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Zhang X, Fan C, Ren Z, Feng H, Zuo S, Hao J, Liao J, Zou Y, Ma L. Maternal PM 2.5 exposure triggers preterm birth: a cross-sectional study in Wuhan, China. Glob Health Res Policy 2020; 5:17. [PMID: 32377568 PMCID: PMC7193342 DOI: 10.1186/s41256-020-00144-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background Most of the studies regarding air pollution and preterm birth (PTB) in highly polluted areas have estimated the exposure level based on fixed-site monitoring. However, exposure assessment methods relying on monitors have the potential to cause exposure misclassification due to a lack of spatial variation. In this study, we utilized a land use regression (LUR) model to assess individual exposure, and explored the association between PM2.5 exposure during each time window and the risk of preterm birth in Wuhan city, China. Methods Information on 2101 singleton births, which were ≥ 20 weeks of gestation and born between November 1, 2013 and May 31, 2014; between January 1, 2015 and August 31, 2015, was obtained from the Obstetrics Department in one 3A hospital in Wuhan. Air quality index (AQI) data were accessed from the Wuhan Environmental Protection Bureau website. Individual exposure during pregnancy was assessed by LUR models and Kriging interpolation. Logistic regression analyses were conducted to determine the association between women exposure to PM2.5 and the risk of different subtypes of PTB. Results During the study period, the average individual exposure concentration of PM2.5 during the entire pregnancy was 84.54 μg/m3. A 10 μg/m3 increase of PM2.5 exposure in the first trimester (OR: 1.169; 95% CI: 1.077, 1.262), the second trimester (OR: 1.056; 95% CI: 1.015, 1.097), the third trimester (OR: 1.052; 95% CI: 1.002, 1.101), and the entire pregnancy (OR: 1.263; 95% CI: 1.158, 1.368) was significantly associated with an increased risk of PTB. For the PTB subgroup, the hazard of PM2.5 exposure during pregnancy was stronger for very preterm births (VPTB) than moderate preterm births (MPTB). The first trimester was the most susceptible exposure window. Moreover, women who had less than 9 years of education or who conceived during the cold season tended to be more susceptible to the PM2.5 exposure during pregnancy. Conclusions Maternal exposure to PM2.5 increased the risk of PTB, and this risk was stronger for VPTB than for MPTB, especially during the first trimester.
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Affiliation(s)
- Xiaotong Zhang
- 1Department of Epidemiology and Health Statistics, School of Health Sciences, Wuhan University, Wuhan, 430071 China
| | - Cuifang Fan
- 2Department of Obstetrics, Renmin Hospital of Wuhan University, Wuhan, 430060 China
| | - Zhan Ren
- 1Department of Epidemiology and Health Statistics, School of Health Sciences, Wuhan University, Wuhan, 430071 China
| | - Huan Feng
- 1Department of Epidemiology and Health Statistics, School of Health Sciences, Wuhan University, Wuhan, 430071 China
| | - Shanshan Zuo
- 1Department of Epidemiology and Health Statistics, School of Health Sciences, Wuhan University, Wuhan, 430071 China
| | - Jiayuan Hao
- 1Department of Epidemiology and Health Statistics, School of Health Sciences, Wuhan University, Wuhan, 430071 China
| | - Jingling Liao
- 3Department of Public Health, Wuhan University of Science and Technology School of Medicine, Wuhan, 430081 China
| | - Yuliang Zou
- 1Department of Epidemiology and Health Statistics, School of Health Sciences, Wuhan University, Wuhan, 430071 China.,4Global Health Institute, Wuhan University, Wuhan, 430071 China
| | - Lu Ma
- 1Department of Epidemiology and Health Statistics, School of Health Sciences, Wuhan University, Wuhan, 430071 China.,4Global Health Institute, Wuhan University, Wuhan, 430071 China
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Gronlund CJ, Yang AJ, Conlon KC, Bergmans RS, Le HQ, Batterman SA, Wahl RL, Cameron L, O'Neill MS. Time series analysis of total and direct associations between high temperatures and preterm births in Detroit, Michigan. BMJ Open 2020; 10:e032476. [PMID: 32029486 PMCID: PMC7045030 DOI: 10.1136/bmjopen-2019-032476] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 12/17/2019] [Accepted: 01/09/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Preterm births (PTBs) represent significant health risks, and several studies have found associations between high outdoor temperatures and PTB. We estimated both the total and natural direct effects (independent of particulate matter, ozone and nitrogen dioxide air pollutants) of the prior 2-day mean apparent temperature (AT) on PTB. We evaluated effect modification by maternal age, race, education, smoking status and prenatal care. DESIGN AND SETTING We obtained birth records and meteorological data for the Detroit, Michigan, USA area, for the warm months (May to September), 1991 to 2001. We used a time series Poisson regression with splines of AT, wind speed, solar radiation and citywide average precipitation to estimate total effects. To accommodate multiple mediators and exposure-mediator interactions, AT inverse odds weights, predicted by meteorological and air pollutant covariates, were added in a subsequent model to estimate direct effects. RESULTS At 24.9°C relative to 18.6°C, 10.6% (95% CI: 3.8% to 17.2%) of PTBs were attributable to the total effects of AT, and 10.4% (95% CI: 2.2% to 17.5%) to direct effects. Relative excess risks of interaction indicated that the risk of PTB with increasing temperature above 18.6°C was significantly lower among black mothers and higher among mothers less than 19, older than 30, with late or no prenatal care and who smoked. CONCLUSION This additional evidence of a direct association between high temperature and PTB may motivate public health interventions to reduce extreme heat exposures among pregnant women, particularly among those who may have enhanced vulnerability.
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Affiliation(s)
- Carina J Gronlund
- Survey Research Center, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
| | - Alyssa J Yang
- Urban Indian Health Institute, Seattle, Washington, USA
| | - Kathryn C Conlon
- Public Health Sciences, University of California Davis, Davis, California, USA
| | - Rachel S Bergmans
- Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Hien Q Le
- Toxicology and Risk Assessment, Chemours Co, Wilmington, Delaware, USA
| | - Stuart A Batterman
- Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert L Wahl
- Surveillance and Program Evaluation Section, Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Lorraine Cameron
- Michigan Climate and Health Adaptation Program, Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Marie S O'Neill
- Environmental Health Sciences and Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
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Sun X, Luo X, Cao G, Zhao C, Xiao J, Liu X, Dong M, Wang J, Zeng W, Guo L, Wan D, Ma W, Liu T. Associations of ambient temperature exposure during pregnancy with the risk of miscarriage and the modification effects of greenness in Guangdong, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 702:134988. [PMID: 31715397 DOI: 10.1016/j.scitotenv.2019.134988] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/13/2019] [Accepted: 10/13/2019] [Indexed: 06/10/2023]
Abstract
Miscarriage is one of the commonest complications of pregnancy. Although previous studies suggested that environmental factors were important causes of miscarriage, evidence is still inadequate. Here, we examined the association of maternal exposure to temperature with the risk of miscarriage and further assessed the modifying effects of surrounding residential greenness. A case-control study was conducted at a large hospital in Guangzhou, China. All participants' information was extracted from hospital records. An inverse distance weighted method was used to estimate the temperature exposure at each residential address, where the greenness was measured by Normalized Difference Vegetation Index (NDVI). A logistic regression model was applied to estimate the association of temperature exposure with the risk of miscarriage. A total of 2044 cases of miscarriage and 2285 controls were included in the present study. We observed a generally non-linear positive relationship between temperature exposure and the risk of miscarriage. More pronounced effects of high temperatures vs. low temperatures were found during the two months prior to hospitalization than in other periods. The odds ratio (OR) of 29.4 °C (95th centile) compared with 15 °C during the first month prior to hospitalization was 1.480 (95% CI: 1.021-2.145). Smaller effects of temperatures were seen on the risk of miscarriage among participants with moderately great surrounding greenness compared with those with less greenness. We concluded that maternal exposure to moderately high temperature during pregnancy may increase the risk of miscarriage, but the modifying effects of greenness on these associations need to be further tested in future studies.
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Affiliation(s)
- Xiaoli Sun
- Gynecology Department, Guangdong Women and Children Hospital, Guangzhou 511442, China
| | - Xiping Luo
- Gynecology Department, Guangdong Women and Children Hospital, Guangzhou 511442, China
| | - Ganxiang Cao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Chunmei Zhao
- Gynecology Department, Guangdong Women and Children Hospital, Guangzhou 511442, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Xin Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Moran Dong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Jiaqi Wang
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Lingchuan Guo
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Donghua Wan
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China; General Practice Center, Nanhai Hospital, Southern Medical University, Foshan 528200, China.
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Liu X, Ye Y, Chen Y, Li X, Feng B, Cao G, Xiao J, Zeng W, Li X, Sun J, Ning D, Yang Y, Yao Z, Guo Y, Wang Q, Zhang Y, Ma W, Du Q, Zhang B, Liu T. Effects of prenatal exposure to air particulate matter on the risk of preterm birth and roles of maternal and cord blood LINE-1 methylation: A birth cohort study in Guangzhou, China. ENVIRONMENT INTERNATIONAL 2019; 133:105177. [PMID: 31622906 DOI: 10.1016/j.envint.2019.105177] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/10/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Epidemiological studies have found that increased risk of preterm birth (PTB) is associated with higher prenatal exposure to PM10 and PM2.5, but few studies have been conducted to assess the impacts of extremely fine particulate matter (PM1) which may have more toxic effects than other types of ambient particulate air pollution (PM). Several studies have separately investigated the associations between DNA methylation and PTB risk and PM. Maternal LINE-1 methylation level negatively correlated with prenatal exposure to PM and risk of PTB. A comprehensive picture is lacking regarding the associations between prenatal exposure to PM, LINE-1 methylation, and risk of PTB. OBJECTIVES This study aimed to estimate the effects of exposure to ambient PM (PM10, PM2.5, and PM1) of different sizes during pregnancy on risk of PTB, identify susceptible exposure windows, and illustrate the roles of LINE-1 methylation in the associations between PM and PTB risk. METHODS The Birth Cohort Study on Prenatal Environments and Offspring Health (PEOH) has been ongoing since 2016 in Guangzhou, China. A total of 4928 pregnant women were recruited during early pregnancy, and 4278 (86.8%) were successfully followed-up. Each individual weekly exposure to PM10 and PM2.5 from 3 months before pregnancy to childbirth was assessed using a spatiotemporal land use regression model, and the weekly PM1 exposure was estimated by employing a generalized additive model. Maternal and cord blood LINE-1 methylation levels (%5mC) were tested using bisulfite-PCR pyrosequencing. A distributed lag nonlinear model incorporated with a Cox proportional hazard model was applied to assess the effect of weekly-specific maternal PM exposure on PTB risk, and a multiple-linear regression model was employed to investigate the associations between PM exposure and LINE-1 methylation levels of maternal and cord bloods. We also assessed the associations between LINE-1 methylation levels and PTB risk by using a logistic regression model. RESULTS The risk of PTB was positively associated with PM2.5 and PM1 concentrations during the 12th to 20th gestational weeks, and the strongest association was in the fourth quartile (Q4) versus the first quartile (Q1) and observed during the 16th gestational week (PM2.5: harzard ratio [HR] = 1.18, 95%CI: 1.04-1.35, IQR = 11.94 μg/m3. PM1: HR = 1.20, 95%CI: 1.03-1.39, IQR = 11.36 μg/m3). We observed significantly negative associations of PM10(β = -0.51%5mC per 10 μg/m3, P = 0.014), PM2.5 (β = -0.66%5mC per 10 μg/m3, P = 0.032) and PM1 (β = -0.67%5mC per 10 μg/m3, P = 0.032) concentrations with cord blood LINE-1 methylation levels, and a negative association between PM1 concentration and maternal LINE-1 methylation level (β = -0.86%5mC per 10 μg/m3, P = 0.034). CONCLUSION Higher prenatal exposure to PM1 and PM2.5 during the 12th to 20th gestational weeks was associated with increased risk of PTB. Maternal and fetal LINE-1 methylation alternation might be an underlying mechanism of PM that increasing the risk of PTB.
