Parental alcohol consumption and the risk of congenital heart diseases in offspring: An updated systematic review and meta-analysis

Abstract

Objective

The aim of this study was to provide updated evidence to assess the association between parental alcohol consumption and the risk of total congenital heart diseases (CHDs) and specific CHD phenotypes in offspring, and explore the possible dose–response pattern.

Methods

PubMed, Embase and Chinese databases were searched with an end-date parameter of July 24, 2019 to identify studies meeting pre-stated inclusion criteria. A random-effects model was used to calculate the overall combined risk estimates. A meta-analysis of the dose–response relationship was performed. Subgroup analysis, sensitivity analysis, and Galbraith plot were conducted to explore potential heterogeneity moderators.

Results

A total of 55 studies involving 41,747 CHD cases and 297,587 controls were identified. Overall, both maternal (odds ratio (OR) = 1.16; 95% confidence interval (CI): 1.05–1.27) and paternal (OR = 1.44; 95% CI: 1.19–1.74) alcohol exposures were significantly associated with risk of total CHDs in offspring. Additionally, a nonlinear dose–response relationship between parental alcohol exposure and risk of total CHDs was observed. With an increase in parental alcohol consumption, the risk of total CHDs in offspring also gradually increases. For specific CHD phenotypes, a statistically significant association was found between maternal alcohol consumption and risk of tetralogy of fallot (OR = 1.20; 95% CI: 1.08–1.33). Relevant heterogeneity moderators have been identified by subgroup analysis, and sensitivity analysis yielded consistent results.

Conclusions

Although the role of potential bias and evidence of heterogeneity should be carefully evaluated, our review indicates that parental alcohol exposures are significantly associated with the risk of CHDs in offspring, which highlights the necessity of improving health awareness to prevent alcohol exposure during preconception and conception periods.

Keywords

Congenital heart diseases alcohol consumption systematic review meta-analysis

Get full access to this article

View all access options for this article.

References

Krasuski

Bashore

. Congenital heart disease epidemiology in the United States. Circulation 2016; 134: 110–113.

Tsilimigras

Oikonomou

Moris

, et al. Stem cell therapy for congenital heart disease. Circulation 2017; 136: 2373–2385.

Saxena

Mehta

Sharma

, et al. Birth prevalence of congenital heart disease: a cross-sectional observational study from North India. Ann Pediatr Cardiol 2016; 9: 205–209.

Liu

Nie

Chen

, et al. Does maternal environmental tobacco smoke interact with social-demographics and environmental factors on congenital heart defects?. Environ Pollut 2018; 234: 214–222.

Wang

Chen

Yang

, et al. Congenital heart disease and risk of cardiovascular disease: a meta-analysis of cohort studies. J Am Heart Assoc 2019; 8: e12030.

Liu

Chen

Zuhlke

, et al. Global birth prevalence of congenital heart defects 1970-2017: updated systematic review and meta-analysis of 260 studies. Int J Epidemiol 2019; 48: 455–463.

Wang

Xie

Zhou

, et al. Increased risk for congenital heart defects in children carrying the ABCB1 Gene C3435T polymorphism and maternal periconceptional toxicants exposure. PLoS One 2013; 8: e68807.

Liu

Tang

, et al. Environmental risk factors for congenital heart disease in the Shandong Peninsula, China: a hospital-based case–control study. J Epidemiol 2009; 19: 122–130.

Hoyme

May

Kalberg

, et al. A practical clinical approach to diagnosis of fetal alcohol spectrum disorders: clarification of the 1996 institute of medicine criteria. Pediatrics 2005; 115: 39–47.

10.

Burd

Deal

Rios

, et al. Congenital heart defects and fetal alcohol spectrum disorders. Congenit Heart Dis 2007; 2: 250–255.

11.

Feng

Cai

Tong

, et al. Non-inheritable risk factors during pregnancy for congenital heart defects in offspring: a matched case-control study. Int J Cardiol 2018; 264: 45–52.

12.

, et al. Influencing factors of congenital heart disease in plateau region: a case-control study. Chin Prev Med 2018; 19: 1–4.

13.

Stingone

Luben

Carmichael

, et al. Maternal exposure to nitrogen dioxide, intake of methyl nutrients, and congenital heart defects in offspring. Am J Epidemiol 2017; 186: 719–729.

14.

Xiang

. Case control study of congenital heart disease related factors in perinatal infants in Wenzhou. Dis Surveillance 2017; 32: 504–508.

15.

Guo

Liu

Zheng

, et al. Analysis of risk factors of congenital heart disease in Xi'an and Xianyang area from 2011 to 2014. Clin Misdiagn and Misther 2016; 29: 80–83.

16.

