratory health has not been studied.

Maternal hyperthermia during pregnancy and cardiovascular malformations in the offspring

During pregnancy, a number of factors predisposing to hyperthermia, such as sleeping in a water bed, sauna bathing, heatwave, high workplace temperature, and fever, are believed capable of harming the foetus. This study aimed to clarify possible associations of maternal workplace temperature, season of birth, sauna bathing, upper respiratory infection, and fever, with cardiovascular malformations in the offspring. The material was composed of all 573 cardiac malformations registered in Finland in 1982–84, and 1055 randomly chosen healthy controls. The mothers were interviewed at maternity welfare centers about three months after delivery. Fever (> 38°C) during early pregnancy was more prevalent among case mothers (10%) than controls (6%) (p< 0.01), largely manifest as increased risks of atrial septal defect and hypoplastic left heart. Upper respiratory infection was also more common among case mothers (26%) than controls (18%) (p < 0.001). By contrast, maternal workplace temperature, sauna bathing, and temperature of the environment (seasonal variation) were not associated with risk of cardiac malformation in the offspring. The use of acetylsalicylic acid-containing medication for reducing fever was equally common (7%) among case and control mothers.Corresponding author.     

Reporting bias and mode of interview in a study of adverse pregnancy outcomes and water consumption.

In an earlier publication, it was shown that consumption of tapwater during the first trimester of pregnancy was associated with a risk of spontaneous abortion among women who attended three prenatal clinics located in northern California between September 1981 and June 1982. Evidence for biased recall was presented. This report demonstrates that the association is limited to women interviewed by telephone and is not observed among those who completed a mail questionnaire. The possibility that the association among women interviewed by telephone is causal and that the lack of association among mail respondents is due to bias, confounding, or apparently chance fluctuations is shown to be unlikely. For instance, the probability is low that, among mail respondents, cases underreported exposure as compared with controls or that random errors were common enough to camouflage a true effect. Demographic differences between mail and telephone respondents also do not explain the results. Interviewers were, however, aware of the outcome of the pregnancy, suggesting that differential reporting of exposure may have been stimulated in the nonblind telephone interview. The pattern of heterogeneity between mail and telephone respondents was also observed for reportable anomalies and tapwater consumption. The data on heterogeneity support the previously published conclusion that differential reporting (biased recall) of this common exposure, tapwater consumption, is the likely explanation for its observed association with the risk of spontaneous abortion. That this association is limited to telephone respondents elucidates the mechanism that apparently produced the bias: that is, the medium of nonblind telephone interviews.     

Folic acid supplementation and risk for imperforate anus in China.

Maternal consumption of folic acid before pregnancy and during early pregnancy is associated with a reduced risk for some birth defects. Whether folic acid can reduce the risk for imperforate anus is unknown. As part of a public health campaign conducted in China from 1993 through 1995, the outcomes of pregnancies of > or =20 weeks' gestation were evaluated among women using folic acid supplements. The women were asked to take one pill containing 400 microg of folic acid (without other vitamins) every day from the time of their premarital examination until the end of their first trimester of pregnancy. Rates of imperforate anus and risk ratios for imperforate anus among the offspring of these women were calculated according to folic acid use. Among the offspring of women who took folic acid and women who did not take folic acid, 20 and 30 infants with imperforate anus were identified, respectively. The rate of imperforate anus was 3.1 per 10,000 among the offspring of women who did not take folic acid and 1.6 per 10,000 among the offspring of women who took folic acid; adjusted for maternal age, the risk ratio was 0.59 (95% confidence interval: 0.33, 1.07). Daily maternal consumption of 400 microg of folic acid before and during early pregnancy may reduce the risk for imperforate anus.     

Tap or bottled water consumption and spontaneous abortion: a 1986 case-control study in California.

To investigate whether drinking tap or bottled water during pregnancy affects the risk of spontaneous abortion, we asked questions about water consumption in a large case-control study (626 cases, 1,300 controls). The study ascertained cases from hospital pathology laboratory reports of pregnancies that began in 1986 and obtained controls from birth certificates. The crude odds ratio for consumption of any vs no cold tapwater at home during the first trimester was 1.2 (95% confidence interval = 1.0-1.5), with no dose-response effect. The crude odds ratio for any bottled water consumption was 0.79 (95% confidence interval = 0.65-0.96), with a downward trend by amount consumed. Adjusting for many potential confounders did not alter these associations appreciably, although some variables appeared to be effect modifiers. The point estimates were stronger among women who were more difficult to contact, suggesting the possibility of bias.     