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Affiliation(s)
- Xin Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Yufeng Ye
- Guangzhou Panyu Central Hospital, Guangzhou 511400, China
| | - Yi Chen
- Guangzhou Panyu Central Hospital, Guangzhou 511400, China
| | - Xiaona Li
- Department of Environmental and Occupational Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Baixiang Feng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Ganxiang Cao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Xing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Jiufeng Sun
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Dan Ning
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Yi Yang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510080, China
| | - Zhenjiang Yao
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510080, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Qiong Wang
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yonghui Zhang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China; General Practice Center, Nanhai Hospital, Southern Medical University, Foshan 528200, China
| | - Qingfeng Du
- General Practice Center, Nanhai Hospital, Southern Medical University, Foshan 528200, China
| | - Bo Zhang
- Food Safety and Health Research Center, School of Public Health, Southern Medical University, Guangzhou 510515, China; Department of Environmental and Occupational Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China; General Practice Center, Nanhai Hospital, Southern Medical University, Foshan 528200, China.
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Siddika N, Rantala AK, Antikainen H, Balogun H, Amegah AK, Ryti NRI, Kukkonen J, Sofiev M, Jaakkola MS, Jaakkola JJK. Synergistic effects of prenatal exposure to fine particulate matter (PM 2.5) and ozone (O 3) on the risk of preterm birth: A population-based cohort study. ENVIRONMENTAL RESEARCH 2019; 176:108549. [PMID: 31252204 DOI: 10.1016/j.envres.2019.108549] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/14/2019] [Accepted: 06/18/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND There is some evidence that prenatal exposure to low-level air pollution increases the risk of preterm birth (PTB), but little is known about synergistic effects of different pollutants. OBJECTIVES We assessed the independent and joint effects of prenatal exposure to air pollution during the entire duration of pregnancy. METHODS The study population consisted of the 2568 members of the Espoo Cohort Study, born between 1984 and 1990, and living in the City of Espoo, Finland. We assessed individual-level prenatal exposure to ambient air pollutants of interest at all the residential addresses from conception to birth. The pollutant concentrations were estimated both by using regional-to-city-scale dispersion modelling and land-use regression-based method. We applied Poisson regression analysis to estimate the adjusted risk ratios (RRs) with their 95% confidence intervals (CI) by comparing the risk of PTB among babies with the highest quartile (Q4) of exposure during the entire duration of pregnancy with those with the lower exposure quartiles (Q1-Q3). We adjusted for season of birth, maternal age, sex of the baby, family's socioeconomic status, maternal smoking during pregnancy, maternal exposure to environmental tobacco smoke during pregnancy, single parenthood, and exposure to other air pollutants (only in multi-pollutant models) in the analysis. RESULTS In a multi-pollutant model estimating the effects of exposure during entire pregnancy, the adjusted RR was 1.37 (95% CI: 0.85, 2.23) for PM2.5 and 1.64 (95% CI: 1.15, 2.35) for O3. The joint effect of PM2.5 and O3 was substantially higher, an adjusted RR of 3.63 (95% CI: 2.16, 6.10), than what would have been expected from their independent effects (0.99 for PM2.5 and 1.34 for O3). The relative risk due to interaction (RERI) was 2.30 (95% CI: 0.95, 4.57). DISCUSSION Our results strengthen the evidence that exposure to fairly low-level air pollution during pregnancy increases the risk of PTB. We provide novel observations indicating that individual air pollutants such as PM2.5 and O3 may act synergistically potentiating each other's adverse effects.
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Affiliation(s)
- Nazeeba Siddika
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, P.O. Box 5000, FI-90014, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, P.O. Box 8000, FI-90014, University of Oulu, Oulu, Finland
| | - Aino K Rantala
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, P.O. Box 5000, FI-90014, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, P.O. Box 8000, FI-90014, University of Oulu, Oulu, Finland
| | - Harri Antikainen
- Geography Research Unit, P.O. Box 3000, 90014, University of Oulu, Oulu, Finland
| | - Hamudat Balogun
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, P.O. Box 5000, FI-90014, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, P.O. Box 8000, FI-90014, University of Oulu, Oulu, Finland
| | - A Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, University Post Office, University of Cape Coast, Cape Coast, Ghana
| | - Niilo R I Ryti
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, P.O. Box 5000, FI-90014, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, P.O. Box 8000, FI-90014, University of Oulu, Oulu, Finland
| | - Jaakko Kukkonen
- Finnish Meteorological Institute, P.O. Box 503, FI-00101, Helsinki, Finland
| | - Mikhail Sofiev
- Finnish Meteorological Institute, P.O. Box 503, FI-00101, Helsinki, Finland
| | - Maritta S Jaakkola
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, P.O. Box 5000, FI-90014, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, P.O. Box 8000, FI-90014, University of Oulu, Oulu, Finland
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, P.O. Box 5000, FI-90014, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, P.O. Box 8000, FI-90014, University of Oulu, Oulu, Finland.
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Guo LQ, Chen Y, Mi BB, Dang SN, Zhao DD, Liu R, Wang HL, Yan H. Ambient air pollution and adverse birth outcomes: a systematic review and meta-analysis. J Zhejiang Univ Sci B 2019; 20:238-252. [PMID: 30829011 DOI: 10.1631/jzus.b1800122] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Several reviews have assessed the relationship between exposure to ambient air pollution and adverse birth outcomes during pregnancy, but the results remain controversial. The objective of this study was to assess this correlation quantitatively and to explore sources of heterogeneity. We included all published case-control or cohort studies that evaluated the correlation between ambient air pollution and low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA). Analytical methods and inclusion criteria were provided on the PROSPERO website (CRD42018085816). We evaluated pooled effects and heterogeneity. Subgroup analyses (grouped by exposure period, study settings, study design, exposure types, data source, Newcastle-Ottawa quality score (NOS), and adjustment for smoking or meteorological factors) were also conducted and publication bias was examined. The risk of bias in systematic reviews (ROBIS) tool was used to evaluate the overall risk of bias in this review. Forty studies met the inclusion criteria. We observed pooled odds ratios (ORs) of 1.03-1.21 for LBW and 0.97-1.06 for PTB when mothers were exposed to CO, NO2, NOx, O3, PM2.5, PM10, or SO2 throughout their pregnancy. For SGA, the pooled estimate was 1.02 in relation to NO2 concentrations. Subgroup analysis and sensitivity analysis decreased the heterogeneity to some extent, such as the subgroups of continuous measures (OR=0.98 (0.97-0.99), I2=0.0%) and NOS>7 (OR=0.98 (0.97-0.99), I2=0.0%) in evaluating the association between PTB and NO2. This review was completed with a low risk of bias. High concentrations of air pollution were significantly related to the higher risk of adverse birth outcomes. However, the sources of heterogeneity among studies should be further explored.
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Affiliation(s)
- Le-Qian Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
| | - Yu Chen
- Medical Records Department, the First Hospital of Yulin, Yulin 718000, China
| | - Bai-Bing Mi
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
| | - Shao-Nong Dang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
| | - Dou-Dou Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
| | - Rong Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
| | - Hong-Li Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
| | - Hong Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
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Xu Y, Wang W, Chen M, Zhou J, Huang X, Tao S, Pan B, Li Z, Xie X, Li W, Kan H, Ying Z. Developmental programming of obesity by maternal exposure to concentrated ambient PM 2.5 is maternally transmitted into the third generation in a mouse model. Part Fibre Toxicol 2019; 16:27. [PMID: 31266526 PMCID: PMC6604135 DOI: 10.1186/s12989-019-0312-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 06/21/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Obesity is an uncontrolled global epidemic and one of the leading global public health challenges. Maternal exposure to ambient fine particulate matter (PM2.5) may adversely program offspring's adiposity, suggesting a specialized role of PM2.5 pollution in the global obesity epidemic. However, the vulnerable window for this adverse programming and how it is cross-generationally transmitted have not been determined. Therefore, in the present study, female C57Bl/6 J mice were exposed to filtered air (FA) or concentrated ambient PM2.5 (CAP) during different periods, and the development and adulthood adiposity of their four-generational offspring were assessed. RESULTS Our data show that the pre-conceptional but not gestational exposure to CAP was sufficient to cause male but not female offspring's low birth weight, accelerated postnatal weight gain, and increased adulthood adiposity. These adverse developmental traits were transmitted into the F2 offspring born by the female but not male F1 offspring of CAP-exposed dams. In contrast, no adverse development was noted in the F3 offspring. CONCLUSIONS The present study identified a pre-conceptional window for the adverse programming of adiposity by maternal exposure to PM2.5, and showed that it was maternally transmitted into the third generation. These data not only call special attention to the protection of women from exposure to PM2.5, but also may facilitate the development of intervention to prevent this adverse programming.
