{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T02:59:57Z","timestamp":1777949997713,"version":"3.51.4"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Background<\/jats:title>\n Maternal exposure to air pollutants are associated with congenital heart defects (CHDs), yet fundamental questions remain unclear: which pollutant matters most, which exposure window is most critical, and whether susceptibility differs by offspring sex.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n To examine the association between maternal PM\n 2.5<\/jats:sub>\n exposure during periconception (from 4\u202fweeks before conception to 28\u202fweeks of gestation) and offspring CHD risk in urban districts of Chongqing (2018\u202f~\u202f2021), and to identify the key exposure windows.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Data on birth defects and air quality in urban Chongqing were utilized. The association between PM\n 2.5<\/jats:sub>\n exposure and congenital heart disease was assessed using the Distributed Lag Nonlinear Model (DLNM) time-series analysis.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The average concentration of PM\n 2.5<\/jats:sub>\n in urban Chongqing from 2018 to 2021 was 37.27\u202f\u03bcg\/m\n 3<\/jats:sup>\n . A total of 884 cases of congenital heart disease were monitored. We observed significant increasing effects between PM\n 2.5<\/jats:sub>\n exposure during gestational weeks 6 to 27 and risk of CHDs (RR\u202f=\u202f1.05, 95% CI: 1.01\u202f~\u202f1.09) per a 10\u202f\u03bcg\/m\n 3<\/jats:sup>\n change in PM\n 2.5<\/jats:sub>\n concentration. Sex-stratified analysis revealed that male offspring exhibited greater susceptibility from preconception week 3 to gestational week 24, with the strongest effect at gestational week 11\u202f~\u202f12 (RR\u202f=\u202f1.10, 95% CI: 1.04\u202f~\u202f1.16). For congenital malformations of cardiac septa (Q21), the critical susceptibility windows were gestational weeks 0\u202f~\u202f26, with the strongest effect at gestational week 13 (RR\u202f=\u202f1.06, 95% CI: 1.02\u202f~\u202f1.11). While, congenital malformations of great arteries (Q25) demonstrated susceptibility from preconception week 3 to gestational week 21, with the strongest effect at gestational week 10 (RR\u202f=\u202f1.11, 95% CI: 1.04\u202f~\u202f1.19).\n <\/jats:p>\n <\/jats:sec>\n \n Significance<\/jats:title>\n \n Maternal exposure to PM\n 2.5<\/jats:sub>\n , especially during the preconception and the first trimester, increases the risk of certain types of CHDs in offspring, and male offspring exhibited greater susceptibility.\n <\/jats:p>\n <\/jats:sec>\n \n Impact<\/jats:title>\n \n Based on data from Chongqing (2018\u202f~\u202f2021), this study used DLNM method to identify that maternal exposure to PM\n 2.5<\/jats:sub>\n between gestational weeks 6\u202f~\u202f27 significantly increased the risk of CHDs, including cardiac septal defects (Q21) and great artery malformations (Q25). Male offspring showed higher susceptibility, with the strongest effect in gestational weeks 11\u202f~\u202f12. Associations were modified after adjusting for co-pollutants (SO\u2082, NO\u2082, CO, O\u2083) in two-pollutant models.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1782443","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T05:31:33Z","timestamp":1777872693000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between maternal PM2.5 exposure and congenital heart defects in offspring: a time-series study"],"prefix":"10.3389","volume":"14","author":[{"given":"Qunying","family":"Li","sequence":"first","affiliation":[{"name":"Chongqing Municipal Center for Disease Control and Prevention, Chongqing Institute of Preventive Medicine","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunyun","family":"Wu","sequence":"additional","affiliation":[{"name":"Chongqing Municipal Center for Disease Control and Prevention, Chongqing Institute of Preventive Medicine","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zihao","family":"Wang","sequence":"additional","affiliation":[{"name":"Chongqing Municipal Center for Disease Control and Prevention, Chongqing Institute of Preventive Medicine","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Li","sequence":"additional","affiliation":[{"name":"Chongqing Municipal Center for Disease Control and Prevention, Chongqing Institute of Preventive Medicine","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deqiang","family":"Mao","sequence":"additional","affiliation":[{"name":"Chongqing Municipal Center for Disease Control and Prevention, Chongqing Institute of Preventive Medicine","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Chongqing Municipal Center for Disease Control and Prevention, Chongqing Institute of Preventive