Exposure to environmental risk factors and Congenital Heart Disease: ARTEMIS results

Introduction Congenital heart defects (CHD) are the most common congenital malformations, with a prevalence of nearly 8 per 1000 live births [1] . Less than 20% of these abnormalities can be attributed to a chromosomal or monogenic anomaly, but in the majority of cases, the cause remains unknown [2] . Some recent studies have identified environmental exposures as possible risk factors for the occurrence of CHD [3] , [4] . A critical period during which a woman or a man exposed to an agent is most at risk of congenital malformation in their fetus is now recognized [5] , [6] . The ARTEMIS Center, at the Bordeaux University Hospital, is dedicated to the evaluation of environmental exposures in patients with fertility disorders, pregnancy pathologies and congenital malformations. Objectives We aimed to present the prevalence of exposure to reproductive risk factors at the time of critical developmental period in patients managed at the ARTEMIS Center for the presence of a cardiac malformation in their child or fetus. Results Environmental exposures assessment of 45 mothers and 42 spouses were realized (from 2017 to February 2018). Regarding occupational exposures during the periconceptional period (3 months before, 3 months after the conception) some potential factors were identified: physical strain (9 mothers, 20.9%), drugs (4 mothers, 9.3%, and 3 spouses, 7.1%), organic solvants (3 mothers, 7.0%), pesticides (3 mothers, 7.0%, and 7 spouses, 16.7%), polycyliv aromatimatic hydrocarbons (4 spouses). Regarding non-occupational exposures, cleaning and maintenance products (12 mothers, 26.7% and 12 spouses, 28.5%), pesticides (8 mothers, 17.8% and 8 spouses, 19.0%), the DIY products (3 mothers, 6.7 and 3 spouses, 7.1%) were identified as well ( Table 1 ). Conclusion Environmental exposures with potential malformative risk have been identified, and prevention measures proposed. Further large studies evaluating the imputability of these exposures on the occurrence of CHD are necessary.