The associations of maternal caffeine consumption and nausea with spontaneous abortion

To examine whether maternal caffeine consumption is associated with the risk of spontaneous abortion, we analyzed data from a population-based prospective study. The study population comprised 575 women delivering singleton livebirths and 75 women who had spontaneous abortions. The subjects were predominantly white, middle-class women enrolled before pregnancy. Study participants were traced to delivery of a liveborn, singleton infant or a spontaneous abortion. Of the 71 women who did not experience nausea, 29.6% had a spontaneous abortion, compared with 7.2% of 514 women who did experience nausea. Maternal caffeine consumption before pregnancy, or in women without nausea, did not increase the risk of spontaneous abortion, whereas maternal caffeine consumption during the first trimester after nausea started might increase risk of spontaneous abortion (risk ratio = 5.4, 95% confidence interval = 2.0-14.6 for caffeine consumption > or = 300 mg per day compared with < 20 mg per day). These results suggest that maternal caffeine consumption during pregnancy may influence fetal viability in women with nausea.     

WOMEN AND THE ENVIRONMENT: A STUDY OF CONGENITAL LIMB ANOMALIES

Suspected environmental risk factors for congenital limb anomalies include pesticide exposure to a woman at home or in the workplace. To examine the relationship between congenital limb defect in the infant and pesticide exposure in pregnancy, data on exposure of 155 mothers of limb deficient children born between 1970 and 1981, and 274 matched normal controls, were compared. Case mothers and their matched controls were divided into two groups, those who reported a pesticide exposure in the first trimester of pregnancy and those who did not. The exposure was placed in one of three categories, dependent on proximity of the mother to the source, and the circumstances surrounding use. Statistical analysis indicated a significant association of congenital limb defects with pesticides. A greater risk was associated with exposures to which the woman was in close proximity. When a woman was exposed more than once, there was an increase in risk of limb defect in the child.     

北京市通州区1889例孕妇睡眠障碍及其相关影响因素研究

目的 调查北京市通州区妇女妊娠期孕期睡眠质量及相关影响因素,为当地妇女孕期睡眠障碍的预防,促进母婴健康提供参考依据。 方法 对2019年12月1日至2020年1月31日期间通州区妇幼保健院门诊产检的单胎孕妇开展问卷调查,基于匹兹堡睡眠质量量表收集孕期睡眠情况等资料,采用logistic回归分析影响睡眠的相关因素。 结果 被调查1889例孕妇睡眠障碍检出率为16.1%,其中孕早、中、晚期检出率分别为14.4%、11.9%和20.2%。多因素分析发现,被动吸烟（OR=3.61,95%CI:1.84~7.09）、年龄＜35岁（OR=1.65,95%CI:1.08~2.53）、居住在城市（OR=1.38,95%CI:1.06~1.80）、早产儿分娩史（OR=3.18,95%CI:1.41~7.17）、自然流产史（OR=2.01,95%CI:1.26~3.20）、人工流产史（OR=1.50,95%CI:1.08~2.0）、孕早期（OR=1.08,95%CI:0.74~1.56）、孕晚期（OR=1.94,95%CI:1.40~2.70）、自我认为健康状况不佳（OR=6.30,95%CI:2.25~17.63）、接触放射线（OR=2.29,95%CI:1.38~3.79）与孕期睡眠障碍有关（均P<0.05）。 结论 北京市通州区妇女孕期睡眠质量不应忽视,尤其是孕早期和孕晚期。被动吸烟、不良生育史、接触放射线等因素与睡眠不佳有关。应加强对睡眠问题高风险人群的早期识别,提高睡眠质量,保障母婴健康。     

Effect of maternal smoking and coffee consumption on the risk of having a recognized Down syndrome pregnancy

To evaluate the possible effects of maternal smoking and caffeine or coffee consumption on the occurrence of a recognized pregnancy with Down syndrome, the authors analyzed data from a case-control study of 997 liveborn infants or fetuses with Down syndrome ascertained in California from 1991 to 1993 and 1,007 liveborn controls without a birth defect. Interviews with mothers covered demographic information, pregnancy, and medical history, with detailed questions on the use of tobacco, alcohol, and caffeinated beverages. All analyses were age-adjusted. High alcohol consumption (> or =4 drinks/week) in the first month of pregnancy was associated with reduced risk for a recognized Down syndrome conceptus (odds ratio (OR) = 0.54; 95% confidence interval (CI): 0.34, 0.85). Maternal smoking during the periconceptional period was not associated with risk of recognized Down syndrome (OR = 1.04; 95% CI: 0.79, 1.37), but maternal consumption of four or more cups of coffee per day was inversely associated (OR = 0.63; 95% CI: 0.41, 0.96). In multivariate analysis, a significant interaction between coffee drinking and smoking was observed. The inverse association remained only for nonsmoking mothers who drank four or more cups of coffee per day (OR = 0.48; 95% CI: 0.28, 0.82). These results suggest that among nonsmoking mothers, high coffee consumption is more likely to reduce the viability of a Down syndrome conceptus than that of a normal conceptus.     