Medicine","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ke","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Medical Services, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2162","DOI":"10.1016\/S0140-6736(24)00933-4","article-title":"Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021","volume":"403","year":"2024","journal-title":"Lancet"},{"key":"ref2","volume-title":"Particulate matter (PM","year":"2021"},{"key":"ref3","first-page":"1","article-title":"Mortality and Morbidity Effects of Long-Term Exposure to Low-Level PM2.5, BC, NO2, and O3: An Analysis of European Cohorts in the ELAPSE Project","volume":"2021","author":"Brunekreef","year":"2021","journal-title":"Res Rep Health Eff Inst"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"4432","DOI":"10.1038\/s41467-023-39797-4","article-title":"Global air pollution exposure and poverty","volume":"14","author":"Rentschler","year":"2023","journal-title":"Nat Commun"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1093\/ije\/dyz009","article-title":"Global birth prevalence of congenital heart defects 1970-2017: updated systematic review and meta-analysis of 260 studies","volume":"48","author":"Liu","year":"2019","journal-title":"Int J Epidemiol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/S2352-4642(19)30402-X","article-title":"Global, regional, and national burden of congenital heart disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"4","year":"2020","journal-title":"Lancet Child Adolesc Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1016\/S2352-4642(23)00076-7","article-title":"Current treatment outcomes of congenital heart disease and future perspectives.Lancet Child Adolesc","volume":"7","author":"Ma","year":"2023","journal-title":"Health"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1007\/s10654-020-00653-0","article-title":"Birth prevalence of congenital heart disease in China, 1980-2019: a systematic review and meta-analysis of 617 studies","volume":"35","author":"Zhao","year":"2020","journal-title":"Eur J Epidemiol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"109784","DOI":"10.1016\/j.envres.2020.109784","article-title":"Adverse birth outcomes in Victoria, Australia in association with maternal exposure to low levels of ambient air pollution","volume":"188","author":"Melody","year":"2020","journal-title":"Environ Res"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2241","DOI":"10.1016\/j.jacc.2011.08.025","article-title":"Birth prevalence of congenital heart disease worldwide:a systematic review and meta-analysis","volume":"58","author":"Vander Linde","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/1743-8977-5-3","article-title":"Effects of prenatal exposure to diesel exhaust particles on postnatal development, behavior, genotoxicity and inflammation in mice","volume":"5","author":"Hougaard","year":"2008","journal-title":"Part Fibre Toxicol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e016890","DOI":"10.1161\/JAHA.120.016890","article-title":"Long-Term PM2.5 Exposure and Risks of Ischemic Heart Disease and Stroke Events: Review and Meta-Analysis","volume":"10","author":"Alexeeff","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"106145","DOI":"10.1007\/s11356-023-29700-5","article-title":"Prenatal PM2.5 exposure increases the risk of adverse pregnancy outcomes: evidence from meta-analysis of cohort studies","volume":"30","author":"Wang","year":"2023","journal-title":"Environ Sci Pollut Res Int"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.envres.2013.03.005","article-title":"Air pollution and congenital heart defects","volume":"124","author":"Agay-Shay","year":"2013","journal-title":"Environ Res"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1111\/j.1742-7843.2007.00161.x","article-title":"Ambient air pollution and adverse birth outcomes: methodologic issues in an emerging field","volume":"102","author":"Ritz","year":"2008","journal-title":"Basic Clin Pharmacol Toxicol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1093\/aje\/kwi189","article-title":"Relation between ambient air quality and selected birth defects, seven county study, Texas, 1997-2000","volume":"162","author":"Gilboa","year":"2005","journal-title":"Am J Epidemiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1289\/ehp.1002946","article-title":"Ambient air pollution and risk of congenital anomalies: a systematic review and meta-analysis","volume":"119","author":"Vrijheid","year":"2011","journal-title":"Environ Health Perspect"},{"key":"ref18","article-title":"National Maternal and child health monitoring manual. Monitoring program for population-based birth defects in China","year":"2021"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1074","DOI":"10.1093\/aje\/kws367","article-title":"The association of ambient air pollution and traffic exposures with