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Affiliation(s)
- Yanyi Xu
- Department of Environmental Health, School of Public Health, Fudan University, 130 Dong’an Rd, Shanghai, 200032 China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China
| | - Wanjun Wang
- Department of Environmental Health, School of Public Health, Fudan University, 130 Dong’an Rd, Shanghai, 200032 China
| | - Minjie Chen
- Department of Medicine Cardiology Division, University of Maryland School of Medicine, 20 Penn St. HSFII S005, Baltimore, MD 21201 USA
| | - Ji Zhou
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China
| | - Xingke Huang
- Department of Environmental Health, School of Public Health, Fudan University, 130 Dong’an Rd, Shanghai, 200032 China
| | - Shimin Tao
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - Bin Pan
- Department of Environmental Health, School of Public Health, Fudan University, 130 Dong’an Rd, Shanghai, 200032 China
| | - Zhouzhou Li
- Department of Environmental Health, School of Public Health, Fudan University, 130 Dong’an Rd, Shanghai, 200032 China
| | - Xiaoyun Xie
- Department of Interventional & Vascular Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Weihua Li
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, 130 Dong’an Rd, Shanghai, 200032 China
| | - Zhekang Ying
- Department of Medicine Cardiology Division, University of Maryland School of Medicine, 20 Penn St. HSFII S005, Baltimore, MD 21201 USA
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Fu L, Chen Y, Yang X, Yang Z, Liu S, Pei L, Feng B, Cao G, Liu X, Lin H, Li X, Ye Y, Zhang B, Sun J, Xu X, Liu T, Ma W. The associations of air pollution exposure during pregnancy with fetal growth and anthropometric measurements at birth: a systematic review and meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:20137-20147. [PMID: 31111384 DOI: 10.1007/s11356-019-05338-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/01/2019] [Indexed: 06/09/2023]
Abstract
Fetal growth has been demonstrated to be an important predictor of perinatal and postnatal health. Although the effects of maternal exposure to air pollution during pregnancy on fetal growth have been investigated using ultrasound in many previous studies, the results were inconsistent and disputable. We aimed to qualitatively and quantitatively investigate the associations of air pollution exposure during different periods of pregnancy with fetal growth and anthropometric measurements at birth. We searched for all studies investigating the associations of air pollution exposure during pregnancy with fetal growth and birth anthropometric measurements in English and Chinese databases published before July 31, 2017. A random-effects model was employed in the meta-analysis to estimate the pooled effects of each 10 μg/m3 increment in air pollutant exposure. The ACROBAT-NRSI tool was applied to assess the quality of each included study, and the GRADE tool was employed to assess the overall quality of the meta-analysis. Maternal PM2.5 exposure (10 μg/m3) during the entire pregnancy was negatively associated with head circumference at birth (β = - 0.30 cm, 95% CI - 0.49, - 0.10), and NO2 exposure during the entire pregnancy was significantly linked to shorter length at birth (β = - 0.03 cm, 95% CI - 0.05, - 0.02). Maternal exposure to higher NO2 and PM2.5 during pregnancy may impair neonatal head circumference and length development, respectively. More studies are needed to confirm the effects of NO2 and PM2.5 and to identify the sources and major toxic components of PMs.
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Affiliation(s)
- Li Fu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, No. 160, Qunxian Road, Panyu District, Guangzhou, 511430, China
| | - Yi Chen
- Guangzhou Panyu Central Hospital, Guangzhou, 511400, China
| | - Xinyi Yang
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, No. 160, Qunxian Road, Panyu District, Guangzhou, 511430, China
| | - Zuyao Yang
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, 999000, Hong Kong, China
| | - Sha Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, No. 160, Qunxian Road, Panyu District, Guangzhou, 511430, China
| | - Lei Pei
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, No. 160, Qunxian Road, Panyu District, Guangzhou, 511430, China
| | - Baixiang Feng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, No. 160, Qunxian Road, Panyu District, Guangzhou, 511430, China
| | - Ganxiang Cao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, No. 160, Qunxian Road, Panyu District, Guangzhou, 511430, China
| | - Xin Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, No. 160, Qunxian Road, Panyu District, Guangzhou, 511430, China
| | - Hualiang Lin
- Department of Preventive Medicine, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Xing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, No. 160, Qunxian Road, Panyu District, Guangzhou, 511430, China
| | - Yufeng Ye
- Guangzhou Panyu Central Hospital, Guangzhou, 511400, China
| | - Bo Zhang
- Center for Food Safety and Health, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangzhou, 510080, China
| | - Jiufeng Sun
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, No. 160, Qunxian Road, Panyu District, Guangzhou, 511430, China
| | - Xiaojun Xu
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, No. 160, Qunxian Road, Panyu District, Guangzhou, 511430, China.
- General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, 528200, Guangdong, China.
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, No. 160, Qunxian Road, Panyu District, Guangzhou, 511430, China.
- General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, 528200, Guangdong, China.
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Yuan L, Zhang Y, Gao Y, Tian Y. Maternal fine particulate matter (PM 2.5) exposure and adverse birth outcomes: an updated systematic review based on cohort studies. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:13963-13983. [PMID: 30891704 DOI: 10.1007/s11356-019-04644-x] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/19/2019] [Indexed: 04/16/2023]
Abstract
Exposure to ambient air pollutants during pregnancy may be associated with numerous side health effects and adverse birth outcomes. Growing numbers of studies have explored a possible linkage between prenatal exposure to PM2.5 (particulate matter with aerodynamic diameter ≤ 2.5 μm) and impacts on fetal development. We aimed to conduct a systematic review based on published cohort studies to summarize evidence regarding the association between maternal PM2.5 exposure and birth outcomes, including birth weight, low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA). Eligible studies meeting the following criterion were selected: PM2.5 exposure during pregnancy and live birth singletons, certain presentation of sample sizes, and quantitative evaluation of the associations between exposure and outcomes. Among the 42 selected studies, 23 evaluated the impact of prenatal PM2.5 exposure on birth weight of infants while 12 of them provided a significantly negative association for exposure and birth weight. Twenty-one studies aimed to identify the possible relationship between maternal exposure and LBW and 8 studies proved significant associations. Among 18 studies that explored the correlation between prenatal exposure and PTB, 9 reached a consistent conclusion that gestational exposure would add to the risk of PTB. Nine studies assessed the impact of PM2.5 on SGA and 5 of them demonstrated a significant effect. So far, linkages between maternal PM2.5 exposure during varied gestational stages and multiple adverse birth outcomes have been observed in many studies. A summary of them will be meaningful for further research on maternal exposure and adverse birth outcomes.
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Affiliation(s)
- Lei Yuan
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, 280 South Chongqing Road, Shanghai, 200025, China
| | - Yan Zhang
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, 280 South Chongqing Road, Shanghai, 200025, China
| | - Yu Gao
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, 280 South Chongqing Road, Shanghai, 200025, China.
| | - Ying Tian
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, 280 South Chongqing Road, Shanghai, 200025, China.
- MOE and Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Perera F, Ashrafi A, Kinney P, Mills D. Towards a fuller assessment of benefits to children's health of reducing air pollution and mitigating climate change due to fossil fuel combustion. ENVIRONMENTAL RESEARCH 2019; 172:55-72. [PMID: 30771627 DOI: 10.1016/j.envres.2018.12.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/20/2018] [Accepted: 12/08/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Fossil fuel combustion by-products, including particulate matter (PM2.5), polycyclic aromatic hydrocarbons (PAH), nitrogen dioxide (NO2) and carbon dioxide (CO2), are a significant threat to children's health and equality. Various policies to reduce emissions have been implemented to reduce air pollution and mitigate climate change, with sizeable estimated health and economic benefits. However, only a few adverse outcomes in children have been considered, resulting in an undercounting of the benefits to this vulnerable population. OBJECTIVES Our goal was to expand the suite of child health outcomes addressed by programs to assess health and economic benefits, such as the Environmental Protection Agency (EPA) Benefits Mapping and Analysis Program (BenMAP), by identifying concentration-response (C-R) functions for six outcomes related to PM2.5, NO2, PAH, and/or PM10: preterm birth (PTB), low birthweight (LBW), autism, attention deficit hyperactivity disorder, IQ reduction, and the development of childhood asthma. METHODS We conducted a systematic review of the literature published between January 1, 2000 and April 30, 2018 to identify relevant peer-reviewed case-control and cohort studies and meta-analyses. In some cases meta-analyses were available that provided reliable C-R functions and we assessed their consistency with subsequent studies. Otherwise, we reviewed all eligible studies published between our search dates. RESULTS For each pollutant and health outcome, we present the characteristics of each selected study. We distinguish between C-R functions for endpoints having a causal or likely relationship (PTB, LBW, autism, asthma development) with the pollutants for incorporation into primary analyses and endpoints having a suggestive causal relationship with the pollutants (IQ reduction, ADHD) for secondary analyses. CONCLUSION We have identified C-R functions for a number of adverse health outcomes in children associated with air pollutants largely from fossil fuel combustion. Their incorporation into expanded assessments of health benefits of clean air and climate mitigation policies will provide an important incentive for preventive action.
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Affiliation(s)
- F Perera
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA.
| | - A Ashrafi
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA.
| | - P Kinney
- Boston University School of Public Health, Boston, MA, USA.
| | - D Mills
- Abt Associates, Boulder, CO, USA.
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Arroyo V, Linares C, Díaz J. Premature births in Spain: Measuring the impact of air pollution using time series analyses. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 660:105-114. [PMID: 30639707 DOI: 10.1016/j.scitotenv.2018.12.470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/27/2018] [Accepted: 12/30/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Premature birth (<37 weeks of gestation) is the principal indicator of neonatal death during the first month of life and the second cause of death of children under age five. There are 15 million premature births (PTB) worldwide. Air pollution in cities, primarily the result of urban traffic, greatly impacts PTBs, though there are few studies carried out on this topic at the country level. The objective of this study is to quantify the relative risks (RR) and the population attributable risk (PAR) of concentrations of contaminants on PTBs in Spain, and to analyze the most susceptible trimesters. METHODS For each province average weekly PTBs were calculated (ICD-10: P07.2-P07.3) during the period 2001-2009 as well as weekly average concentrations of PM10, NO2 and O3. Estimations were made of RR and PAR using generalized linear models with link Poisson, controlling for the trend, seasonality, the autoregressive nature of the series and the influence of temperature in periods of heat and/or cold waves. A meta-analysis was carried out to estimate RR and PAR at the global level based on the RR obtained for each of the provinces. RESULTS For all of Spain, the global RR of PTB due to the impact of PM10 was 1.071 (1.049, 1.093) and 1.150 (1.084, 1.220) for NO2, with no detected association for O3. Therefore, with decreases of 10 μg/m3 in the concentrations of PM10 and NO2, around 12.5% and 4.5% of PTBs could have been avoided respectively. CONCLUSIONS Around 1.35% of PTBs that occurred in Spain during the study period can be attributed to air pollution. The adoption of structural measures to reduce these air pollutants should result in a decrease in the number of PTBs in Spain.