Mai

Zhuang

, et al. Risk factors of different congenital heart defects in Guangdong, China. Pediatr Res 2016; 79: 549–558.

17.

. Influencing factors analysis on 151 cases of congenital heart disease children. Chin J Clin (electronic version) 2016; 10: 641–644.

18.

Liu

Qiu

Liu

, et al. Analysis of influencing factors on perinatal congenital heart disease in Guangxi. Chin J Birth Health and Hered 2016; 24: 88–91.

19.

Chen

. High risk factors of fetal congenital heart diseases: a case-control analysis. Matern and Child Health Care of Chin 2016; 31: 3818–3820.

20.

Yang

Qiu

, et al. Prenatal alcohol exposure and congenital heart defects: a meta-analysis. PLoS One 2015; 10: e130681.

21.

Sun

Chen

, et al. Maternal alcohol consumption before and during pregnancy and the risks of congenital heart defects in offspring: a systematic review and meta-analysis. Congenit Heart Dis 2015; 10: E216–E224.

22.

Wen

Zhang

, et al. Association between alcohol consumption during pregnancy and risks of congenital heart defects in offspring: meta-analysis of epidemiological observational studies. Ital J Pediatr 2016; 42: 1–12.

23.

Moher

Liberati

Tetzlaff

, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010; 8: 336–341.

24.

Baardman

Kerstjens-Frederikse

Corpeleijn

, et al. Combined adverse effects of maternal smoking and high body mass index on heart development in offspring: evidence for interaction?. Heart 2012; 98: 474–479.

25.

Williams

Correa

Rasmussen

. Maternal lifestyle factors and risk for ventricular septal defects. Birth Defects Res A Clin Mol Teratol 2004; 70: 59–64.

26.

Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa scale (NOS) for assessing the quality if non-randomized studies in meta-analysis, http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp (2011, accessed 24 July 2019).

27.

Higgins

Thompson

Deeks

, et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557–560.

28.

Bax

Ikeda

Fukui

, et al. More than numbers: the power of graphs in meta-analysis. Am J Epidemiol 2008; 169: 249–255.

29.

Egger

Davey

Schneider

, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629–634.

30.

Greenland

Longnecker

. Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol 1992; 135: 1301–1309.

31.

Patra

Bakker

Irving

, et al. Dose-response relationship between alcohol consumption before and during pregnancy and the risks of low birthweight, preterm birth and small for gestational age (SGA)-a systematic review and meta-analyses. BJOG 2011; 118: 1411–1421.

32.

World Health Organization. Global status report on alcohol and health 2018 (Geneva), https://www.who.int/substance_abuse/publications/global_alcohol_report/en/ (2018, accessed 24 July 2019).

33.

Burd

Deal

Rios

, et al. Congenital heart defects and fetal alcohol spectrum disorders. Congenit Heart Dis 2007; 2: 250–255.

34.

Grewal

Carmichael

, et al. Maternal periconceptional smoking and alcohol consumption and risk for select congenital anomalies. Birth Defects Res A Clin Mol Teratol 2008; 82: 519–526.

35.

Serrano

Han

Brinez

, et al. Fetal alcohol syndrome: cardiac birth defects in mice and prevention with folate. Am J Obstet Gynecol 2010; 203: 75–77.

36.

Shi

Zhao

Pan

, et al. Alcohol exposure causes overexpression of heart development-related genes by affecting the histone H3 acetylation via BMP signaling pathway in cardiomyoblast cells. Alcohol Clin Exp Res 2017; 41: 87–95.

37.

Krauss

Hong

. Gene-environment interactions and the etiology of birth defects. Curr Top Dev Biol 2016; 116: 569.

38.

Strandberg-Larsen

Skov-Ettrup

Grønbaek

, et al. Maternal alcohol drinking pattern during pregnancy and the risk for an offspring with an isolated congenital heart defect and in particular a ventricular septal defect or an atrial septal defect. Birth Defects Res A Clin Mol Teratol 2011; 91: 616–622.

39.

Carmichael

Shaw

Yang

, et al. Maternal periconceptional alcohol consumption and risk for conotruncal heart defects. Birth Defects Res A Clin Mol Teratol 2003; 67: 875–878.

40.

Day

Savani

Krempley

, et al. Influence of paternal preconception exposures on their offspring: through epigenetics to phenotype. Am J Stem Cells 2016; 5: 11–18.

41.

Abel

. Paternal contribution to fetal alcohol syndrome. Addict Biol 2004; 9: 127–133, 135–136.

42.

Mahnke

Salem

Tseng

, et al. Nonprotein-coding RNAs in fetal alcohol spectrum disorders. Prog Mol Biol Transl Sci 2018; 157: 299–342.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

1.39 MB