title: Association between maternal aluminum exposure and the risk of congenital heart defects in offspring.
abstract: BACKGROUND
  Aluminum (Al) is the third most common element in the earth' s crust and has been reported to be teratogenic. However, there is lack of understanding about the association between maternal aluminum exposure and the risks of birth defects such as congenital heart defects (CHDs).
  
  
  METHODS
  A multi-center, hospital-based case-control study was performed at four maternal and child tertiary hospitals in China. A total of 223 cases with CHDs and 223 controls without any abnormalities were recruited according to the inclusion and matching criteria. Hair samples were prepared and measured by inductively coupled plasma mass spectrometry (ICP-MS). The correlation between CHDs and maternal aluminum concentrations was estimated by a 1:1 conditional logistic regression.
  
  
  RESULTS
  The geometric mean and median of hair aluminum levels in isolated or multiple CHD cases was significantly higher than in controls (p < 0.05). A significant association was found between increased hair aluminum concentrations and the risk of total CHDs in offspring (adjusted odds ration [aOR], 2.32; 95% confidence interval [CI], 1.72-3.13), especially in some subtypes of CHDs, such as septal defects (aOR, 2.17; 95% CI, 1.15-4.10), conotruncal defects (aOR, 5.42; 95%CI, 2.43-12.10), and right ventricular outflow track obstruction (aOR, 2.43; 95% CI, 1.08-5.44). However, there was no statistically significant association with left ventricular outflow track obstruction (aOR, 1.66; 95% CI, 0.95-2.88).
  
  
  CONCLUSIONS
  A high maternal aluminum concentration may significantly increase the risk of delivering a child with a CHD, such as a septal defect, conotruncal heart defect and right-side obstruction.
authors.affiliation: National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.|Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Obstetrics & Gynecology, Fujian Provincial Maternal and Child Healthcare Hospital, Fuzhou, Fujian, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Department of Ultrasound, Maternal and Child Healthcare Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
authors.forename: Xiaoxian
authors.initials: X
authors.lastname: Tian
authors.affiliation: Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Ultrasound, Hubei Provincial Maternal and Child Healthcare Hospital, Wuhan, Hubei, China.
authors.forename: Xinlin
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Ultrasound, Sichuan Provincial Maternal and Child Healthcare Hospital, Chengdu, Sichuan, China.
authors.forename: Jiaxiang
authors.initials: J
authors.lastname: Yang
authors.affiliation: National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Li
authors.affiliation: National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.|Department of Obstetrics & Gynecology, Fujian Provincial Maternal and Child Healthcare Hospital, Fuzhou, Fujian, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Deng
authors.affiliation: National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.|Department of Obstetrics & Gynecology, Fujian Provincial Maternal and Child Healthcare Hospital, Fuzhou, Fujian, China.
authors.forename: Nana
authors.initials: N
authors.lastname: Li
authors.affiliation: National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Liang
authors.affiliation: Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China.
authors.forename: Shengli
authors.initials: S
authors.lastname: Li
authors.affiliation: National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhu
mesh_terms: D000328:Adult; D000535:Aluminum / Q000009:adverse effects*; D015415:Biomarkers / Q000032:analysis; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D005260:Female; D006197:Hair / Q000737:chemistry*; D006330:Heart Defects, Congenital / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D013058:Mass Spectrometry; D018811:Maternal Exposure / Q000009:adverse effects*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D000535:Aluminum
keywords: aluminum; congenital heart defects; hair biomarker; maternal exposure