Prenatal tea consumption and risks of anencephaly and spina bifida

PURPOSE: To evaluate the relationship between prenatal tea consumption and risk of anencephaly and spina bifida.METHODS: Data from the population-based Atlanta Birth Defects Case-Control Study were examined. Cases were infants with anencephaly (n = 122) or spina bifida (r = 154) and no other associated anomalies, and identified between 1968 and 1980. Controls were infants without birth defects (n = 3029) identified from birth certificates of the same birth cohort and frequency matched to cases by race, period of birth, and hospital of birth.RESULTS: Maternal tea consumption during the periconceptional period (3 months before through the first trimester of pregnancy) was reported at 82, 83.6, and 92.9% among controls, anencephaly, and spina bifida cases, respectively. With subjects whose mothers consumed no tea as a reference, odds ratios (OR) for tea consumption during the periconceptional period (adjusted for gender, race, period of birth, maternal age, education, alcohol consumption, smoking, and periconceptional multivitamins) were: anencephaly 0.9 (95% confidence limits (CI) 0.5-1.5); spina bifida 2.3 (CI 1.2-4.4). Odds ratios for spina bifida and number of cups of tea consumed/day were: 1-2 cups 2.1 (CI 1.1-4.0); 3+ cups 2.8 (CI 1.4-5.6). Consumption of other caffeinated beverages was not associated with risk for anencephaly or spina bifida.CONCLUSIONS: Further studies are warranted to corroborate and elucidate the observed association between tea consumption and spina bifida.     

Maternal fish consumption, fetal growth and the risks of neonatal complications: the Generation R Study

Maternal fish consumption during pregnancy has been suggested to affect birth outcomes. Previous studies mainly focused on birth outcomes and did not study fetal growth during pregnancy. In a prospective cohort study from early pregnancy onwards in The Netherlands, we assessed the associations of first-trimester maternal total-fish, lean-fish, fatty-fish and shellfish consumption with fetal growth characteristics in the second and third trimesters, growth characteristics at birth and the risks of neonatal complications, including pre-term birth, low birth weight and small for gestational age. In total, 3380 mothers completed a 293-item semi-quantitative FFQ to obtain information about fish consumption during the first trimester of pregnancy. Head circumference, femur length and fetal weight were estimated in the second and third trimesters by ultrasound. Information about birth anthropometrics and neonatal complications was available from hospital and midwife registries. Maternal older age, higher educational level, folic acid supplement use, alcohol use and not smoking were associated with higher fish consumption (P < 0·01). After adjustment, we observed no consistent associations of maternal total-fish consumption or specific consumption of lean fish, fatty fish or shellfish with fetal growth characteristics in the second and third trimesters and at birth. Likewise, total-fish consumption or specific consumption of any type of fish was not consistently associated with the risks of neonatal complications. These findings suggest that in a population with a relatively low fish intake, consumption of lean fish, fatty fish or shellfish in the first trimester is not associated with fetal growth or the risks of neonatal complications.     

Dieting behaviors and risk of neural tube defects

The authors examined whether maternal dieting behaviors were associated with increased neural tube defect (NTD) risk among offspring, using population-based, case-control data. The analysis included 538 cases and 539 nonmalformed controls delivered from 1989 to 1991 in selected California counties, and exposures were assessed by in-person maternal interview. Among four reported dieting behaviors involving restricted food intake, diets to lose weight (odds ratio=2.1, 95% confidence interval: 1.1, 4.1), fasting diets (odds ratio=5.8, 95% confidence interval: 1.7, 20.0), and eating disorders (odds ratio=1.7, 95% confidence interval: 0.8, 3.6) were associated with increased NTD risk during the first trimester of pregnancy. Risk estimates for these behaviors during the 3 months before conception tended to be closer to 1. The fourth behavior, "other special diets," was not associated with increased NTD risk during either period. Women also reported whether they took diet pills, laxatives, or diuretics, engaged in binge eating, induced vomiting, or exercised excessively from the first 3 months before conception through the end of pregnancy. Only the intake of diuretics was associated with substantially increased NTD risk (odds ratio=2.7, 95% confidence interval: 0.7, 10.2). This study suggests that maternal dieting behaviors involving restricted food intake during the first trimester may be associated with increased NTD risk.