Early-life environmental exposures and pediatric cardiovascular health

Authors

  • I Ketut Alit Utamayasa Division of Pediatric Cardiology, Department of Paediatrics, Universitas Airlangga, Surabaya, East Java, Indonesia , Division of Pediatric Cardiology, Dr. Soetomo General Hospital, Surabaya, East Java, Indonesia
  • Ayurveda Zaynabila Heriqbaldi Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
  • Shabrina Nur Imanina Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
  • Prima Hari Nastiti Division of Pediatric Cardiology, Department of Paediatrics, Universitas Airlangga, Surabaya, East Java, Indonesia , Division of Pediatric Cardiology, Dr. Soetomo General Hospital, Surabaya, East Java, Indonesia
Published 2026-06-11
Issue Vol. 17 No. 1 (2026): June 2026
Section Review Articles
DOI: https://doi.org/10.30659/sainsmed.v17i1.52124
Keywords: Congenital heart disease, Endocrine-disrupting chemicals, Environmental exposure, Kawasaki disease, Lead exposure, Pediatric cardiovascular risk

Abstract

Environmental exposures in early life are increasingly recognised as key determinants of pediatric cardiovascular health. Beyond genetic susceptibility, insults during fetal development and childhood can shape risk for congenital and acquired cardiac conditions. This review synthesizes epidemiological data and plausible biological mechanisms linking four exposure domains to pediatric cardiovascular outcomes: (1) climate-related maternal heat exposure and other prenatal stressors associated with increased risk of congenital heart defects; (2) air pollution, especially traffic-related pollutants and sulfur dioxide, as a trigger for Kawasaki disease via immune activation and systemic inflammation; (3) early-life heavy metals, notably prenatal lead exposure, associated with modest but clinically meaningful increases in childhood blood pressure; and (4) endocrine-disrupting chemicals that promote early alterations in adiposity and metabolic regulation, elevating cardiometabolic risk. Collectively, the evidence highlights critical developmental windows when environmental insults exert lasting cardiovascular effects and supports incorporating environmental risk reduction into early-life prevention strategies.

Downloads

Download data is not yet available.

License

Creative Commons License

© 2026 Author(s). Published by Sains Medika: Jurnal Kedokteran dan Kesehatan. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

How to Cite

Utamayasa, I. K. A., Heriqbaldi, A. Z., Imanina, S. N., & Nastiti, P. H. (2026). Early-life environmental exposures and pediatric cardiovascular health. Sains Medika: Jurnal Kedokteran Dan Kesehatan, 17(1), 35-44. https://doi.org/10.30659/sainsmed.v17i1.52124

References

Agay-Shay, K., Friger, M., Linn, S., Peled, A., Amitai, Y., & Peretz, C. (2013). Ambient temperature and congenital heart defects. Human Reproduction, 28(8): 2289–2297. https://doi.org/10.1093/humrep/det244

Amin, M. M., Ebrahim, K., Hashemi, M., Shoshtari-Yeganeh, B., Rafiei, N., Mansourian, M., & Kelishadi, R. (2019). Association of exposure to Bisphenol A with obesity and cardiometabolic risk factors in children and adolescents. International Journal of Environmental Health Research, 29(1): 94–106. https://doi.org/10.1080/09603123.2018.1515896

Amin, M. M., Ebrahimpour, K., Parastar, S., Shoshtari-Yeganeh, B., Hashemi, M., Mansourian, M., Poursafa, P., Fallah, Z., Rafiei, N., & Kelishadi, R. (2018). Association of urinary concentrations of phthalate metabolites with cardiometabolic risk factors and obesity in children and adolescents. Chemosphere, 211: 547–556. https://doi.org/10.1016/j.chemosphere.2018.07.172

Auger, N., Fraser, W. D., Sauve, R., Bilodeau-Bertrand, M., & Kosatsky, T. (2017). Risk of congenital heart defects after ambient heat exposure early in pregnancy. Environmental Health Perspectives, 125(1): 8–14. https://doi.org/10.1289/EHP171