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Affiliation(s)
- Virginia Arroyo
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain; Autonomous University of Madrid, Spain
| | - Cristina Linares
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - Julio Díaz
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain.
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62
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Xie P, Zhao C, Huang W, Yong T, Chung ACK, He K, Chen X, Cai Z. Prenatal exposure to ambient fine particulate matter induces dysregulations of lipid metabolism in adipose tissue in male offspring. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 657:1389-1397. [PMID: 30677905 DOI: 10.1016/j.scitotenv.2018.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/29/2018] [Accepted: 12/02/2018] [Indexed: 06/09/2023]
Abstract
Prenatal exposure to ambient fine particles (diameter < 0.25 μm, PM2.5) has been found to be associated with abnormal growth and development in offspring. However, the effects of PM2.5 on the lipid metabolism of adipose tissue in offspring are unclear. In the present study, we established a mouse model of prenatal exposure to PM2.5 by intratracheal instillation to pregnant C57BL/6 female mice with PM2.5 suspension or normal saline. We found that prenatal exposure to PM2.5 of a mouse model reduced body weight in adult male offspring after 6 weeks old. Histological analysis showed that the adipocyte size was significantly reduced in epididymal adipose tissue (eWAT) in male offspring, but not in brown adipose tissue. The expression levels of genes related to fatty acid synthesis (ACC1, ACSL1) and oxidation (PPARα) in eWAT were also significantly decreased. In addition, downregulation of pro-inflammatory cytokines (TNFα, IL-1β, IL-6) was also observed. Lipidomics analysis of eWAT demonstrated that prenatal exposure of PM2.5 reduced lysophosphatidylcholines (LPC), phosphatidylcholines (PC), phosphatidylethanolamines (PE), sphingomyelins (SM), and ceramides (Cer), indicating that metabolic pathways, including SM-Cer signaling and glycerophospholipids remodeling, were disrupted. In summary, prenatal exposure to PM2.5 was associated with the dysregulations in lipid metabolism of eWAT and pro-inflammatory response in male offspring.
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Affiliation(s)
- Peisi Xie
- State Key Laboratory of Environmental and Biological Analysis, Hong Kong Baptist University, Hong Kong, SAR, China
| | - Chao Zhao
- State Key Laboratory of Environmental and Biological Analysis, Hong Kong Baptist University, Hong Kong, SAR, China
| | - Wei Huang
- State Key Laboratory of Environmental and Biological Analysis, Hong Kong Baptist University, Hong Kong, SAR, China
| | - Ting Yong
- State Key Laboratory of Environmental and Biological Analysis, Hong Kong Baptist University, Hong Kong, SAR, China
| | - Arthur C K Chung
- State Key Laboratory of Environmental and Biological Analysis, Hong Kong Baptist University, Hong Kong, SAR, China; HKBU Institute for Research and Continuing Education, Shenzhen, China
| | - Kaiwu He
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Xiangfeng Chen
- Shandong Analysis and Test Center, Qilu University of Technology (Shandong Academy of Sciences), Jinan, Shandong, China
| | - Zongwei Cai
- State Key Laboratory of Environmental and Biological Analysis, Hong Kong Baptist University, Hong Kong, SAR, China; HKBU Institute for Research and Continuing Education, Shenzhen, China.
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63
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Kim JJ, Axelrad DA, Dockins C. Preterm birth and economic benefits of reduced maternal exposure to fine particulate matter. ENVIRONMENTAL RESEARCH 2019; 170:178-186. [PMID: 30583127 PMCID: PMC6423977 DOI: 10.1016/j.envres.2018.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/27/2018] [Accepted: 12/06/2018] [Indexed: 05/13/2023]
Abstract
Preterm birth (PTB) is a predictor of infant mortality and later-life morbidity. Despite recent declines, PTB rates remain high in the United States. Growing research suggests a possible relationship between a mother's exposure to common air pollutants, including fine particulate matter (PM2.5), and PTB of her baby. Many policy actions to reduce exposure to common air pollutants require benefit-cost analysis (BCA), and it's possible that PTB will need to be included in BCA in the future. However, an estimate of the willingness to pay (WTP) to avoid PTB risk is not available, and a comprehensive alternative valuation of the health benefits of reducing pollutant-related PTB currently does not exist. This paper demonstrates an approach to assess potential economic benefits of reducing PTB resulting from environmental exposures when an estimate of WTP to avoid PTB risk is unavailable. We utilized a recent meta-analysis, county-level air quality data and county-level PTB prevalence data to estimate the potential health and economic benefits of a reduction in air pollution-related PTB, with PM2.5 as our case study pollutant. Using this method, a simulated nationwide 10% decrease from 2008 PM2.5 levels resulted in an estimated reduction of 5016 PTBs and benefits of at least $339 million, potentially reaching over one billion dollars when considering later-life effects of PTB.
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Affiliation(s)
- Jina J Kim
- ASPPH/EPA Environmental Health Fellowship Program, Hosted by US Environmental Protection Agency, 1200 Pennsylvania Ave. NW, Washington, D.C. 20460, USA.
| | - Daniel A Axelrad
- National Center for Environmental Economics, Office of Policy, US Environmental Protection Agency, 1200 Pennsylvania Ave. NW, Washington, D.C. 20460, USA
| | - Chris Dockins
- National Center for Environmental Economics, Office of Policy, US Environmental Protection Agency, 1200 Pennsylvania Ave. NW, Washington, D.C. 20460, USA
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Guan T, Xue T, Gao S, Hu M, Liu X, Qiu X, Liu X, Zhu T. Acute and chronic effects of ambient fine particulate matter on preterm births in Beijing, China: A time-series model. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 650:1671-1677. [PMID: 30273726 DOI: 10.1016/j.scitotenv.2018.09.279] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/05/2018] [Accepted: 09/21/2018] [Indexed: 05/16/2023]
Abstract
Accumulating evidence suggests that short- and long-term exposure to ambient fine particulate matter ≤ 2.5 μm (PM2.5) during pregnancy is associated with preterm births, yet the results are inconsistent, and the shape of the exposure-response curve is unclear, partially due to the limited studies conducted in areas with high air pollution. Our study evaluated the association between ambient PM2.5 concentration and preterm births in Beijing, China. Daily preterm birth data were collected from a hospital in Beijing during 2006 to 2013; a time-series of daily PM2.5 concentrations during the same period is assembled with measured data at three monitoring sites in Beijing. An extension of the Poisson regression and a time-series model were applied to simultaneously estimate the acute and chronic effects of exposure to PM2.5, with mutual adjustment for short- and long-term exposure as well as for confounders. During the study period, the PM2.5 concentration was 70.4 ± 60.6 μg/m3 and was found to be associated with an increased risk of preterm birth. In the study cohort, a 0.52% (95% confidence interval, CI: 0.09%, 0.96%) and 3.13% (95%CI: 1.92%, 4.35%) increase in preterm births was estimated for each 10-μg/m3 increase in short- and long-term exposure, respectively. This association was significantly modified by season (p < 0.05). With mutual adjustments for short- and long-term exposure, a more robust association (3.16%, 95% CI: 1.95%, 4.39%; per 10-μg/m3 increment in PM2.5) was observed for chronic effects. The exposure-response relationships for both short- and long-term exposure were linear, without a threshold, over the relatively low exposure range and flattened out at higher concentration levels. The maximum effect for long-term exposure to PM2.5 (33.6%) was much greater than that for short-term exposure (19.9%). These findings indicate that air quality improvements over a long period could yield significant health benefits.
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Affiliation(s)
- Tianjia Guan
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; BIC-EAST and SKL-ESPC, College of Environmental Sciences and Engineering, Peking University, Beijing 100871, China
| | - Tao Xue
- BIC-EAST and SKL-ESPC, College of Environmental Sciences and Engineering, Peking University, Beijing 100871, China
| | - Suhong Gao
- Department of Child Health, Beijing Haidian Maternal and Child Health Hospital, Beijing, China
| | - Min Hu
- SKL-ESPC, College of Environmental Sciences and Engineering, Peking University, Beijing 100871, China.
| | - Xin Liu
- Beijing Municipal Environmental Protection Bureau, Beijing 100048, China
| | - Xinghua Qiu
- BIC-EAST and SKL-ESPC, College of Environmental Sciences and Engineering, Peking University, Beijing 100871, China.
| | - Xiaohong Liu
- Department of Gynecology and Obstetrics, Beijing Haidian Maternal and Child Health Hospital, Beijing, China.
| | - Tong Zhu
- BIC-EAST and SKL-ESPC, College of Environmental Sciences and Engineering, Peking University, Beijing 100871, China.
