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Risk factors for congenital heart diseases in Alexandria, Egypt

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Abstract

A matched case control study has been conducted in the children's hospitals in Alexandria, Egypt, during 2 years-period, aiming at investigating the risk factors for the occurrence of congenital heart diseases. Our results showed that the significant risk factors for developing any type of congenital heart disease and ventricular septal defects were: older paternal age at birth, positive consanguinity, positive family history, female sex hormones, irradiation, hazardous maternal occupation, diabetes mellitus and suburban or rural residence. However, some environmental/teratogenic factors were not implicated in the etiology of atrial septal defects or pulmonary stenosis. These findings strongly suggest that environmental factors vary according to the specific type of congenital heart disease. This study emphasizes on the need to instruct the public about the importance of pre-marital counseling and the deleterious effects of various teratogens in the environment.

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References

  1. Nora JJ, Nora AH. The environmental contribution to congenital heart disease. In: Nora JJ, Takao A (eds), Congenital Heart Disease: Causes and Processes, Mount Kisko, New York: Future Publishing Co., 1984: 15–27.

    Google Scholar 

  2. Tikkanen J, Heinonen OP. Risk factors for cardiovascular malformations in Finland. Eur J Epidemiol 1990; 6(4): 348–356.

    Google Scholar 

  3. Pradat P. Epidemiology of major congenital heart defects in Sweden, 1981–1986. J Epidemiol Commun Health 1992; 46: 211–215.

    Google Scholar 

  4. Francannet C, Lancaster PAL, Pradat P, Cocchi G, Stolli C. The epidemiology of three serious cardiac defects. A joint study between five centres. Eur J Epidemiol 1993; 9(6): 607–616.

    Google Scholar 

  5. Lian ZH, Zack MM, Erickson JD. Paternal age and the occurrence of birth defects. Am J Human Genet 1986; 39: 648–660.

    Google Scholar 

  6. Faeser FC, Biddle CG. Estimating the risks for off-spring of first-cousin matings: An approach. Am J Human Genet 1976; 28: 522.

    Google Scholar 

  7. Rothman KJ, Fyler DC. Sex, birth order and maternal age characteristics of infants with CHD. Am J Epidemiol 1976; 104: 527–534.

    Google Scholar 

  8. Tay SH, Yip WCL, Joseph R. Parental age and birth order in Chinese children with CHD. J Med Genet 1982; 19: 441–443.

    Google Scholar 

  9. Frohn-Mulder IM, Meilof JF, Szatmari A, Stewart PA, Swaak TJ, Hess J. Clinical significance of maternal Anti-Ro/SS-A antibodies in children with isolated heart block. J Am College Cardiol 1994; 23: 1677–1681.

    Google Scholar 

  10. Shaw GM, Malcoe LH, Swan SH, Cummins SK, Schulman J. Congenital cardiac anomalies relative to selected maternal exposures and conditions during early pregnancy. Eur J Epidemiol 1992; 8(5): 757–760.

    Google Scholar 

  11. Nora JJ, Nora AH. The evolution of specific genetic and environmental counseling in congenital heart diseases. Circulation 1987; 57: 205–213.

    Google Scholar 

  12. Jackson BT. The pathogenesis of congenital cardiovascular anomalies. New Engl J Med 1968; 279: 25–29, 80–89.

    Google Scholar 

  13. Nora JJ, Nora AH. The genetic contribution to congenital heart disease. In: Nora JJ, Takao A (eds), Congenital Heart Disease: Causes and Processes, Mount Kisko, New York: Future Publishing Co., 1984; 3–13.

    Google Scholar 

  14. Feingold M, Payshan H. Genetics and Birth Defects. Clinical Practice, 1st edn. Boston: Little Brown, 1983.

    Google Scholar 

  15. Iturbe-Alessio I, Carmen F, Mutchinik O, Angel Santos M, Zajarias A, Salazar E. Risks of anticoagulant therapy in pregnant women with artificial heart valves. New Engl J Med 1986; 315: 1390–1393.

    Google Scholar 

  16. Heinonen OP, Slone D, Shapiro S. Birth Defects and Drugs in Pregnancy. Littleton; MA: Publishing Sciences Group, 1977.

    Google Scholar 

  17. Thompson MW, Mc Innes RR, Willard HF. Patterns of Single Gene Inheritance. In: Thompson, Thompson (eds). Genetics in Medicine. 5th edn, Philadelphia, London, Toronto, Montreal, Sydney, Tokyo: WB Saunders Company; 1991; pp. 53–94.

    Google Scholar 

  18. Layde PM, Dooley K, Erickson JD, Edmonds LD. Is there an epidemic of ventricular septal defects in the USA? Lancet 1980; February, 23: 407–408.

    Google Scholar 

  19. Stoll C, Alembik Y, Roth MP, Dott B, Geeter B. Risk factors for congenital heart disease. Eur J Epidemiol 1989; 5: 382–391.

    Google Scholar 

  20. Kuzera K. Exposure to fat solvents. A possible cause of sacral agenesis in man. J Pediat 1960; 72: 857–859.

    Google Scholar 

  21. Meirik O, Kallen B, Gauffin U, Ericson A. Major malformations in infants born of women who worked in laboratories while pregnant. Lancet 1979; 2: 91.

    Google Scholar 

  22. Goldberg SJ, Lebowitz MD, Graver EJ, Hicks S. An association of human congenital cardiac malformations and drinking water contaminants. J Am College Cardiol 1990; 16: 155–164.

