Association between Maternal Selenium Exposure and Congenital Heart Defects in Offspring: A Systematic Review and Meta-Analysis
Abstract
Background: The association between congenital heart defects (CHDs) and selenium (Se) is still unclear. We aimed to systematically review and quantitative analyze the potential relationship between maternal Se exposure and CHDs in the offspring.
Methods: PubMed, Embase, Web of Science and Scopus databases were searched from inception up to August 2021 for relevant studies. Methodological quality of the studies was assessed through Newcastle-Ottawa scale. The Standard mean difference (SMD) and corresponding 95% confidence interval (CI) were calculated to compare maternal Se levels between CHDs groups and control groups using a random-effects model.
Results: Four articles covering five studies were included in the systematic review, and three articles covering four studies were included in the meta-analysis. One study measured Se concentrations in maternal hair and found a positive correlation between high concentrations and increased risk of CHDs in offspring. However, one study on cord blood, and one on whole blood illustrated that Se exposure was associated with decreased risk of CHDs. There was no significant association found between serum Se levels and CHDs in two studies. Pooled results showed decreased Se levels in the circulation of mothers with CHDs offspring (SMD = -108.27, 95% CI: -192.72, -23.82), with statistically significant heterogeneity (I2 = 99.8%, P < 0.001) but not in hair, as compared with controls.
Conclusion: Low maternal Se status may be associated with increased risk of CHDs in offspring. However, further larger-scale studies with strict and consistent design methods are still required to investigate this issue.
1. Liu Z, Li X, Li N, et al (2013). Association between maternal exposure to housing renovation and offspring with congenital heart disease: a multi-hospital case-control study. Environ Health, 12:25.
2. Liu Y, Chen S, Zühlke L, et al (2019). Global birth prevalence of congenital heart de-fects 1970-2017: updated systematic re-view and meta-analysis of 260 studies. Int J Epidemiol, 48(2):455-463.
3. Huang JB, Liu YL, Lv XD (2010). Patho-genic mechanisms of congenital heart disease. Fetal Pediatr Pathol, 29(5):359-72.
4. Jenkins KJ, Correa A, Feinstein JA, et al (2007). Noninherited risk factors and congenital cardiovascular defects: current knowledge: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Pediatrics. Circulation, 115(23):2995-3014.
5. Zhang D, Cui H, Zhang L, Huang Y, Zhu J, Li X (2017). Is maternal smoking during pregnancy associated with an increased risk of congenital heart defects among offspring? A systematic review and meta-analysis of observational studies. J Matern Fetal Neonatal Med, 30(6):645-657.
6. Ghaderian M, Emami-Moghadam AR, Khalilian MR, Riahi K, Ghaedi F (2014). Prepregnancy Maternal Weight and Body Mass Index of Children with and without Congenital Heart Disease. Iran J Pediatr, 24(3):313-8.
7. Jin X, Tian X, Liu Z, et al (2016). Maternal exposure to arsenic and cadmium and the risk of congenital heart defects in off-spring. Reprod Toxicol, 59:109-16.
8. Zhang N, Liu Z, Tian X, et al (2018). Bari-um exposure increases the risk of con-genital heart defects occurrence in off-spring. Clin Toxicol (Phila), 56(2):132-139.
9. Gorini F, Chiappa E, Gargani L, Picano E (2014). Potential effects of environmental chemical contamination in congenital heart disease. Pediatr Cardiol, 35(4):559-68.
10. van Beynum IM, Kapusta L, Bakker MK,et al (2010). Protective effect of periconcep-tional folic acid supplements on the risk of congenital heart defects: a registry-based case-control study in the northern Netherlands. Eur Heart J, 31(4):464-71.
11. Fairweather-Tait SJ, Bao Y, et al (2011). Sele-nium in human health and disease. Anti-oxid Redox Signal, 14(7):1337-83.
12. Mousa R, Notis Dardashti R, Metanis N (2017). Selenium and Selenocysteine in Protein Chemistry. Angew Chem Int Ed Engl, 56(50):15818-15827.
13. Forstrom JW, Zakowski JJ, Tappel AL (1978). Identification of the catalytic site of rat liver glutathione peroxidase as sele-nocysteine. Biochemistry, 17(13):2639-44.