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Stieb DM, Lavigne E, Chen L, Pinault L, Gasparrini A, Tjepkema M. Air pollution in the week prior to delivery and preterm birth in 24 Canadian cities: a time to event analysis. Environ Health 2019; 18:1. [PMID: 30606207 PMCID: PMC6318965 DOI: 10.1186/s12940-018-0440-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/07/2018] [Indexed: 05/05/2023]
Abstract
BACKGROUND Numerous studies have examined the association between air pollution and preterm birth (< 37 weeks gestation) but findings have been inconsistent. These associations may be more difficult to detect than associations with other adverse birth outcomes because of the different duration of exposure in preterm vs. term births, and the existence of seasonal cycles in incidence of preterm birth. METHODS We analyzed data pertaining to 1,001,700 singleton births occurring between 1999 and 2008 in 24 Canadian cities where daily air pollution data were available from government monitoring sites. In the first stage, data were analyzed in each city employing Cox proportional hazards models using gestational age in days as the time scale, obtaining city-specific hazard ratios (HRs) with their 95% confidence intervals (CIs) expressed per interquartile range (IQR) of each air pollutant. Effects were examined using distributed lag functions for lags of 0-6 days prior to delivery, as well as cumulative lags from two to six days. We accounted for the potential nonlinear effect of daily mean ambient temperature using a cubic B-spline with three internal knots. In the second stage, we pooled the estimated city-specific hazard ratios using a random effects model. RESULTS Pooled estimates across 24 cities indicated that an IQR increase in ozone (O3, 13.3 ppb) 0-3 days prior to delivery was associated with a hazard ratio of 1.036 (95% CI 1.005, 1.067) for preterm birth, adjusting for infant sex, maternal age, marital status and country of birth, neighbourhood socioeconomic status (SES) and visible minority, temperature, year and season of birth, and a natural spline function of day of year. There was some evidence of effect modification by gestational age and season. Associations with carbon monoxide, nitrogen dioxide, particulate matter, and sulphur dioxide were inconsistent. CONCLUSIONS We observed associations between daily O3 in the week before delivery and preterm birth in an analysis of approximately 1 million births in 24 Canadian cities between 1999 and 2008. Our analysis is one of a limited number which have examined these short term associations employing Cox proportional hazards models to account for the different exposure durations of preterm vs. term births.
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Affiliation(s)
- David M. Stieb
- Environmental Health Science and Research Bureau, Health Canada, 101 Tunney’s Pasture Driveway, Ottawa, ON K1A 0K9 Canada
- School of Epidemiology and Public Health, University of Ottawa, Room 101, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3 Canada
| | - Eric Lavigne
- School of Epidemiology and Public Health, University of Ottawa, Room 101, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3 Canada
- Water and Air Quality Bureau, Health Canada, 269 Laurier Avenue W, Ottawa, ON K1A 0K9, Mail Stop 4903B Canada
| | - Li Chen
- Environmental Health Science and Research Bureau, Health Canada, 101 Tunney’s Pasture Driveway, Ottawa, ON K1A 0K9 Canada
| | - Lauren Pinault
- Health Analysis Division, Statistics Canada, 100 Tunney’s Pasture Driveway, Ottawa, ON K1A 0T6 Canada
| | - Antonio Gasparrini
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, Room 213, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Michael Tjepkema
- Health Analysis Division, Statistics Canada, 100 Tunney’s Pasture Driveway, Ottawa, ON K1A 0T6 Canada
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Xiong L, Xu Z, Tan J, Wang H, Liu Z, Wang A, Xie D, Kong F. Acute effects of air pollutants on adverse birth outcomes in Changsha, China: A population data with time-series analysis from 2015 to 2017. Medicine (Baltimore) 2019; 98:e14127. [PMID: 30653143 PMCID: PMC6370066 DOI: 10.1097/md.0000000000014127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Evidence for the acute effects of air pollutants on adverse birth outcomes is not yet conclusive. Furthermore, there are no investigations relating to the association between air pollutants and macrosomia. The aim of this study was to determine the relationship between air pollutants and low birth weight, preterm birth, and macrosomia in Changsha. Time-series analysis, using a generalized additive model was applied. Data about the adverse birth outcomes was collected from 78 midwifery institutions. Air pollution data including SO2, NO2, particulate matter <10 μm in diameter (PM10), particulate matter <2.5 μm in diameter (PM2.5), O3, CO, and climate data were respectively collected from the Changsha Environmental Protection Agency and the Changsha Meteorological Bureau from January 2015 to December 2017. During the study period, there were 344,880 live births to be studied. In a single pollutant model, for every increase of 10 μg/m in PM10 and PM2.5, low birth weight increased by 0.12% (95% confidence interval [CI]: 0.01-0.23%) at a lag 06 and 0.44% (95% CI: 0.35-0.53%) at a lag 3, respectively. Preterm birth increased most by 1.60% (95% CI: 1.41-1.80%) at a lag 2 for every increase of 10 μg/m in SO2. The highest increases in macrosomia associated with a 10 μg/m increase in air pollutant were 3.53% (95% CI: 3.41-3.64%) for NO2 at lag 0, 3.33% (95% CI: 3.05-3.60%) for SO2 at lag03. Multi-pollutant models showed that only PM10 increased the low birth weight and preterm birth risk effect by 3.91% (95% CI: 3.67-4.12%) and 0.25% (95% CI: 0.14-0.37%). NO2 increased macrosomia risk by 4.14% (95% CI: 3.97-4.31%) with a 10 μg/m increase. There was no association observed between the air pollutants O3 and CO and adverse birth outcomes. Pregnant women should also take steps to limit their exposure to high levels of air pollutants during the final weeks of pregnancy.
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Affiliation(s)
- Lili Xiong
- Hunan Province Maternal and Children Care Hospital
| | | | - Jie Tan
- Hunan Province Environmental Monitoring Centre, Changsha, China
| | - Hua Wang
- Hunan Province Maternal and Children Care Hospital
| | - Zhiyu Liu
- Hunan Province Maternal and Children Care Hospital
| | - Aihua Wang
- Hunan Province Maternal and Children Care Hospital
| | - Donghua Xie
- Hunan Province Maternal and Children Care Hospital
| | - Fanjuan Kong
- Hunan Province Maternal and Children Care Hospital
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Zhu J, Lee RW, Twum C, Wei Y. Exposure to ambient PM 2.5 during pregnancy and preterm birth in metropolitan areas of the state of Georgia. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:2492-2500. [PMID: 30471062 DOI: 10.1007/s11356-018-3746-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/12/2018] [Indexed: 05/21/2023]
Abstract
A number of studies has pointed to air pollution as an additional factor that could be associated with preterm birth. We assessed in this study the association between exposure to PM2.5 in ambient air during pregnancy and preterm birth in metropolitan areas of the state of Georgia, where the rate of preterm birth has been among the highest in the nation over the years. Birth data were obtained from the National Center for Health Statistics natality dataset. The study population consisted of 53,094 singleton live births between January 1 and December 31, 2004 in nine metropolitan counties of Georgia. Preterm birth was defined as birth, which occurs before 37 weeks of gestation. County-level daily air quality index (AQI) data obtained from the US Environmental Protection Agency (EPA) was used to estimate individual exposure levels of PM2.5 for each study participant based on the county of residence for the duration of the pregnancy. A multivariate logistic regression analysis was conducted to assess the association, adjusting for potential confounders. Of the infants whose mothers resided in the nine metropolitan counties of Georgia, 4543 (8.6%) were born preterm. A higher rate of preterm birth (9.8%) was observed in infants whose mothers were exposed to ambient PM2.5 with AQI values > 50 than the ones with AQI ≤ 50 (EPA standard for good air quality conditions). Mothers with exposure to PM2.5 at average AQI values greater than 50 during the entire pregnancy were at increased risk of preterm birth (odds ratio 1.15; 95% CI 1.07, 1.25), after adjusting for sex of infant, mother's age, race/ethnicity, education, marital status, prenatal care, cigarette smoking, alcohol consumption, and season of conception. The study provides more evidence on the role of PM2.5 in preterm birth. Reducing exposure to ambient particulate matter, especially in urban areas, for pregnant women would be necessary to improve the health of infants.
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Affiliation(s)
- Jianmin Zhu
- Department of Mathematics and Computer Science, Fort Valley State University, Fort Valley, GA, 31030, USA
| | - Rina Won Lee
- Mercer University School of Medicine, Macon, GA, 31207, USA
| | - Claudia Twum
- Mercer University School of Medicine, Macon, GA, 31207, USA
| | - Yudan Wei
- Department of Community Medicine, Mercer University School of Medicine, 1550 College St, Macon, GA, 31207, USA.
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Huang H, Woodruff TJ, Baer RJ, Bangia K, August LM, Jellife-Palowski LL, Padula AM, Sirota M. Investigation of association between environmental and socioeconomic factors and preterm birth in California. ENVIRONMENT INTERNATIONAL 2018; 121:1066-1078. [PMID: 30075861 PMCID: PMC6638551 DOI: 10.1016/j.envint.2018.07.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/27/2018] [Accepted: 07/17/2018] [Indexed: 05/29/2023]
Abstract
BACKGROUND Preterm birth (PTB),2 defined as birth at gestational age <37 weeks, is a major public health concern. Infants born prematurely, comprising of about 10% of the US newborns, have elevated risks of neonatal mortality and a wide array of health problems. Although numerous clinical, genetic, environmental and socioeconomic factors have been implicated in PTB, very few studies investigate the impacts of multiple pollutants and social factors on PTB using large scale datasets. OBJECTIVES To evaluate association between environmental and socioeconomic factors and PTB in California. METHODS We linked the birth cohort file maintained by the California Office of Statewide Health Planning and Development from 2009 to 2012 years across 1.8 million births and the CalEnviroScreen 3.0 dataset from California Communities Environmental Health Screening Tool at the census tract level for 56 California counties. CalEnviroScreen contains 7 exposure and 5 environmental effects variables that constitute the Pollution Burden variable, and 5 socioeconomic variables. We evaluated relationships between environmental exposures and the risk of PTB using hierarchical clustering analyses and GIS-based visualization. We also used logistic regression to evaluate the relationship between specific pollutant and exposure indicators and PTB, accounted for socio-demographic determinants such as maternal race/ethnicity, maternal age, maternal education and payment of delivery costs. RESULTS There exists geographic variability in PTB for groups of counties with similar environmental and social exposure profiles. We found an association between Pollution Burden, particulate matter ≤2.5 μm (PM2.5), and Drinking Water Scores and PTB (adjusted odds ratios were 1.03 (95% Confidence Interval (CI): 1.01, 1.04), 1.03 (95% CI: 1.02,1.04), and 1.04 (95% CI: 1.03,1.05), respectively). Additional findings suggest that certain drinking water contaminants such as arsenic and nitrate are associated with PTB in California. CONCLUSIONS CalEnviroScreen data combined with birth records offer great opportunity for revealing novel exposures and evaluating cumulative exposures related to PTB by providing useful environmental and social information. Certain drinking water contaminants such as arsenic and nitrate are potentially associated with PTB in California and should be investigated further. Small association signals may involve sizeable population impacts.
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Affiliation(s)
- Hongtai Huang
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA; Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.
| | - Tracey J Woodruff
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Rebecca J Baer
- Department of Pediatrics, University of California, San Diego, CA, USA; California Preterm Birth Initiative, University of California, San Francisco, CA, USA
| | - Komal Bangia
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Sacramento, CA, USA
| | - Laura M August
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Sacramento, CA, USA
| | - Laura L Jellife-Palowski
- California Preterm Birth Initiative, University of California, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Amy M Padula
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Marina Sirota
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA; Department of Pediatrics, University of California, San Francisco, CA, USA.