selected congenital anomalies in the San Joaquin Valley of California","volume":"177","author":"Padula","year":"2013","journal-title":"Am J Epidemiol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.1093\/aje\/kwp011","article-title":"Ambient air pollution and cardiovascular malformations in Atlanta, Georgia,1986\u20132003","volume":"169","author":"Strickland","year":"2009","journal-title":"Am J Epidemiol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"518","DOI":"10.5271\/sjweh.3423","article-title":"Air pollution exposure and adverse pregnancy outcomes in a large UK birth cohort: use of a novel spatiotemporal modelling technique","volume":"40","author":"Hannam","year":"2014","journal-title":"Scand J Work Environ Health"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/1476-069X-13-4","article-title":"Assessing the impact of race, social factors and air pollution on birth outcomes: a population-based study","volume":"13","author":"Gray","year":"2014","journal-title":"Environ Health"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"126973","DOI":"10.1016\/j.envpol.2025.126973","article-title":"Joint effects of PM2.5 components during periconception on offspring congenital heart disease risk in Chongqing, China","volume":"384","author":"Li","year":"2025","journal-title":"Environ Pollut"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"668252","DOI":"10.3389\/fcvm.2021.668252","article-title":"Sexual Dimorphism of the Heart: Genetics, Epigenetics, and Development","volume":"8","author":"Deegan","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"127133","DOI":"10.1016\/j.chemosphere.2020.127133","article-title":"Effects of PM2.5 exposure in utero on heart injury, histone acetylation and GATA4 expression in offspring mice","volume":"256","author":"Li","year":"2020","journal-title":"Chemosphere"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1161\/CIRCULATIONAHA.122.061245","article-title":"Maternal Exposure to PM2.5 and the Risk of Congenital Heart Defects in 1.4 Million Births: A Nationwide Surveillance-Based Study","volume":"147","author":"Yuan","year":"2023","journal-title":"Circulation"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"34852","DOI":"10.1038\/srep34852","article-title":"Ozone and Other Air Pollutants and the Risk of Congenital Heart Defects","volume":"6","author":"Zhang","year":"2016","journal-title":"Sci Rep"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1002\/bdra.23159","article-title":"Early prenatal exposure to air pollution and its associations with birth defects in a state-wide birth cohort from North Carolina","volume":"97","author":"Vinikoor-Imler","year":"2013","journal-title":"Birth Defects Res A Clin Mol Teratol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"126668","DOI":"10.1016\/j.chemosphere.2020.126668","article-title":"Maternal\u2002air\u2002pollution exposure and\u2002congenital\u2002heart\u2002defects\u2002in offspring: A systematic review and meta-analysis","volume":"253","author":"Hu","year":"2020","journal-title":"Chemosphere"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1289\/ehp.1307289","article-title":"Maternal exposure to criteria air pollutants and congenital heart defects in offspring: results from the national birth defects prevention study","volume":"122","author":"Stingone","year":"2014","journal-title":"Environ Health Perspect"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1017644","DOI":"10.3389\/fpubh.2022.1017644","article-title":"Maternal exposure to ambient air pollution and risk of congenital heart defects in Suzhou, China","volume":"4","author":"Sun","year":"2023","journal-title":"Front Public Health"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"67009","DOI":"10.1289\/EHP11120","article-title":"Association between First Trimester Exposure to Ambient PM2.5 and NO2 and Congenital Heart Defects: A Population-Based Cohort Study of 1,342,198 Live Births in Canada","volume":"131","author":"Buteau","year":"2023","journal-title":"Environ Health Perspect"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"111014","DOI":"10.1016\/j.envres.2021.111014","article-title":"Association between gestational exposure and risk of congenital heart disease: A systematic review and meta-analysis","volume":"197","author":"Ma","year":"2021","journal-title":"Environ Res"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1782443\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T05:31:34Z","timestamp":1777872694000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1782443\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,4]]},"references-count":33,"alternative-id":["10.3389\/fpubh.2026.1782443"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1782443","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,4]]},"article-number":"1782443"}}