The association of air pollution with congenital anomalies: An exploratory study in the northern Netherlands

• Published in: International journal of hygiene and environmental health 2018-08, Vol.221 (7), p.1061-1067
• Main Authors: Salavati, N., Strak, M., Burgerhof, J.G.M., de Walle, H.E.K., Erwich, J.J.H.M., Bakker, M.K.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Air Pollutants - adverse effects; Air pollution; Air Pollution - adverse effects; Case-Control Studies; Congenital Abnormalities - epidemiology; Congenital anomalies; Female; Humans; Infant, Newborn; Land use regression model; Male; Maternal Exposure - adverse effects; Netherlands - epidemiology; Nitrogen Oxides - adverse effects; Particulate Matter - adverse effects; Particulate matter pregnancy outcome; Young Adult
• ISSN: 1438-4639; 1618-131X
• DOI: 10.1016/j.ijheh.2018.07.008

There are a growing number of reports on the association between air pollution and the risk of congenital anomalies. However, the results are inconsistent and most studies have only focused on the association of air pollution with congenital heart defects and orofacial clefts. Using an exploratory study design, we aimed to identify congenital anomalies that may be sensitive to maternal exposure to specific air pollutants during the periconceptional period. We conducted a case-control study of 7426 subjects born in the 15 years between 1999 and 2014 and registered in the European Registration of Congenital Anomalies and Twins Northern Netherlands (EUROCAT NNL). Concentrations of various air pollutants (PM10, PM2.5, PM10-2.5, NO2, NOX, absorbance) were obtained using land use regression models from the European Study of Cohorts for Air Pollution Effects (ESCAPE). We linked these data to every subject in the EUROCAT NNL registry via their full postal code. Cases were classified as children or fetuses born in the 15-year period with a major congenital anomaly that was not associated with a known monogenic or chromosomal anomaly. Cases were divided into anomaly subgroups and compared with two different control groups: control group 1 comprised children or fetuses with a known monogenic or chromosomal anomaly, while control group 2 comprised all other non-monogenic and non-chromosomal registrations. Using control group 1 (n = 1618) for analysis, we did not find any significant associations, but when we used control group 2 (ranges between n = 4299 and n = 5771) there were consistent positive associations between several air pollutants (NO2, PM2.5, PM10-2.5, absorbance) and the genital anomalies subgroup. We examined various congenital anomalies and their possible associations with a number of air pollutants in order to generate hypotheses for future research. We found that air pollution exposure was positively associated with genital anomalies, mainly driven by hypospadias. These results broaden the evidence of associations between air pollution exposure during gestation and congenital anomalies in the child. They warrant further research, which should also focus on possible underlying mechanisms.