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Klepac P, Locatelli I, Korošec S, Künzli N, Kukec A. Ambient air pollution and pregnancy outcomes: A comprehensive review and identification of environmental public health challenges. ENVIRONMENTAL RESEARCH 2018; 167:144-159. [PMID: 30014896 DOI: 10.1016/j.envres.2018.07.008] [Citation(s) in RCA: 211] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 05/19/2023]
Abstract
There is a growing number of studies on the association between ambient air pollution and adverse pregnancy outcomes, but their results have been inconsistent. Consequently, a comprehensive review of this research area is needed. There was a wide variability in studied pregnancy outcomes, observed gestational windows of exposure, observed ambient air pollutants, applied exposure assessment methods and statistical analysis methods Gestational duration, preterm birth, (low) birth weight, and small for gestational age/intrauterine growth restriction were most commonly investigated pregnancy outcomes. Gestational windows of exposure typically included were whole pregnancy period, 1st, 2nd, 3rd trimester, first and last gestational months. Preterm birth was the outcome most extensively studied across various gestational windows, especially at the beginning and at the end of pregnancy. Particulate matter, nitrogen dioxide, ozone, and carbon monoxide were the most commonly used markers of ambient air pollution. Continuous monitoring data were frequently combined with spatially more precisely modelled estimates of exposure. Exposure to particulate matter and ozone over the entire pregnancy was significantly associated with higher risk for preterm birth: the pooled effect estimates were 1.09 (1.03-1.16) per 10 μg/m3 increase in particulate matter with an aerodynamic diameter of 10 µm or less (PM10),1.24 (1.08-1.41) per 10 μg/m3 increase in particulate matter with an aerodynamic diameter of 2.5 µm or less (PM2.5), and 1.03 (1.01-1.04) per 10 ppb increase in ozone. For pregnancy outcomes other than PTB, ranges of observed effect estimates were reported due to smaller number of studies included in each gestational window of exposure. Further research is needed to link the routine pregnancy outcome data with spatially and temporally resolved ambient air pollution data, while adjusting for commonly defined confounders. Methods for assessing exposure to mixtures of pollutants, indoor air pollution exposure, and various other environmental exposures, need to be developed.
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Affiliation(s)
- Petra Klepac
- National institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia.
| | - Igor Locatelli
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva 7, 1000 Ljubljana, Slovenia.
| | - Sara Korošec
- Department of Obstetrics and Gynecology, Reproductive Unit, University Medical Centre Ljubljana, Zaloška 3, 1525 Ljubljana, Slovenia.
| | - Nino Künzli
- Swiss Tropical and Public Health Institute (SwissTPH), Socinstrasse 57, 4002 Basel, Switzerland; University of Basel, Petersplatz 1, 4001 Basel, Switzerland.
| | - Andreja Kukec
- National institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia; University of Ljubljana, Faculty of Medicine, Vrazov trg 2, 1000 Ljubljana, Slovenia.
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Blanchard O, Deguen S, Kihal-Talantikite W, François R, Zmirou-Navier D. Does residential mobility during pregnancy induce exposure misclassification for air pollution? Environ Health 2018; 17:72. [PMID: 30340597 PMCID: PMC6194718 DOI: 10.1186/s12940-018-0416-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 09/28/2018] [Indexed: 05/23/2023]
Abstract
BACKGROUND Prenatal exposure to outdoor air pollution has been shown to have health effects in many studies; low birth weight, preterm delivery, small for gestational age, and stillbirth are the most often cited. However, exposure of pregnant women is difficult to quantify, especially with regard to their mobility, which is rarely taken into account in epidemiological studies. This study aimed to assess the impact of mobility of pregnant women living in Paris, France, on their exposure estimates to nitrogen dioxide (NO2). METHODS A total of 486 pregnant women were recruited in 5 maternity hospitals in Paris between January and April 2016. A questionnaire was used to collect mothers' characteristics (demography, education, etc.) and to assess their daily mobility during pregnancy (time spent at work, commuting time and mode used to move from residential to occupational places). Daily NO2 concentrations were estimated based on the combination of annual average concentrations modeled at the census block scale and daily concentrations measured from fixed monitoring stations. Different models were used to compare the exposure of pregnant women in residential and occupational places, also taking into account travel time and travel mode. The socioeconomic profile of the census blocks was characterized using a multi-component index. RESULTS During the first trimester of pregnancy, women living in the least deprived census blocks were exposed to higher concentrations of NO2 than those living in the most deprived ones. Occupational mobility had a small impact on exposure levels (average increase after taking account of mobility: + 0.52 μg/m3) which was not related to the socioeconomic profile of the women. The commuting mode made a greater difference (+ 1.46 μg/m3 on average), in particular among women living in the most deprived census blocks. CONCLUSIONS Our study illustrates that air pollution exposure can be underestimated when ignoring occupational mobility and commuting mode of pregnant women. This effect might be differential according to the neighborhood deprivation profile.
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Affiliation(s)
- Olivier Blanchard
- Univ Rennes, EHESP, Inserm, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Séverine Deguen
- EHESP, Inserm, IPLESP (Institut Pierre Louis d’Epidémiologie et de Santé Publique) - UMR_S 1136, F-35000 Rennes, France
| | - Wahida Kihal-Talantikite
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, F-6700 Strasbourg, France
| | - Romain François
- Univ Rennes, EHESP, Inserm, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Denis Zmirou-Navier
- Univ Rennes, EHESP, Inserm, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
- Lorraine University Medical School, F-54500 Vandoeuvre-Les-Nancy, France
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Xue T, Zhu T, Han Y. Association between birthweight and ambient PM 2.5 in the United States: Individually-varied susceptibility and spatial heterogeneity. ENVIRONMENT INTERNATIONAL 2018; 119:388-397. [PMID: 30005187 DOI: 10.1016/j.envint.2018.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/27/2018] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
Abstract
The association between maternal exposure to PM2.5 and birthweight varies geographically, which may be caused by susceptibility. Whether this population-level association is a function of mixtures of individuals with different susceptibilities is unclear. We investigated the probability distribution of individuals with different susceptibilities to PM2.5-related birthweight change, and evaluated spatial variation of the effect across the United States (US). We estimated the individual-level susceptibility using the effect of PM2.5 among a homogenous subpopulation, which was defined by a specific combination of modifiers. According to frequencies for all combinations, we derived the probability distribution of differential susceptibilities across the US and by states. From birth certificates across the US (1999-2004), we analyzed a total of 18,317,707 samples of singletons. Of the samples, 54-55% were assigned valid exposures, and linked to PM2.5. The subpopulation-specific associations of PM2.5 on birthweight change (i.e., susceptibilities) ranged from negative to positive. For the first-trimester exposure, 61.4% of the associations were negative, and the mean was -1.01 g (95% confidence interval, CI: -1.63, -0.38) of birthweight change per 5 μg/m3 increase of PM2.5. The state-level associations varied (from -2.04 g [-2.76, -1.31] in New Hampshire to -0.30 g [-1.01, 0.41] in Texas) with demographic compositions in the US. The between-state variations of maternal race and education level were the greatest contributors to the spatial heterogeneity. Our findings may be useful to the policymaker in planning interventions for subpopulations susceptible to ambient pollution.
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Affiliation(s)
- Tao Xue
- BIC-ESAT, SKL-ESPC, College of Environmental Science and Engineering, Peking University, Beijing 100871, China
| | - Tong Zhu
- BIC-ESAT, SKL-ESPC, College of Environmental Science and Engineering, Peking University, Beijing 100871, China.
| | - Yiqun Han
- Analytical, Environmental and Forensic Sciences, School of Population Health & Environmental Sciences, Kings College London, United Kingdom
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Liu WY, Yu ZB, Qiu HY, Wang JB, Chen XY, Chen K. Association between ambient air pollutants and preterm birth in Ningbo, China: a time-series study. BMC Pediatr 2018; 18:305. [PMID: 30236089 PMCID: PMC6147039 DOI: 10.1186/s12887-018-1282-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 09/12/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Exposure to air pollutants has been related to preterm birth, but little evidence can be available for PM2.5, O3 and CO in China. This study aimed to investigate the short-term effect of exposure to air pollutants on risk preterm birth during 2014-2016 in Ningbo, China. METHODS We conducted a time-series study to evaluate the associations between daily preterm birth and major air pollutants (including PM2.5, PM10, SO2, NO2, O3 and CO) in Ningbo during 2014-2016. A General Additive Model extend Poisson regression was used to evaluate the relationship between preterm birth and air pollution with adjustment for time-trend, meteorological factors and day of the week (DOW). We also conducted a subgroup analysis by season and age. RESULTS In this study, a total of 37,389 birth occurred between 2014 and 2016 from the Electronic Medical Records System of Ningbo Women and Children's Hospital, of which 5428 were verified as preterm birth. The single pollutant model suggested that lag effect of PM2.5, PM10, NO2 reached a peak at day 3 before delivery and day 6 for SO2, and no relationships were observed for O3 and preterm birth. Excess risks (95% confidence intervals) for an increase of IQR of air pollutant concentrations were 4.84 (95% CI: 1.77, 8.00) for PM2.5, 3.56 (95% CI: 0.07, 7.17) for PM10, 3.65 (95% CI: 0.86, 6.51) for SO2, 6.49 (95% CI: 1.86, 11.34) for NO2, - 0.90 (95% CI: -4.76, 3.11) for O3, and 3.36 (95% CI: 0.50, 6.30) for CO. Sensitivity analyses by exclusion of maternal age < 18 or > 35 years did not materially alter our results. CONCLUSIONS This study indicates that short-term exposure to air pollutants (including PM2.5, PM10, SO2, NO2) are positively associated with risk of preterm birth in Ningbo, China.