Braun, J. M. (2017). Early life exposure to endocrine disrupting chemicals and childhood obesity and neurodevelopment. Nature Reviews. Endocrinology, 13(3): 161–173. https://doi.org/10.1038/nrendo.2016.186

Burns, J., Heims-Waldron, D. A., Angelino, A. C., Lopez, K. N., Zachariah, J. P., & Deen, J. F. (2026). Environmental justice in vulnerable populations: Climate Change and congenital heart disease in American Indian/Alaska native children. Journal of Racial and Ethnic Health Disparities, 1–12. https://doi.org/10.1007/s40615-025-02789-9

Buteau, S., Belkaibech, S., Bilodeau-Bertrand, M., Hatzopoulou, M., Smargiassi, A., & Auger, N. (2020). Association between Kawasaki disease and prenatal exposure to ambient and industrial air pollution: A population-based cohort study. Environmental Health Perspectives, 128(10): 1-8. https://doi.org/10.1289/EHP6920

CDC. (2025a). About childhood lead poisoning prevention. childhood lead poisoning prevention. https://www.cdc.gov/lead-prevention/about/index.html . Accessed on 23 December 2025

CDC. (2025b). Clinical overview of heat and pregnancy. Heat Health. https://www.cdc.gov/heat-health/hcp/clinical-overview/heat-and-pregnant-women.html. Accessed on 23 December 2025

Elakabawi, K., Lin, J., Jiao, F., Guo, N., & Yuan, Z. (2020). Kawasaki disease: Global burden and genetic background. Cardiology Research, 11(1): 9–14. https://doi.org/10.14740/cr993

Farzan, S. F., Howe, C. G., Chen, Y., Gilbert-Diamond, D., Cottingham, K. L., Jackson, B. P., Weinstein, A. R., & Karagas, M. R. (2018). Prenatal lead exposure and elevated blood pressure in children. Environment International, 121: 1289–1296. https://doi.org/10.1016/j.envint.2018.10.049

Fujii, F., Egami, N., Inoue, M., & Koga, H. (2020). Weather condition, air pollutants, and epidemics as factors that potentially influence the development of Kawasaki disease. Science of The Total Environment, 741 (140469): 1-7. https://doi.org/10.1016/j.scitotenv.2020.140469

Gao, H., Geng, M., Tong, J., Wang, B., Huang, K., Zhang, Y., Gan, H., Zhu, B., Ding, P., Wang, Q., Wang, J., Zhang, C., Zhu, P., & Tao, F. (2023). Combined effects of prenatal phthalate exposure on cardiometabolic risk score among 4- to 7-year-old children: MABC study. Chemosphere, 311(137135): 1-11. https://doi.org/10.1016/j.chemosphere.2022.137135

Gore, A. C., Chappell, V. A., Fenton, S. E., Flaws, J. A., Nadal, A., Prins, G. S., Toppari, J., & Zoeller, R. T. (2015). EDC-2: The endocrine society’s second scientific statement on endocrine-disrupting chemicals. Endocrine Reviews, 36(6): E1–E150. https://doi.org/10.1210/er.2015-1010

Güil-Oumrait, N., Stratakis, N., Maitre, L., Anguita-Ruiz, A., Urquiza, J., Fabbri, L., Basagaña, X., Heude, B., Haug, L. S., & Sakhi, A. K. (2024). Prenatal exposure to chemical mixtures and metabolic syndrome risk in children. JAMA Network Open, 7(5): e2412040–e2412040. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2819044

Jin, S., Yoon, S. Z., Choi, Y. J., Kang, G., & Choi, S. U. (2024). Prenatal exposure to air pollutants and the risk of congenital heart disease: A Korean national health insurance database-based study. Scientific Reports, 14(1): 1-9. https://doi.org/10.1038/s41598-024-63150-4

