Meta-analysis of parental occupational exposure to pesticides or agricultural work and congenital heart disease Open Access

Burkel, Veronica (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/wd375w70x?locale=en
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Abstract

Objective: To use systematic review and meta-analysis tools and techniques to identify and synthesize the current literature on occupational exposure to pesticides or agricultural work and congenital heart disease.

Methods: A search on Pub Med for study articles with key terms (See Appendix) resulting in 4,552 articles. Articles were examined for relevance via title, keywords, abstract, and full-text review, resulting in eleven articles for independent abstraction by two reviewers. Pooled effect estimates and 95% confidence intervals (CI) were calculated using random and fixed effects models for maternal and paternal effects on all cardiovascular defects and for ventricular septal defects (VSD).

Results: The results for occupational exposure to pesticides or agricultural work on congenital heart disease were found to be null for maternal and paternal estimates for all pooled results; maternal exposure for all cardiovascular defects (n = 7; OR 0.92; 95% CI 0.78-1.09) maternal exposure with covariate adjustment for all cardiovascular defects (n = 4; OR 0.84; 95% CI 0.69-1.02), maternal exposure on VSD (n = 3; OR 0.90; 95% CI 0.74-1.10), paternal exposure with covariate adjustment for all cardiovascular defects (n = 3; OR: 0.82; 95% CI: 0.68-1.00), and paternal exposure for VSD (n = 3; OR: 1.01; 95% CI: 0.76-1.33). Systematic review of these studies identified study methods in need of improvement for more accurate results, including issues related to exposure measurement and misclassification, precision and consistency of outcome definitions and outcome inclusions, adjustment for covariates, and specificity of the agent.

Conclusions: The current literature on occupational pesticide or agricultural work exposure and congenital heart disease in offspring suggests no association. Due to the challenging nature of data collection, the many avenues of potential bias to the null, and the methodological inconsistencies across studies, we think it is too soon to rule out an effect of exposure on disease. Future studies should attempt to specify an agent, adjust for covariates, enumerate all pesticide exposure sources, measure the dose of the exposure(s), and identify specific ICD-coded birth outcomes.

Table of Contents

Table of Contents

Page

Introduction

Methods

Results

Discussion

Pooled effect estimates

Exposure assessment issues

Outcome classification

Other study limitations

Conclusion

References

Tables & Figures

Appendix

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