title: Maternal occupational pesticide exposure and risk of congenital heart defects in the National Birth Defects Prevention Study.
abstract: BACKGROUND
  Congenital heart defects (CHDs) are common birth defects, affecting approximately 1% of live births. Pesticide exposure has been suggested as an etiologic factor for CHDs, but previous results were inconsistent.
  
  
  METHODS
  We examined maternal occupational exposure to fungicides, insecticides, and herbicides for 3328 infants with CHDs and 2988 unaffected control infants of employed mothers using data for 1997 through 2002 births from the National Birth Defects Prevention Study, a population-based multisite case-control study. Potential pesticide exposure from 1 month before conception through the first trimester of pregnancy was assigned by an expert-guided task-exposure matrix and job history details self-reported by mothers. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression.
  
  
  RESULTS
  Maternal occupational exposure to pesticides was not associated with CHDs overall. In examining specific CHD subtypes compared with controls, some novel associations were observed with higher estimated pesticide exposure: insecticides only and secundum atrial septal defect (OR = 1.8; 95% CI, 1.3-2.7, 40 exposed cases); both insecticides and herbicides and hypoplastic left heart syndrome (OR = 5.1; 95% CI, 1.7-15.3, 4 exposed cases), as well as pulmonary valve stenosis (OR = 3.6; 95% CI, 1.3-10.1, 5 exposed cases); and insecticides, herbicides, and fungicides and tetralogy of Fallot (TOF) (OR = 2.2; 95% CI, 1.2-4.0, 13 exposed cases).
  
  
  CONCLUSIONS
  Broad pesticide exposure categories were not associated with CHDs overall, but examining specific CHD subtypes revealed some increased odds ratios. These results highlight the importance of examining specific CHDs separately. Because of multiple comparisons, additional work is needed to verify these associations.
authors.affiliation: Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio.
authors.forename: Carissa M
authors.initials: CM
authors.lastname: Rocheleau
authors.affiliation: Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Bertke
authors.affiliation: Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio.
authors.forename: Christina C
authors.initials: CC
authors.lastname: Lawson
authors.affiliation: Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Romitti
authors.affiliation: Department of Epidemiology, University of Kentucky, Lexington, Kentucky.
authors.forename: Wayne T
authors.initials: WT
authors.lastname: Sanderson
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Sadia
authors.initials: S
authors.lastname: Malik
authors.affiliation: Department of Pediatrics, Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Lupo
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Tania A
authors.initials: TA
authors.lastname: Desrosiers
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, New York.
authors.forename: Erin
authors.initials: E
authors.lastname: Bell
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, New York.|Center for Environmental Health, New York State Department of Health, Albany, New York.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Druschel
authors.affiliation: Departments of Medicine and Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Correa
authors.affiliation: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia.
authors.forename: Jennita
authors.initials: J
authors.lastname: Reefhuis
mesh_terms: D000328:Adult; D005260:Female; D006330:Heart Defects, Congenital / Q000139:chemically induced* / Q000453:epidemiology*; D006801:Humans; D018811:Maternal Exposure / Q000009:adverse effects*; D016273:Occupational Exposure / Q000009:adverse effects*; D010575:Pesticides / Q000009:adverse effects*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States
chemical_list: D010575:Pesticides
keywords: birth defects; congenital heart defects; occupation; pesticides