Kalisch-Smith, J. I., Ved, N., & Sparrow, D. B. (2020). Environmental risk factors for congenital heart disease. Cold Spring Harbor Perspectives in Biology, 12(3), a037234. https://doi.org/10.1101/cshperspect.a037234

Katznelson, E., Navarro, M. J., Yuan, S., Kazi, D. S., & Singh, H. S. (2024). Climate change and congenital heart disease: A narrative review. Congenital Heart Disease, 19(6): 627-634. https://doi.org/10.32604/chd.2025.062309

Khalil, N., Chen, A., & Lee, M. (2014). Endocrine disruptive compounds and cardio-metabolic risk factors in children. Current Opinion in Pharmacology, Gastrointestinal • Endocrine and Metabolic Diseases, 19: 120–124. https://doi.org/10.1016/j.coph.2014.09.015

Khalil, N., Ebert, J. R., Wang, L., Belcher, S., Lee, M., Czerwinski, S. A., & Kannan, K. (2014). Bisphenol A and cardiometabolic risk factors in obese children. Science of The Total Environment, 470–471: 726–732. https://doi.org/10.1016/j.scitotenv.2013.09.088

Kim, B., Park, B., Kim, C. H., Kim, S., & Park, B. (2022). Association between endocrine-disrupting chemical mixture and metabolic indices among children, adolescents, and adults: A population-based study in Korea. Environmental Pollution, 315 (120399): 1-11. https://doi.org/10.1016/j.envpol.2022.120399

Kuo, N.-C., Lin, C.-H., & Lin, M.-C. (2022). Prenatal and early life exposure to air pollution and the incidence of Kawasaki disease. Scientific Reports, 12(1): 1-9. https://doi.org/10.1038/s41598-022-07081-y

Kwon, D., Choe, Y. J., Kim, S., Chun, B. C., & Choe, S. (2022). Ambient air pollution and Kawasaki disease in Korean children: A study of the national health insurance claim data. Journal of the American Heart Association, 11(9): 1-21. https://doi.org/10.1161/JAHA.121.024092

Lava, S. A. G. (2023). Cardiovascular disease in children: The future is now. Children, 10(5): 1-3. https://doi.org/10.3390/children10050886

Li, C., Lei, S., Liu, L., Yuan, Y., & Tian, J. (2025). The burden of cardiovascular disease in children in Asian countries (1990–2021): Systematic analysis and projection of the burden of disease. American Journal of Preventive Cardiology, 21, 100956: 1-10. https://doi.org/10.1016/j.ajpc.2025.100956

Liang, Y., Zhang, M., Jin, W., Zhao, L., & Wu, Y. (2024). Association of heavy metals exposure with lower blood pressure in the population aged 8–17 years: A cross-sectional study based on NHANES. Frontiers in Public Health, 12: 1-12. https://doi.org/10.3389/fpubh.2024.1411123

McCrindle, B. W., Rowley, A. H., Newburger, J. W., Burns, J. C., Bolger, A. F., Gewitz, M., Baker, A. L., Jackson, M. A., Takahashi, M., & Shah, P. B. (2017). Diagnosis, treatment, and long-term management of Kawasaki disease: A scientific statement for health professionals from the American Heart Association. Circulation, 135(17): e927–e999. https://doi.org/10.1161/CIR.0000000000000484

Pennington, A. F., Smith, M. R., Chuke, S. O., Cornwell, C. R., Allwood, P. B., & Courtney, J. G. (2024). Effects of blood lead levels <10 µg/dL in school-age children and adolescents: A scoping review. Pediatrics, 154(S 2): S1-S10. https://doi.org/10.1542/peds.2024-067808F

Qiu, H., He, Y., Rong, X., Ren, Y., Pan, L., Chu, M., Wu, R., & Shi, H. (2018). Delayed intravenous immunoglobulin treatment increased the risk of coronary artery lesions in children with Kawasaki disease at different status. Postgraduate Medicine, 130(4): 442–447. https://doi.org/10.1080/00325481.2018.1468712

