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.

BACKGROUND: The extent to which ambient air pollution contributes to the pathogenesis of congenital heart defects remains uncertain. OBJECTIVE: We investigated whether first trimester exposure to ambient fine particulate matter (PM2.5) and nitrogen dioxide (NO2) was associated with the risk of critical and noncritical heart defects in a large population-based cohort of births. METHODS: We carried out a retrospective cohort study of children conceived between 2000 and 2016 in Quebec, Canada. Heart defects were identified via data from the Maintenance and Use of Data for the Study of Hospital Clientele registry. The main exposures were average concentration of PM2.5 and NO2 in a) the first trimester and b) the month of conception. Exposures were estimated at the residential postal code. Associations with critical and noncritical heart defects were assessed using logistic regression models, adjusted for maternal and infant characteristics. We considered single- and two-pollutant models and assessed modifying effects of maternal comorbidity, including preexisting hypertension, preeclampsia, anemia, and diabetes. RESULTS: The cohort comprised 1,342,198 newborns, including 12,715 with heart defects. Exposure in the first trimester and month of conception yielded similar results; both were associated with a greater risk of heart defects. Adjusted odds ratios (OR) for any heart defect per interquartile range increase were 1.02 (95% CI: 1.00, 1.05) for PM2.5 and 1.10 (95% CI: 1.07, 1.13) for NO2. Associations with atrial septal defects were 1.08 (95% CI: 1.03, 1.14) for PM2.5 and 1.19 (95% CI: 1.12, 1.25) for NO2. Corresponding ORs for ventricular septal defects and individual critical heart defects were not significant. PM2.5 (OR=1.11; 95% CI: 1.06, 1.17) and NO2 (OR=1.23; 95% CI: 1.17, 1.31) exposure were associated with a greater risk of heart defects in mothers with comorbidity. DISCUSSION: In this population-based cohort, prenatal exposure to ambient air pollution during the first trimester was associated with an increased risk of heart defects, particularly atrial septal defects. The association with heart defects was greater in mothers with comorbidity. https://doi.org/10.1289/EHP11120.

Black-White Inequality in Outcomes of In Vitro Fertilization: a Systematic Review and Meta-analysis.

This study aims to systematically review disparities in outcomes of in vitro fertilization between Black and White patients. We searched CINAHL, Cochrane Library, EMBASE, Global Health, PsycINFO, PubMed, and Web of Science for observational studies published before August 2021. Outcomes included implantation, clinical pregnancy, spontaneous abortion, and live birth following in vitro fertilization in Black versus White patients. We used random-effects models for meta-analysis and the Mantel-Haenszel method to calculate unadjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between race and in vitro fertilization outcomes, comparing Black relative to White patients. We used the generic inverse variance method to calculate adjusted ORs. Nine observational studies met eligibility criteria, including 696 Black and 7,458 White patients. All were retrospective studies of US cohorts. In unadjusted meta-analyses, Black patients had a greater likelihood of spontaneous abortion (OR 2.08, 95% CI 1.59-2.71) and lower likelihood of live birth (OR 0.67, 95% CI 0.47-0.95) compared with White patients but no difference in implantation (OR 0.95, 95% CI 0.32-2.77) or clinical pregnancy (OR 0.78, 95% CI 0.54-1.12). In adjusted meta-analyses, Black patients had lower odds of live birth (OR 0.57, 95% CI 0.43-0.75) and no difference in clinical pregnancy (OR 0.87, 95% CI 0.51-1.48). This meta-analysis suggests that in vitro fertilization services achieve similar pregnancy rates in Black and White patients. However, Black patients have more spontaneous abortions and fewer live births, suggesting there may be disparities in the quality of achieved pregnancies or other factors associated with pregnancy loss. Systematic review registration: PROSPERO (ID CRD42021256250).

The Calorie and Nutrient Density of More- Versus Less-Processed Packaged Food and Beverage Products in the Canadian Food Supply.

The association between the degree of processing and healthfulness of foods remains unclear. Most evidence of this relationship is based on dietary intake surveys rather than individual products and varies depending on the food processing classification system used. This study aimed to compare the nutritional quality of more- versus less-processed packaged foods and beverages in Canada, using a large, branded food database and two processing classification systems. Nutritional information for products (n = 17,269) was sourced from the University of Toronto FLIP 2017 database. Products were categorized using the NOVA and Poti et al. processing classification systems. Calories, sodium, saturated fat, total and free sugars, fibre and protein per 100 g (or mL) were examined by processing category using descriptive statistics and linear regression. Overall, the most-processed products under both systems were more likely to be lower in protein, and higher in total and free sugars, compared with less-processed foods (p < 0.05); the direction and strength of the association between other nutrients/components and level of processing were less consistent. These findings demonstrate that calorie- and nutrient-dense foods exist across different levels of processing, suggesting that food choices and dietary recommendations should be based primarily on energy or nutrient density rather than processing classification.