14. Yang GQ, Chen JS, Wen ZM, et al (1984). The role of selenium in Keshan disease. Adv Nutr Res, 6:203-31.
15. Loscalzo J (2014). Keshan disease, selenium deficiency, and the selenoproteome. N Engl J Med, 370(18):1756-60.
16. MacFarquhar JK, Broussard DL, Melstrom P, et al (2010). Acute selenium toxicity as-sociated with a dietary supplement. Arch Intern Med, 170(3):256-61.
17. Yang GQ, Wang SZ, Zhou RH, Sun SZ (1983). Endemic selenium intoxication of humans in China. Am J Clin Nutr, 37(5):872-81.
18. Valdiglesias V, Pasaro E, Mendez J, Laffon B (2010). In vitro evaluation of selenium genotoxic, cytotoxic, and protective ef-fects: a review. Arch Toxicol, 84(5):337-51.
19. Zachara BA, Pawluk H, Korenkiewicz J, Skok Z (2001). Selenium levels in kidney, liver and heart of newborns and infants. Early Hum Dev, 63(2):103-111.
20. Guo Y, Yu P, Zhu J, et al (2019). High ma-ternal selenium levels are associated with increased risk of congenital heart defects in the offspring. Prenatal Diagn, 39(12):1107-1114.
21. Ou Y, Bloom MS, Nie Z, et al (2017). Asso-ciations between toxic and essential trace elements in maternal blood and fetal congenital heart defects. Environ Int, 106:127-134.
22. Stroup DF, Berlin JA, Morton SC, et al (2000). Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observation-al Studies in Epidemiology (MOOSE) group. JAMA, 283(15):2008-12.
23. GA Wells BS, D O'Connell, J Peterson, V Welch, M Losos, P Tugwell, (2011). The Newcastle-Ottawa Scale (NOS) for As-sessing the Quality of Nonrandomised Studies in Meta-Analysis. https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
24. Wan X, Wang W, Liu J, Tong T (2014). Es-timating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol, 14:135.
25. Higgins JP, Thompson SG (2002). Quanti-fying heterogeneity in a meta-analysis. Stat Med, 21(11):1539-58.
26. Aschengrau A, Zierler S, Cohen A (1993). Quality of Community Drinking Water and the Occurrence of Late Adverse Pregnancy Outcomes. Arch Environ Health, 48(2):105-113.
27. Zhang B-Y, Zhang T, Lin L-M (2008). Cor-relation between birth defects and dietary nutrition status in a high incidence area of China. Biomed Environ Sci, 21(1):37-44.
28. Ou Y, Bloom Michael S, Xiaoqing L, Shao L (2017). Maternal blood trace element levels and risks for fetal congenital heart defects in guangdong, china. Journal of the American College of Cardiology, 69:576-576.
29. Vinceti M, Cann CI, Calzolari E, Vivoli R, Garavelli L, Bergomi M (2000). Repro-ductive outcomes in a population ex-posed long-term to inorganic selenium via drinking water. Sci Total Environ, 250(1-3):1-7.
30. Zierler S, Theodore M, Cohen A, Rothman KJ (1988). Chemical quality of maternal drinking water and congenital heart dis-ease. Int J Epidemiol, 17(3):589-594.
31. Sahin K, Elevli M, Pence S, et al (2019). Zinc, copper, and selenium levels in ba-bies with congenital heart disease. Trace Elements and Electrolytes, 36:156-162.
32. Hammouda SAI, Abd Al-Halim OAF, Mo-hamadin AM (2013). Serum levels of some micronutrients and congenital mal-formations: A prospective cohort study in healthy Saudi-Arabian first-trimester pregnant women. International Journal for Vitamin and Nutrition Research, 83:346-354.
33. Leirgul E, Fomina T, Brodwall K, et al (2014). Birth prevalence of congenital heart defects in Norway 1994-2009--a na-tionwide study. Am Heart J, 168(6):956-64.
34. Botto LD, Lin AE, Riehle-Colarusso T, Ma-lik S, Correa A (2007). Seeking causes: Classifying and evaluating congenital heart defects in etiologic studies. Birth De-fects Res A Clin Mol Teratol, 79:714-27.