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Affiliation(s)
- Wen-Yuan Liu
- Key laboratory of maternal-fetal medicine, Ningbo Women and Children’s Hospital, Ningbo, 315012 China
| | - Zhe-Bin Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, 310058 China
- Research Center for Air Pollution and Health, Zhejiang University, Hangzhou, 310058 China
| | - Hai-Yan Qiu
- Key laboratory of maternal-fetal medicine, Ningbo Women and Children’s Hospital, Ningbo, 315012 China
| | - Jian-Bing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, 310058 China
- Research Center for Air Pollution and Health, Zhejiang University, Hangzhou, 310058 China
| | - Xue-Yu Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, 310058 China
| | - Kun Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, 310058 China
- Research Center for Air Pollution and Health, Zhejiang University, Hangzhou, 310058 China
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Hill EL. Shale gas development and infant health: Evidence from Pennsylvania. JOURNAL OF HEALTH ECONOMICS 2018; 61:134-150. [PMID: 30114565 PMCID: PMC6629042 DOI: 10.1016/j.jhealeco.2018.07.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 04/08/2018] [Accepted: 07/07/2018] [Indexed: 05/17/2023]
Abstract
This research exploits the introduction of shale gas wells in Pennsylvania in response to growing controversy around the drilling method of hydraulic fracturing. Using detailed location data on maternal addresses and GIS coordinates of gas wells, this study examines singleton births to mothers residing close to a shale gas well from 2003 to 2010 in Pennsylvania. The introduction of drilling increased low birth weight and decreased term birth weight on average among mothers living within 2.5 km of a well compared to mothers living within 2.5 km of a permitted well. Adverse effects were also detected using measures such as small for gestational age and APGAR scores, while no effects on gestation periods were found. In the intensive margin, an additional well is associated with a 7 percent increase in low birth weight, a 5 g reduction in term birth weight and a 3 percent increase in premature birth. These results are robust to other measures of infant health, many changes in specification and falsification tests. These findings suggest that shale gas development poses significant risks to human health.
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Affiliation(s)
- Elaine L Hill
- University of Rochester Medical Center, School of Medicine & Dentistry, 265 Crittenden Blvd Box 420644, Rochester, NY 14642, United States.
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Xiao Q, Chen H, Strickland MJ, Kan H, Chang HH, Klein M, Yang C, Meng X, Liu Y. Associations between birth outcomes and maternal PM 2.5 exposure in Shanghai: A comparison of three exposure assessment approaches. ENVIRONMENT INTERNATIONAL 2018; 117:226-236. [PMID: 29763818 PMCID: PMC6091210 DOI: 10.1016/j.envint.2018.04.050] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/20/2018] [Accepted: 04/28/2018] [Indexed: 05/21/2023]
Abstract
BACKGROUND Few studies have estimated effects of maternal PM2.5 exposure on birth outcomes in China due to the lack of historical air pollution data. OBJECTIVES We estimated the associations between maternal PM2.5 exposure and birth outcomes using gap-filled satellite estimates in Shanghai, China. METHODS We obtained birth registration records of 132,783 singleton live births during 2011-2014 in Shanghai. PM2.5 exposures were assessed from satellite-derived estimates or central-site measurements. Linear and logistic regressions were used to estimate associations with term birth weight and term low birth weight (LBW), respectively. Logistic and discrete-time survival models were used to estimate associations with preterm birth. Effect modification by maternal age and parental education levels was investigated. RESULTS A 10 μg/m3 increase in gap-filled satellite-based whole-pregnancy PM2.5 exposure was associated with a -12.85 g (95% CI: -18.44, -7.27) change in term birth weight, increased risk of preterm birth (OR 1.27, 95% CI: 1.20, 1.36), and increased risk of term LBW (OR 1.22, 95% CI: 1.06, 1.41). Sensitivity analyses during 2013-2014, when ground PM2.5 measurements were available, showed that the health associations using gap-filled satellite PM2.5 concentrations were higher than those obtained using satellite PM2.5 concentrations without accounting for missingness. The health associations using gap-filled satellite PM2.5 had similar magnitudes to those using central-site measurements, but with narrower confidence intervals. CONCLUSIONS The magnitude of associations between maternal PM2.5 exposure and adverse birth outcomes in Shanghai was higher than previous findings. One reason could be reduced exposure error of the gap-filled high-resolution satellite PM2.5 estimates.
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Affiliation(s)
- Qingyang Xiao
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Hanyi Chen
- Science Research and Information Management Section, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China; Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | | | - Haidong Kan
- School of Public Health, Fudan University, Shanghai, China
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mitchel Klein
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Chen Yang
- Section of Cancer and Injury Prevention, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China; Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Xia Meng
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Yang Liu
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Chen M, Liang S, Qin X, Zhang L, Qiu L, Chen S, Hu Z, Xu Y, Wang W, Zhang Y, Cao Q, Ying Z. Prenatal exposure to diesel exhaust PM 2.5 causes offspring β cell dysfunction in adulthood. Am J Physiol Endocrinol Metab 2018; 315:E72-E80. [PMID: 29351483 PMCID: PMC6087722 DOI: 10.1152/ajpendo.00336.2017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Environmental stressors that encounter in early-life and cause abnormal fetal and/or neonatal development may increase susceptibility to non-communicable diseases such as diabetes. Maternal exposure to ambient fine particulate matter (PM2.5) is associated with various fetal abnormalities, suggesting that it may program offspring's susceptibility to diabetes. In the present study, we therefore examined whether maternal exposure to diesel exhaust PM2.5 (DEP), one of the major sources of ambient PM2.5 in urban areas, programs adult offspring's glucose metabolism. Female C57Bl/6J mice were intratracheally instilled with DEP or vehicle throughout a 7-wk preconceptional period, gestation, and lactation, and the glucose homeostasis of their adult male offspring was assessed. Intraperitoneal glucose tolerance test (IPGTT) revealed that the maternal exposure to DEP significantly impaired adult male offspring's glucose tolerance. Unexpectedly, it did not influence their insulin sensitivity, whereas it significantly decreased their glucose-induced insulin secretion (GIIS). This deficit in insulin secretion was corroborated by their significant decrease in arginine-induced insulin secretion. Histological analysis demonstrated that the deficit in insulin secretion was accompanied by the decrease in pancreatic islet and β cell sizes. To differentiate the effects of maternal exposure to DEP before birth and during lactation, some offspring were cross-fostered once born. We did not observe any significant effect of cross-fostering on the glucose homeostasis of adult male offspring and the function and morphology of their β cells. Prenatal exposure to DEP programs the morphology and function of β cells and thus homeostatic regulation of glucose metabolism in adult male offspring.
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Affiliation(s)
- Minjie Chen
- Department of Medicine Cardiology Division, University of Maryland School of Medicine , Baltimore, Maryland
- Department of Environmental Health, School of Public Health, Fudan University , Shanghai , China
| | - Shuai Liang
- Department of Medicine Cardiology Division, University of Maryland School of Medicine , Baltimore, Maryland
- Department of Bile Pancreatic Surgery, Xiangya Hospital, Central South University , Changsha, Hunan , China
| | - Xiaobo Qin
- Department of Medicine Cardiology Division, University of Maryland School of Medicine , Baltimore, Maryland
- Department of Electrocardiography, the People's Hospital of Guangxi Zhuang Autonomous Region , Nanning , China
| | - Li Zhang
- Department of Medicine Cardiology Division, University of Maryland School of Medicine , Baltimore, Maryland
- Department of Pharmacology, Medical College of Wuhan University , Wuhan, Hubei , China
| | - Lianglin Qiu
- Department of Medicine Cardiology Division, University of Maryland School of Medicine , Baltimore, Maryland
- Department of Occupational and Environmental Health, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Sufang Chen
- Department of Medicine Cardiology Division, University of Maryland School of Medicine , Baltimore, Maryland
- Department of Geriatric Endocrinology, the First Affiliated Hospital of Zhengzhou University , Zhengzhou, Henan , China
| | - Ziying Hu
- Department of Medicine Cardiology Division, University of Maryland School of Medicine , Baltimore, Maryland
- Department of Endocrinology, the People's Hospital of Zhengzhou University (Henan Provincial People's Hospital) , Zhengzhou, Henan , China
| | - Yanyi Xu
- Department of Environmental Health, School of Public Health, Fudan University , Shanghai , China
| | - Wanjun Wang
- Department of Environmental Health, School of Public Health, Fudan University , Shanghai , China
| | - Yuhao Zhang
- Department of Neurology, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Qi Cao
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine , Baltimore, Maryland
| | - Zhekang Ying
- Department of Medicine Cardiology Division, University of Maryland School of Medicine , Baltimore, Maryland
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Reis H, Reis C, Sharip A, Reis W, Zhao Y, Sinclair R, Beeson L. Diesel exhaust exposure, its multi-system effects, and the effect of new technology diesel exhaust. ENVIRONMENT INTERNATIONAL 2018; 114:252-265. [PMID: 29524921 DOI: 10.1016/j.envint.2018.02.042] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 02/24/2018] [Accepted: 02/24/2018] [Indexed: 11/07/2023]
Abstract
Exposure to diesel exhaust (DE) from vehicles and industry is hazardous and affects proper function of organ systems. DE can interfere with normal physiology after acute and chronic exposure to particulate matter (PM). Exposure leads to potential systemic disease processes in the central nervous, visual, hematopoietic, respiratory, cardiovascular, and renal systems. In this review, we give an overview of the epidemiological evidence supporting the harmful effects of diesel exhaust, and the numerous animal studies conducted to investigate the specific pathophysiological mechanisms behind DE exposure. Additionally, this review includes a summary of studies that used biomarkers as an indication of biological plausibility, and also studies evaluating new technology diesel exhaust (NTDE) and its systemic effects. Lastly, this review includes new approaches to improving DE emissions, and emphasizes the importance of ongoing study in this field of environmental health.
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Affiliation(s)
- Haley Reis
- Loma Linda University School of Medicine, 11175 Campus Street, Loma Linda, CA 92350, USA
| | - Cesar Reis
- Department of Preventive Medicine, Loma Linda University Medical Center, 24785 Stewart Street, Suite 204, Loma Linda, CA 92354, USA; Loma Linda University School of Medicine, 11175 Campus Street, Loma Linda, CA 92350, USA.
| | - Akbar Sharip
- Department of Occupational Medicine, Loma Linda University Medical Center, 328 East Commercial Road, Suite 101, San Bernardino, CA 92408, USA
| | - Wenes Reis
- Department of Preventive Medicine, Loma Linda University Medical Center, 24785 Stewart Street, Suite 204, Loma Linda, CA 92354, USA
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, Chongqing, China; Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China; The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Ryan Sinclair
- Center for Community Resilience, School of Public Health, Loma Linda University, Loma Linda, CA 92350, USA
| | - Lawrence Beeson
- Center for Nutrition, Healthy Lifestyle, and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, CA 92350, USA.
