{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T20:26:21Z","timestamp":1793219181763,"version":"4.5.0"},"reference-count":36,"publisher":"American Chemical Society (ACS)","issue":"1","license":[{"start":{"date-parts":[[2017,12,29]],"date-time":"2017-12-29T00:00:00Z","timestamp":1514505600000},"content-version":"vor","delay-in-days":511,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Congenital heart defects may be environmentally related, but the association with elevated ambient temperature has received little attention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>We studied the relationship between outdoor heat during the first trimester of pregnancy and risk of congenital heart defects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We carried out a retrospective cohort study of 704,209 fetuses between 2 and 8 weeks postconception from April to September in Quebec, Canada, 1988\u20132012. We calculated the prevalence of congenital heart defects at birth according to the number of days women were exposed to maximum temperature \u2265 30\u00b0C. In log-binomial regression models, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) for the relationship of temperature with seven critical and eight noncritical heart defects, adjusted for pregnancy characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Prevalence of congenital heart defects was 979.5 per 100,000 for 10 days or more of temperature \u2265 30\u00b0C compared with 878.9 per 100,000 for 0 days of exposure. Temperature was more precisely associated with noncritical than critical defects, which had lower prevalence. Fetuses exposed to 15 days of temperature \u2265 30\u00b0C between 2 and 8 weeks postconception had 1.06 times the risk of critical defects (95% CI: 0.67, 1.67) and 1.12 times the risk of noncritical defects (95% CI: 0.98, 1.29) relative to 0 days. Associations were higher for atrial septal defects (PR 1.37, 95% CI: 1.10, 1.70) than for other noncritical defects. For atrial septal defects, associations with elevated temperatures began the 3rd week postconception.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Extreme heat exposure during the first trimester may be associated with noncritical heart defects, especially of the atrial septum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Citation:<\/jats:title>\n                    <jats:p>Auger N, Fraser WD, Sauve R, Bilodeau-Bertrand M, Kosatsky T. 2017. Risk of congenital heart defects after ambient heat exposure early in pregnancy. Environ Health Perspect 125:8\u201314;\u2002http:\/\/dx.doi.org\/10.1289\/EHP171<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1289\/ehp171","type":"journal-article","created":{"date-parts":[[2016,8,5]],"date-time":"2016-08-05T09:33:29Z","timestamp":1470389609000},"page":"8-14","source":"Crossref","is-referenced-by-count":96,"title":["Risk of Congenital Heart Defects after Ambient Heat Exposure Early in Pregnancy"],"prefix":"10.1021","volume":"125","author":[{"given":"Nathalie","family":"Auger","sequence":"first","affiliation":[{"name":"University of Montreal Hospital Research Centre, Montreal, Quebec, Canada"},{"name":"Institut national de sant\u00e9 publique du Qu\u00e9bec, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William D.","family":"Fraser","sequence":"additional","affiliation":[{"name":"University of Sherbrooke Hospital Research Centre, Sherbrooke, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reg","family":"Sauve","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Community Health Sciences, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"Bilodeau-Bertrand","sequence":"additional","affiliation":[{"name":"University of Montreal Hospital Research Centre, Montreal, Quebec, Canada"},{"name":"Institut national de sant\u00e9 publique du Qu\u00e9bec, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Kosatsky","sequence":"additional","affiliation":[{"name":"National Collaborating Centre for Environmental Health, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"316","published-online":{"date-parts":[[2016,8,5]]},"reference":[{"key":"2026080314111953200_micit1","doi-asserted-by":"crossref","first-page":"2289","DOI":"10.1093\/humrep\/det244","article-title":"Ambient temperature and congenital heart defects.","volume":"28","author":"Agay-Shay","year":"2013","journal-title":"Hum Reprod"},{"key":"2026080314111953200_micit2","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.1001\/jama.2015.12505","article-title":"Association between preeclampsia and congenital heart defects.","volume":"314","author":"Auger","year":"2015","journal-title":"JAMA"},{"key":"2026080314111953200_micit3","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyw077","article-title":"Elevated outdoor temperatures and risk of stillbirth.","author":"Auger","year":"2016","journal-title":"Int J Epidemiol"},{"key":"2026080314111953200_micit4","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1097\/EDE.0000000000000074","article-title":"Extreme heat and risk of early delivery among preterm and term pregnancies.","volume":"25","author":"Auger","year":"2014","journal-title":"Epidemiology"},{"issue":"12","key":"2026080314111953200_micit5","first-page":"S410","article-title":"Adult congenital heart disease: a growing epidemic.","volume":"30","author":"\u00c1vila","year":"2014","journal-title":"Can J Cardiol"},{"key":"2026080314111953200_micit6","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1161\/CIRCULATIONAHA.115.019137","article-title":"Exposure to low-dose ionizing radiation from cardiac procedures in patients with congenital heart disease: 15-year data from a population-based longitudinal cohort.","volume":"133","author":"Beaus\u00e9jour Ladouceur","year":"2016","journal-title":"Circulation"},{"key":"2026080314111953200_micit7","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1002\/bdrb.20254","article-title":"Hyperthermia: malformations to chaperones.","volume":"89","author":"Bennett","year":"2010","journal-title":"Birth Defects Res B Dev Reprod Toxicol"},{"key":"2026080314111953200_micit8","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/EDE.0000000000000051","article-title":"Commentary: does air pollution confound studies of temperature?","volume":"25","author":"Buckley","year":"2014","journal-title":"Epidemiology"},{"key":"2026080314111953200_micit9","article-title":"ICD-10-CA: International Statistical Classification of Diseases and Related Health Problems. 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