35. Hartikainen H (2005). Biogeochemistry of selenium and its impact on food chain quality and human health. J Trace Elem Med Biol, 18(4):309-18.
36. Mayne ST (2003). Antioxidant nutrients and chronic disease: use of biomarkers of ex-posure and oxidative stress status in epi-demiologic research. J Nutr, 133 Suppl 3:933s-940s.
37. Yang G, Zhou R, Yin S, et al (1989). Studies of safe maximal daily dietary selenium in-take in a seleniferous area in China. I. Se-lenium intake and tissue selenium levels of the inhabitants. J Trace Elem Electrolytes Health Dis, 3(2):77-87.
38. Lemire M, Mergler D, Huel G,et al (2009). Biomarkers of selenium status in the Amazonian context: blood, urine and se-quential hair segments. J Expo Sci Environ Epidemiol, 19(2):213-22.
39. Mihailović M, Cvetković M, Ljubić A, et al (2000). Selenium and malondialdehyde content and glutathione peroxidase activi-ty in maternal and umbilical cord blood and amniotic fluid. Biol Trace Elem Res, 73(1):47-54.
40. Dhanantwari P, Leatherbury L, Lo CW, Donofrio MT (2012). Chapter 18 - Hu-man Cardiac Development in the First Trimester. In: Hemodynamics and Cardiology: Neonatology Questions and Controversies (Second Edition). Ed(s), Kleinman CS, Seri I. Phil-adelphia: W.B. Saunders, pp. 377-389.
41. Sun R, Liu M, Lu L, Zheng Y, Zhang P (2015). Congenital Heart Disease: Causes, Diagnosis, Symptoms, and Treatments. Cell Biochem Biophys, 72(3):857-60.
42. Lopez V, Keen CL, Lanoue L (2008). Prena-tal zinc deficiency: influence on heart morphology and distribution of key heart proteins in a rat model. Biol Trace Elem Res, 122(3):238-55.
43. Hawk SN, Uriu-Hare JY, Daston GP, et al (1998). Rat embryos cultured under cop-per-deficient conditions develop abnor-mally and are characterized by an im-paired oxidant defense system. Teratology, 57(6):310-20.
44. Zhu B, Liu L, Li DL, Ling F, Wang GX (2014). Developmental toxicity in rare minnow (Gobiocypris rarus) embryos exposed to Cu, Zn and Cd. Ecotoxicol En-viron Saf, 104:269-77.
45. Dinh QT, Cui Z, Huang J, et al (2018). Sele-nium distribution in the Chinese envi-ronment and its relationship with human health: A review. Environ Int, 112:294-309.
2. Liu Y, Chen S, Zühlke L, et al (2019). Global birth prevalence of congenital heart de-fects 1970-2017: updated systematic re-view and meta-analysis of 260 studies. Int J Epidemiol, 48(2):455-463.
3. Huang JB, Liu YL, Lv XD (2010). Patho-genic mechanisms of congenital heart disease. Fetal Pediatr Pathol, 29(5):359-72.
4. Jenkins KJ, Correa A, Feinstein JA, et al (2007). Noninherited risk factors and congenital cardiovascular defects: current knowledge: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Pediatrics. Circulation, 115(23):2995-3014.
5. Zhang D, Cui H, Zhang L, Huang Y, Zhu J, Li X (2017). Is maternal smoking during pregnancy associated with an increased risk of congenital heart defects among offspring? A systematic review and meta-analysis of observational studies. J Matern Fetal Neonatal Med, 30(6):645-657.
6. Ghaderian M, Emami-Moghadam AR, Khalilian MR, Riahi K, Ghaedi F (2014). Prepregnancy Maternal Weight and Body Mass Index of Children with and without Congenital Heart Disease. Iran J Pediatr, 24(3):313-8.
7. Jin X, Tian X, Liu Z, et al (2016). Maternal exposure to arsenic and cadmium and the risk of congenital heart defects in off-spring. Reprod Toxicol, 59:109-16.
8. Zhang N, Liu Z, Tian X, et al (2018). Bari-um exposure increases the risk of con-genital heart defects occurrence in off-spring. Clin Toxicol (Phila), 56(2):132-139.
