Association Between Maternal Exposure to Environmental Endocrine Disruptors and The Risk of Congenital Heart Diseases in Offspring: A Systematic Review and Meta-analysis

Background: Congenital heart diseases ( CHD ) are the most common type of congenital malformation and are the leading cause of death in newborns. Many studies have investigated the relationship between maternal exposure to environmental endocrine disruptors ( EEDs ) during pregnancy and the risk of CHD in offspring. However, there is a lack of comprehensive and systematic research to assess their relationship. Therefore, the purpose of this paper is to review the literature published in the past 20 years on maternal EEDs exposure during pregnancy and the risk of CHD in offspring, and to explore the exact relationship between them. Methods: Three databases ( PubMed, Embase, and Web of Science ) were searched, and 16 studies with 1068211 participants were included. The Newcastle Ottawa Scale ( NOS ) was used to evaluate the quality of the literature, Begg's test and Egger's test to determine the publication bias of the literature, Q test and I2 statistics to evaluate the statistical heterogeneity among the studies, and subgroup analysis to examine the association between each EEDs and CHD and its subtypes. Results: The results showed that maternal maternal exposure to polycyclic aromatic hydrocarbons ( PAHs ) ( OR = 1.34, 95% CI: 1.17-1.53 ) ( e.g., PAHs and Tetralogy of Fallot ( TOF ), Septal defects ( SD ), Conotruncal defects ( CD ) ), pesticides/insecticides ( OR = 1.21, 95% CI: 1.05 - 1.40 ), alkylphenolic compounds ( OR = 1.46, 95% CI: 1.14 - 1.86 ) and Heavy metals ( Arsenic, Cadmium, Mercury, Lead ) ( OR = 2.09, 95% CI: 1.53 - 2.86 ) during pregnancy increased the risk of CHD in offspring. Conclusion: This study suggests that maternal exposure to EEDs during pregnancy may be an important factor for increasing the risk of CHD in offspring.