    Google Scholar 

  23. Fleiss. Statistical Methods for Rates and Proportions. 2nd edn, (Wiley).

  24. Dawson-Saunders B, Trapp RG. Probability, sampling and probability distributions. In: Basic and Clinical Biostatistics. Chapter 5, Prentice Hall International Inc. 1990, pp. 65–81.

  25. Sofaer JA. Population genetics Hardy-Weinberg equilibrium and factors affecting it. In: Principles and Practice of Medical Genetics. Churchill Livingstone, Edinburgh London and New York: 1990, 121–132.

    Google Scholar 

  26. Belletti I, Troscel L, Pisani P, and Berrino F. Retrospective assessment of exposure by experts: The example of formaldehyde, solvents and mineral oils among textile and metal workers. Int J Epidemiol 1993; 22(6): S127-S133.

    Google Scholar 

  27. Burn J, Goodship J. Congenital heart disease. In: Emery, Rimoins (eds) Principles and Practice of Medical Genetics, 3rd edn. Chapter 41, Appendix 41–1, Churchill Livingstone, New York, Edinburgh, London, Melbourne, Madrid, San Fransisco and Tokyo: 1996, 804–828.

    Google Scholar 

  28. Vidaillet HJ Jr, Pressley JC, Henke E, Harrell FE Jr, German LD. Familial occurrence of accessory atrio-ventricular pathways (preexcitaion syndrome) New Engl J Med 1987 July 9; 317(2): 65–69.

    Google Scholar 

  29. Olshan AF, Schnitzer PG, Baird PA. Paternal age and the risk of congenital heart defects. Teratology 1994; 50: 80–84.

    Google Scholar 

  30. Raphael K. Recall bias: A proposal for assessment and control. Int J Epidemiol 1987; 16: 167–170.

    Google Scholar 

  31. Gev D, Roguin N, Freundlich E. Consanguinity and congenital heart disease in the rural Arab population in northern Israel. Human Heredity 1986; 36: 213–217.

    Google Scholar 

  32. Jain VK, Nalini P, Chandra R, Srinivasan S. Congenital malformations, reproductive wastage and consanguineous mating. Australia, New Zealand. J Obst Gynaecol 1993; February, 33(1): 33–36.

    Google Scholar 

  33. Al-Gazali LI, Bener A, Abdulrazzaq YM, Micallef R, Al-Khayat AI, Gaber T. Consanguineous marriages in the United Arab Emirates. J Biosoc Sci 1997; 29(4): 491–497.

    Google Scholar 

  34. Bittles AH, Grant JC, Shami SA. Consanguinity as a determinant of reproductive behaviour and mortality in Pakistan. Int J Epidemiol 1993; June, 22(3): 463–467.

    Google Scholar 

  35. Kleinbaum DG, Kupper LL, Morgenstern H. Selection bias. In: Epidemiologic Research. Principles and Methods. Chapter 11, New York: Van Nostrand Reinhold, 1982, 195–219.

    Google Scholar 

  36. Bassili A, Mokhtar SA, Dabous NI, Zaher SR, Mokhtar MM, Zaki A. (in press) Congenital heart diseases among school children in Alexandria, Egypt: An overview on prevalence and relative frequencies. Tropical Pediat 1999.

  37. Health Insurance Records 1994–1995. Health Insurance Organization, Alexandria, Egypt.

  38. Tikkanen J, Heinonen OP. Occupational risk factors for congenital heart disease. Occup Environ health 1992; 64: 59–64.

    Google Scholar 

  39. Zhu-S. Survey and analysis on correlative factors with CHD in 12,468 pupils in yimeng mountain area. Chung-Hua-Liu-Hsing-Ping-Hsueh-Tsa-Chih 1993; June, 14(3): 163–165.

    Google Scholar 

  40. Hook EB. Cardiovascular birth defects and prenatal exposure to female sex hormones: A reevaluation of data reanalysis from a large prospective study. Teratology 1992; 46: 261–266.

    Google Scholar 

  41. Addis A, Impicciatore P, Miglio D, Colombo F, Bonati M. Drug use in pregnancy and lactation: The work of a regional drug information center. The Ann Pharmacother 1995; 29: 632–633.

    Google Scholar 

  42. Wiseman RA, Dodds-Smith IC. Cardiovascular birth defects and antenatal exposure to female sex hormones: A reevaluation of some base data. Teratology 1984; 30: 359–370.

    Google Scholar 

  43. Jackson BT. The pathogenesis of congenital cardiovascular anomalies. New Engl J Med 1968; 279(2): 80–89.

    Google Scholar 

  44. Grabitz RG, Joffrez MR, Collins-Nakai RL. Congen-ital heart disease: Incidence in the first year of life. The Alberta Heritage pediatric cardiology program. Am J Epidemiol, 1988; 128(2): 381–388.

    Google Scholar 

  45. Hoffman JIE, Christianson R. Congenital heart disease in a cohort of 19,502 births with long term follow-up. Am J Cardiol 1978; 42: 641–647.

    Google Scholar 

  46. Bland JM. Multiple significance tests: The Bonferroni method. Br Med J 1995; 310: 170.

    Google Scholar 

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Bassili, A., Mokhtar, S., Dabous, N. et al. Risk factors for congenital heart diseases in Alexandria, Egypt. Eur J Epidemiol 16, 805–814 (2000). https://doi.org/10.1023/A:1007601919164

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