9. Gorini F, Chiappa E, Gargani L, Picano E (2014). Potential effects of environmental chemical contamination in congenital heart disease. Pediatr Cardiol, 35(4):559-68.
10. van Beynum IM, Kapusta L, Bakker MK,et al (2010). Protective effect of periconcep-tional folic acid supplements on the risk of congenital heart defects: a registry-based case-control study in the northern Netherlands. Eur Heart J, 31(4):464-71.
11. Fairweather-Tait SJ, Bao Y, et al (2011). Sele-nium in human health and disease. Anti-oxid Redox Signal, 14(7):1337-83.
12. Mousa R, Notis Dardashti R, Metanis N (2017). Selenium and Selenocysteine in Protein Chemistry. Angew Chem Int Ed Engl, 56(50):15818-15827.
13. Forstrom JW, Zakowski JJ, Tappel AL (1978). Identification of the catalytic site of rat liver glutathione peroxidase as sele-nocysteine. Biochemistry, 17(13):2639-44.
14. Yang GQ, Chen JS, Wen ZM, et al (1984). The role of selenium in Keshan disease. Adv Nutr Res, 6:203-31.
15. Loscalzo J (2014). Keshan disease, selenium deficiency, and the selenoproteome. N Engl J Med, 370(18):1756-60.
16. MacFarquhar JK, Broussard DL, Melstrom P, et al (2010). Acute selenium toxicity as-sociated with a dietary supplement. Arch Intern Med, 170(3):256-61.
17. Yang GQ, Wang SZ, Zhou RH, Sun SZ (1983). Endemic selenium intoxication of humans in China. Am J Clin Nutr, 37(5):872-81.
18. Valdiglesias V, Pasaro E, Mendez J, Laffon B (2010). In vitro evaluation of selenium genotoxic, cytotoxic, and protective ef-fects: a review. Arch Toxicol, 84(5):337-51.
19. Zachara BA, Pawluk H, Korenkiewicz J, Skok Z (2001). Selenium levels in kidney, liver and heart of newborns and infants. Early Hum Dev, 63(2):103-111.
20. Guo Y, Yu P, Zhu J, et al (2019). High ma-ternal selenium levels are associated with increased risk of congenital heart defects in the offspring. Prenatal Diagn, 39(12):1107-1114.
21. Ou Y, Bloom MS, Nie Z, et al (2017). Asso-ciations between toxic and essential trace elements in maternal blood and fetal congenital heart defects. Environ Int, 106:127-134.
22. Stroup DF, Berlin JA, Morton SC, et al (2000). Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observation-al Studies in Epidemiology (MOOSE) group. JAMA, 283(15):2008-12.
23. GA Wells BS, D O'Connell, J Peterson, V Welch, M Losos, P Tugwell, (2011). The Newcastle-Ottawa Scale (NOS) for As-sessing the Quality of Nonrandomised Studies in Meta-Analysis. https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
24. Wan X, Wang W, Liu J, Tong T (2014). Es-timating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol, 14:135.
25. Higgins JP, Thompson SG (2002). Quanti-fying heterogeneity in a meta-analysis. Stat Med, 21(11):1539-58.
26. Aschengrau A, Zierler S, Cohen A (1993). Quality of Community Drinking Water and the Occurrence of Late Adverse Pregnancy Outcomes. Arch Environ Health, 48(2):105-113.
27. Zhang B-Y, Zhang T, Lin L-M (2008). Cor-relation between birth defects and dietary nutrition status in a high incidence area of China. Biomed Environ Sci, 21(1):37-44.
28. Ou Y, Bloom Michael S, Xiaoqing L, Shao L (2017). Maternal blood trace element levels and risks for fetal congenital heart defects in guangdong, china. Journal of the American College of Cardiology, 69:576-576.
29. Vinceti M, Cann CI, Calzolari E, Vivoli R, Garavelli L, Bergomi M (2000). Repro-ductive outcomes in a population ex-posed long-term to inorganic selenium via drinking water. Sci Total Environ, 250(1-3):1-7.
