Maternal residential greenness and congenital heart defects in infants: A large case-control study in Southern China

Zhiqiang Nie; Boyi Yang; Yanqiu Ou; Michael S. Bloom; Fengzhen Han; Yanji Qu; Philip Nasca; Rosemary Matale; Jinzhuang Mai; Yong Wu; Xiangmin Gao; Yuming Guo; Iana Markevych; Yuxuan Zou; Shao Lin; Guanghui Dong; Xiaoqing Liu

Environment International (Sep 2020)

Maternal residential greenness and congenital heart defects in infants: A large case-control study in Southern China

Zhiqiang Nie,
Boyi Yang,
Yanqiu Ou,
Michael S. Bloom,
Fengzhen Han,
Yanji Qu,
Philip Nasca,
Rosemary Matale,
Jinzhuang Mai,
Yong Wu,
Xiangmin Gao,
Yuming Guo,
Iana Markevych,
Yuxuan Zou,
Shao Lin,
Guanghui Dong,
Xiaoqing Liu

Affiliations

Zhiqiang Nie: Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou 510080, Guangdong, China
Boyi Yang: Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China
Yanqiu Ou: Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou 510080, Guangdong, China
Michael S. Bloom: Departments of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY 12144, USA
Fengzhen Han: Department of Obstetrics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road , Guangzhou 510080, Guangdong, China
Yanji Qu: Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou 510080, Guangdong, China
Philip Nasca: Departments of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY 12144, USA
Rosemary Matale: Departments of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY 12144, USA
Jinzhuang Mai: Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou 510080, Guangdong, China
Yong Wu: Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou 510080, Guangdong, China
Xiangmin Gao: Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou 510080, Guangdong, China
Yuming Guo: Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China
Iana Markevych: Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China
Yuxuan Zou: School of Geographical Sciences, Guangzhou University, Guangzhou 510080, China
Shao Lin: Departments of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY 12144, USA
Guanghui Dong: Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China
Xiaoqing Liu: Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou 510080, Guangdong, China; Corresponding authors at: 106 Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, Guangdong, China (X. Liu). Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China (G. Dong). GEC 100, One University Place, Rensselaer, Albany, NY, USA (S. Lin).

Journal volume & issue: Vol. 142
p. 105859

Abstract

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Background: Proximity to greenness has shown protective effects on coronary heart diseases by limiting exposure to environmental hazards, encouraging physical activity, and reducing mental stress. However, no studies have previously evaluated the impacts of greenness on congenital heart defects (CHDs). We examined the association between maternal residential greenness and the risks of CHDs. Methods: We conducted a case-control study (8042 children with major CHDs and 6887 controls without malformations) in 21 cities in Southern China, 2004 – 2016. CHDs cases were diagnosed and verified by obstetrician, pediatrician, or pediatric cardiologists, within one year. We estimated maternal residential greenness using satellite-derived normalized difference vegetation index (NDVI) in zones of 500 meters (m) and 1000 m surrounding participants’ residences. Logistic regression models were used to assess NDVI-CHD relationships adjusting for confounders. Results: Interquartile range NDVI increases within 500 m or 1000 m were associated with odds ratios (OR) of 0.95 (95% confidence interval (CI): 0.92, 0.98) and 0.94 (95%CI: 0.91, 0.97) for total CHDs respectively. Air pollutants mediated 52.1% of the association. We also identified a protective threshold at 0.21 NDVI on CHD. Similar protective effects from greenness were found in most CHDs subtypes. The protective associations were stronger for fall, urban or permanent residents, higher household income maternal age ≤35 years of age, and high maternal education (ORs: ranged from 0.85 to 0.96). Conclusion: Our findings suggest a beneficial effect of maternal residential greenness on CHDs. Further studies are needed to confirm our findings, which will help to refine preventive health and urban design strategies.

Published in Environment International

ISSN: 0160-4120 (Print)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Geography. Anthropology. Recreation: Environmental sciences
Website: https://www.journals.elsevier.com/environment-international

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