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Prenatal Ultraviolet Dose And Risk Of Limb Reduction Defects: A United States Birth Analysis
Giap H. Vu, MD, Clinton Morrison, MD, Constantinos Ketonis, MD, PhD, Patrick Reavey, MD.
University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
PURPOSE: The etiology of
limb reduction defects remains unclear. This study investigated the association between prenatal ultraviolet (UV) dose and the risk of limb reduction defects in the United States.
METHODS: The U.S. 2014 and 2015 Natality Data were utilized. Mean daily county-level population-weighted erythemally-weighted daily UV dose was calculated over the first trimester and the three months prior to conception for each live birth. Multivariable logistic regressions controlled for household demographics, prenatal characteristics, infant characteristics, and socioeconomic factors.
RESULTS: Of 7,693,026 live births included, 1044 (0.014%) had limb reduction defects. Compared to levels below the first quartile (1407 J/m
2), daily UV dose above the third quartile (3868 J/m
2) during the three months prior to conception was associated with statistically significantly lower odds of limb reduction defects (adjusted OR = 0.71 [0.57, 0.89],
p < 0.001). The model suggested several other risk factors for limb reduction defects, including lower maternal education level (
p < 0.05), lower birth weight (
p < 0.001), maternal pre-pregnancy diabetes (
p < 0.001), and user status of government-based insurance programs (
p < 0.05).
CONCLUSION: Prenatal UV exposure may present a protective factor against limb reduction defects. Existing literature suggests that this novel finding may potentially be mediated by UV-induced endothelial nitric oxide production, which decreases peripheral vascular tone and potentially the risk of fetal limb ischemia. However, further animal and clinical studies are needed to confirm this association and elucidate the mechanism. Our results also indicate several socioeconomic risk factors for this condition.
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