30. Zierler S, Theodore M, Cohen A, Rothman KJ (1988). Chemical quality of maternal drinking water and congenital heart dis-ease. Int J Epidemiol, 17(3):589-594.
31. Sahin K, Elevli M, Pence S, et al (2019). Zinc, copper, and selenium levels in ba-bies with congenital heart disease. Trace Elements and Electrolytes, 36:156-162.
32. Hammouda SAI, Abd Al-Halim OAF, Mo-hamadin AM (2013). Serum levels of some micronutrients and congenital mal-formations: A prospective cohort study in healthy Saudi-Arabian first-trimester pregnant women. International Journal for Vitamin and Nutrition Research, 83:346-354.
33. Leirgul E, Fomina T, Brodwall K, et al (2014). Birth prevalence of congenital heart defects in Norway 1994-2009--a na-tionwide study. Am Heart J, 168(6):956-64.
34. Botto LD, Lin AE, Riehle-Colarusso T, Ma-lik S, Correa A (2007). Seeking causes: Classifying and evaluating congenital heart defects in etiologic studies. Birth De-fects Res A Clin Mol Teratol, 79:714-27.
35. Hartikainen H (2005). Biogeochemistry of selenium and its impact on food chain quality and human health. J Trace Elem Med Biol, 18(4):309-18.
36. Mayne ST (2003). Antioxidant nutrients and chronic disease: use of biomarkers of ex-posure and oxidative stress status in epi-demiologic research. J Nutr, 133 Suppl 3:933s-940s.
37. Yang G, Zhou R, Yin S, et al (1989). Studies of safe maximal daily dietary selenium in-take in a seleniferous area in China. I. Se-lenium intake and tissue selenium levels of the inhabitants. J Trace Elem Electrolytes Health Dis, 3(2):77-87.
38. Lemire M, Mergler D, Huel G,et al (2009). Biomarkers of selenium status in the Amazonian context: blood, urine and se-quential hair segments. J Expo Sci Environ Epidemiol, 19(2):213-22.
39. Mihailović M, Cvetković M, Ljubić A, et al (2000). Selenium and malondialdehyde content and glutathione peroxidase activi-ty in maternal and umbilical cord blood and amniotic fluid. Biol Trace Elem Res, 73(1):47-54.
40. Dhanantwari P, Leatherbury L, Lo CW, Donofrio MT (2012). Chapter 18 - Hu-man Cardiac Development in the First Trimester. In: Hemodynamics and Cardiology: Neonatology Questions and Controversies (Second Edition). Ed(s), Kleinman CS, Seri I. Phil-adelphia: W.B. Saunders, pp. 377-389.
41. Sun R, Liu M, Lu L, Zheng Y, Zhang P (2015). Congenital Heart Disease: Causes, Diagnosis, Symptoms, and Treatments. Cell Biochem Biophys, 72(3):857-60.
42. Lopez V, Keen CL, Lanoue L (2008). Prena-tal zinc deficiency: influence on heart morphology and distribution of key heart proteins in a rat model. Biol Trace Elem Res, 122(3):238-55.
43. Hawk SN, Uriu-Hare JY, Daston GP, et al (1998). Rat embryos cultured under cop-per-deficient conditions develop abnor-mally and are characterized by an im-paired oxidant defense system. Teratology, 57(6):310-20.
44. Zhu B, Liu L, Li DL, Ling F, Wang GX (2014). Developmental toxicity in rare minnow (Gobiocypris rarus) embryos exposed to Cu, Zn and Cd. Ecotoxicol En-viron Saf, 104:269-77.
45. Dinh QT, Cui Z, Huang J, et al (2018). Sele-nium distribution in the Chinese envi-ronment and its relationship with human health: A review. Environ Int, 112:294-309.
| Files | ||
| Issue | Vol 51 No 10 (2022) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v51i10.10974 | |
| Keywords | ||
| Selenium Metal exposure Congenital heart defects Offspring | ||
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How to Cite
1.
Pan Z, Zhu T, Zhu J, Zhang N. Association between Maternal Selenium Exposure and Congenital Heart Defects in Offspring: A Systematic Review and Meta-Analysis. Iran J Public Health. 2022;51(10):2149-2158.