Rowley, A. H. (2011). Kawasaki disease: Novel insights into etiology and genetic susceptibility. Annual Review of Medicine, 62: 69–77. https://doi.org/10.1146/annurev-med-042409-151944

Rowley, A. H. (2018). Is Kawasaki disease an infectious disorder? International Journal of Rheumatic Diseases, 21(1), 20–25. https://doi.org/10.1111/1756-185X.13213

Sanders, A. P., Svensson, K., Gennings, C., Burris, H. H., Oken, E., Amarasiriwardena, C., Basnet, P., Pizano-Zarate, M. L., Schnaas, L., Tamayo-Ortiz, M., Baccarelli, A. A., Satlin, L. M., Wright, R. O., & Tellez-Rojo, M. M. (2018). Prenatal lead exposure modifies the effect of shorter gestation on increased blood pressure in children. Environment International, 120: 464–471. https://doi.org/10.1016/j.envint.2018.08.038

Shetty, N. P., & Shetty, P. S. (2009). Epidemiology of disease in the tropics. Manson’s Tropical Diseases, Section 1. 19–34. https://doi.org/10.1016/B978-1-4160-4470-3.50007-0

Sittiwangkul, R., Pongprot, Y., Silvilairat, S., & Phornphutkul, C. (2011). Delayed diagnosis of Kawasaki disease: Risk factors and outcome of treatment. Annals of Tropical Paediatrics, 31(2): 109–114. https://doi.org/10.1179/1465328111Y.0000000005

Warembourg, C., Maitre, L., Tamayo-Uria, I., Fossati, S., Roumeliotaki, T., Aasvang, G. M., Andrusaityte, S., Casas, M., Cequier, E., Chatzi, L., Dedele, A., Gonzalez, J.-R., Gražulevičienė, R., Haug, L. S., Hernandez-Ferrer, C., Heude, B., Karachaliou, M., Krog, N. H., McEachan, R., Nieuwenhuijsen, M.; Petraviciene, I.; Quentin, J.; Robinson, O.; Sakhi, A.K.; Slama, R.; Thomsen, C.; Urquiza, J.; Vafeiadi, M.; West, J.; Wright, J.; Vrijheid, M.; Basagaña, X. (2019). Early-life environmental exposures and blood pressure in children: An exposome approach. Journal of the American College of Cardiology, 74(10): 1317–1328. https://doi.org/10.1016/j.jacc.2019.06.069

Zachariah, J. P., Jone, P.-N., Agbaje, A. O., Ryan, H. H., Trasande, L., Perng, W., & Farzan, S. F. (2024). Environmental exposures and pediatric cardiology: A scientific statement from the American Heart Association. Circulation, 149(20), e1165–e1175. https://doi.org/10.1161/CIR.0000000000001234

Zachariah, J. P., Wang, Y., Penny, D. J., & Baranowski, T. (2018). Relation between lead exposure and trends in blood pressure in children. The American Journal of Cardiology, 122(11): 1890–1895. https://doi.org/10.1016/j.amjcard.2018.08.033

Zhang, A., Hu, H., Sánchez, B. N., Ettinger, A. S., Park, S. K., Cantonwine, D., Schnaas, L., Wright, R. O., Lamadrid-Figueroa, H., & Tellez-Rojo, M. M. (2011). Association between prenatal lead exposure and blood pressure in children. Environmental Health Perspectives, 120(3), 445-450. https://pmc.ncbi.nlm.nih.gov/articles/PMC3295346/pdf/ehp.1103736.pdf

Zhang, M., Liu, T., Wang, G., Buckley, J. P., Guallar, E., Hong, X., Wang, M.-C., Wills-Karp, M., Wang, X., & Mueller, N. T. (2021). In utero exposure to heavy metals and trace elements and childhood blood pressure in a U.S. Urban, low-income, minority birth cohort. Environmental Health Perspectives, 129(6): 1-17. https://doi.org/10.1289/EHP8325