title: Proximity of residence to trichloroethylene-emitting sites and increased risk of offspring congenital heart defects among older women.
abstract: BACKGROUND
  Previous studies suggest that trichloroethylene (TCE) is a selective cardiac teratogen. We tested the hypothesis that the odds of maternal residence close to TCE-emitting sites would be greater among infants with congenital heart defects (CHDs) than among infants without CHDs.
  
  
  METHODS
  We conducted a case-control study of 4025 infants, identified from hospital and birth records, born from 1997 to 1999 to Milwaukee, Wisconsin mothers. A geographic information system was used to calculate distances between maternal residences and TCE sites. We used classification tree analysis to determine appropriate values by which to dichotomously categorize mothers by TCE exposure (exposed: residence within 1.32 miles of at least one TCE site) and age (older: >/=38 years), and logistic regression to test for CHD risk factors.
  
  
  RESULTS
  The proportion of mothers who were both older and had presumed TCE exposure was more than six-fold greater among case infants than among control infants (3.3% [8/245] versus 0.5% [19/3780]). When adjusted for other variables, CHD risk was over three-fold greater among infants of older, exposed mothers compared to infants of older, nonexposed mothers (adjusted OR, 3.2; 95% CI, 1.2-8.7). Older maternal age, alcohol use, chronic hypertension, and preexisting diabetes were each associated with CHDs (adjusted ORs, 1.9, 2.1, 2.8, 4.1; 95% CIs, 1.1-3.5, 1.1-4.2, 1.2-6.7, 1.5-11.2, respectively), but residence close to TCE sites alone was not.
  
  
  CONCLUSIONS
  Our findings suggest that maternal age and TCE exposure interact to increase CHD risk, although the mechanism by which this occurs is unknown. A prospective study is underway to confirm this finding.
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. jyauck@mcw.edu
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Yauck
authors.forename: Marsha E
authors.initials: ME
authors.lastname: Malloy
authors.forename: Kathleen
authors.initials: K
authors.lastname: Blair
authors.forename: Pippa M
authors.initials: PM
authors.lastname: Simpson
authors.forename: D Gail
authors.initials: DG
authors.lastname: McCarver
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000139:chemically induced* / Q000145:classification; D006801:Humans; D007231:Infant, Newborn; D018811:Maternal Exposure; D012111:Residence Characteristics; D012307:Risk Factors; D013723:Teratogens / Q000633:toxicity*; D014241:Trichloroethylene / Q000633:toxicity*
chemical_list: D013723:Teratogens; D014241:Trichloroethylene