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Intrauterine inflammatory activation, functional progesterone withdrawal, and the timing of term and preterm birth. J Reprod Immunol 2018; 125:89-99. [DOI: 10.1016/j.jri.2017.12.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 12/17/2017] [Accepted: 12/21/2017] [Indexed: 01/19/2023]
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Steenland K, Pillarisetti A, Kirby M, Peel J, Clark M, Checkley W, Chang HH, Clasen T. Modeling the potential health benefits of lower household air pollution after a hypothetical liquified petroleum gas (LPG) cookstove intervention. ENVIRONMENT INTERNATIONAL 2018; 111:71-79. [PMID: 29182949 PMCID: PMC5801118 DOI: 10.1016/j.envint.2017.11.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/01/2017] [Accepted: 11/22/2017] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Improved biomass and advanced fuel cookstoves can lower household air pollution (HAP), but levels of fine particulate matter (PM2.5) often remain above the World Health Organization (WHO) recommended interim target of 35μg/m3. METHODS Based on existing literature, we first estimate a range of likely levels of personal PM2.5 before and after a liquefied petroleum gas (LPG) intervention. Using simulations reflecting uncertainty in both the exposure estimates and exposure-response coefficients, we estimate corresponding expected health benefits for systolic blood pressure (SBP) in adults, birthweight, and pneumonia incidence among children <2years old. We also estimate potential avoided premature mortality among those exposed. RESULTS Our best estimate is that an LPG stove intervention would decrease personal PM2.5 exposure from approximately 270μg/m3 to approximately 70μg/m3, due to likely continued use of traditional open-fire stoves. We estimate that this decrease would lead to a 5.5mmHg lower SBP among women over age 50, a 338g higher birthweight, and a 37% lower incidence of severe childhood pneumonia. We estimate that decreased SBP, if sustained, would result in a 5%-10% decrease in mortality for women over age 50. We estimate that higher birthweight would reduce infant mortality by 4 to 11 deaths per 1000 births; for comparison, the current global infant mortality rate is 32/1000 live births. Reduced exposure is estimated to prevent approximately 29 cases of severe pneumonia per year per 1000 children under 2, avoiding approximately 2-3 deaths/1000 per year. However, there are large uncertainties around all these estimates due to uncertainty in both exposure estimates and in exposure-response coefficients; all health effect estimates include the null value of no benefit. CONCLUSIONS An LPG stove intervention, while not likely to lower exposure to the WHO interim target level, is still likely to offer important health benefits.
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Affiliation(s)
- Kyle Steenland
- Rollins School of Public Health, Emory U., Atlanta, Georgia.
| | - Ajay Pillarisetti
- Environmental Health Sciences, University of California, Berkeley, United States
| | - Miles Kirby
- Rollins School of Public Health, Emory U., Atlanta, Georgia
| | - Jennifer Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Maggie Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Will Checkley
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Howard H Chang
- Rollins School of Public Health, Emory U., Atlanta, Georgia
| | - Thomas Clasen
- Rollins School of Public Health, Emory U., Atlanta, Georgia
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Mukherjee A, Agrawal M. A Global Perspective of Fine Particulate Matter Pollution and Its Health Effects. REVIEWS OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2018; 244:5-51. [PMID: 28361472 DOI: 10.1007/398_2017_3] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Fine particulate matter (PM) in the ambient air is implicated in a variety of human health issues throughout the globe. Regulation of fine PM in the atmosphere requires information on the dimension of the problem with respect to variations in concentrations and sources. To understand the current status of fine particles in the atmosphere and their potential harmful health effects in different regions of the world this review article was prepared based on peer-reviewed scientific papers, scientific reports, and database from government organizations published after the year 2000 to evaluate the global scenario of the PM2.5 (particles <2.5 μm in aerodynamic diameter), its exceedance of national and international standards, sources, mechanism of toxicity, and harmful health effects of PM2.5 and its components. PM2.5 levels and exceedances of national and international standards were several times higher in Asian countries, while levels in Europe and USA were mostly well below the respective standards. Vehicular traffic has a significant influence on PM2.5 levels in urban areas; followed by combustion activities (biomass, industrial, and waste burning) and road dust. In urban atmosphere, fine particles are mostly associated with different health effects with old aged people, pregnant women, and more so children being the most susceptible ones. Fine PM chemical constituents severely effect health due to their carcinogenic or mutagenic nature. Most of the research indicated an exceedance of fine PM level of the standards with a diverse array of health effects based on PM2.5 chemical constituents. Emission reduction policies with epidemiological studies are needed to understand the benefits of sustainable control measures for fine PM mitigation.
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Affiliation(s)
- Arideep Mukherjee
- Laboratory of Air Pollution and Global Climate Change, Department of Botany, Banaras Hindu University, Varanasi, 221005, India
| | - Madhoolika Agrawal
- Laboratory of Air Pollution and Global Climate Change, Department of Botany, Banaras Hindu University, Varanasi, 221005, India.
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Wu H, Jiang B, Geng X, Zhu P, Liu Z, Cui L, Yang L. Exposure to fine particulate matter during pregnancy and risk of term low birth weight in Jinan, China, 2014-2016. Int J Hyg Environ Health 2017; 221:183-190. [PMID: 29097084 DOI: 10.1016/j.ijheh.2017.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Existing studies exploring the association between low birth weight (LBW) and maternal fine particulate matter (aerodynamic diameter<2.5μm, PM2.5) exposure have presented equivocal results, and one of the possible reasons for this finding might be due to relatively low maternal exposures. In addition, relatively narrow maternal exposure windows to PM2.5 have not been well established for LBW. METHODS We employed a nested matched case-control design among 43,855 term births in a large maternity and child care hospital in Jinan, China. A total of 369 cases were identified, and four controls per case matched by maternal age were randomly selected among those with normal birth weight (n=1,476) from 2014 to 2016. Ambient air monitoring data on continuous measures of PM2.5, nitrogen dioxide (NO2), and sulfur dioxide (SO2) (24-h average concentrations) from 2013 to 2016 were collected from thirteen local monitoring stations. An inverse distance weighting method based on both home and work addresses was adopted to estimate the individual daily exposures to these air pollutants during pregnancy by weighting the average of the twelve nearest monitoring stations within 30km of each 100m×100m grid cell by an inverse squared distance, and then the average exposure concentrations for gestational months, trimesters and the entire pregnancy were calculated. Adjusted conditional logistic regression models were used to estimate the odds ratios (ORs) per 10μg/m3 increment in PM2.5 and by PM2.5 quartiles during different gestational periods. RESULTS In this study, the estimated mean values of PM2.5, NO2, and SO2 exposure during the entire pregnancy were 88.0, 54.6, and 63.1μg/m3, respectively. Term low birth weight (TLBW) increased in association with per 10μg/m3 increment in PM2.5 for the 8th month [OR=1.13, 95% confidence interval (CI): 1.04, 1.22], the 9th month (OR=1.06, 95% CI: 0.99, 1.15), the third trimester (OR=1.17, 95% CI: 1.05, 1.29), and the entire pregnancy (OR=1.38, 95% CI: 1.07, 1.77) in models adjusted for one pollutant (PM2.5). In models categorizing the PM2.5 exposure by quartiles, comparing the second, third, and highest with the lowest PM2.5 exposure quartile, the PM2.5 was positively associated with TLBW during the 8th month (OR: 1.77, 95% CI: 1.09, 2.88; OR: 1.77, 95% CI: 1.03, 3.04; OR: 1.92, 95% CI: 1.04, 3.55, respectively) and for the 9th month, only association for exposure in the third versus the lowest quartile was significant (OR: 1.91, 95% CI: 1.02, 3.58). CONCLUSIONS The study provides evidence that exposure to PM2.5 during pregnancy might be associated with the risk of TLBW in the context of very high pollution level of PM2.5, and the 8th and 9th months were identified as potentially relevant exposure windows.
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Affiliation(s)
- Han Wu
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandong, China
| | - Baofa Jiang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandong, China
| | - Xingyi Geng
- Jinan Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Ping Zhu
- Jinan Maternity and Child Care Hospital, Jinan, Shandong, China
| | - Zhong Liu
- Jinan Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Liangliang Cui
- Jinan Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Liping Yang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandong, China.
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Li X, Huang S, Jiao A, Yang X, Yun J, Wang Y, Xue X, Chu Y, Liu F, Liu Y, Ren M, Chen X, Li N, Lu Y, Mao Z, Tian L, Xiang H. Association between ambient fine particulate matter and preterm birth or term low birth weight: An updated systematic review and meta-analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2017; 227:596-605. [PMID: 28457735 DOI: 10.1016/j.envpol.2017.03.055] [Citation(s) in RCA: 270] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/18/2017] [Accepted: 03/24/2017] [Indexed: 05/19/2023]
Abstract
An increasing number of studies have been conducted to determine a possible linkage between maternal exposure to ambient fine particulate matter and effects on the developing human fetus that can lead to adverse birth outcomes, but, the present results are not consistent. A total of 23 studies published before July 2016 were collected and analyzed and the mean value of reported exposure to fine particulate matter (PM2.5) ranged from 1.82 to 22.11 We found a significantly increased risk of preterm birth with interquartile range increase in PM2.5 exposure throughout pregnancy (odds ratio (OR) = 1.03; 95% conditional independence (CI): 1.01-1.05). The pooled OR for the association between PM2.5 exposure, per interquartile range increment, and term low birth weight throughout pregnancy was 1.03 (95% CI: 1.02-1.03). The pooled ORs for the association between PM2.5 exposure per 10 increment, and term low birth weight and preterm birth were 1.05 (95% CI: 0.98-1.12) and 1.02 (95% CI: 0.93-1.12), respectively throughout pregnancy. There is a significant heterogeneity in most meta-analyses, except for pooled OR per interquartile range increase for term low birth weight throughout pregnancy. We here show that maternal exposure to fine particulate air pollution increases the risk of preterm birth and term low birth weight. However, the effect of exposure time needs to be further explored. In the future, prospective cohort studies and personal exposure measurements needs to be more widely utilized to better characterize the relationship between ambient fine particulate exposure and adverse birth outcomes.
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Affiliation(s)
- Xiangyu Li
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Shuqiong Huang
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, Hubei Province, China.
| | - Anqi Jiao
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Xuhao Yang
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Junfeng Yun
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Yuxin Wang
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Xiaowei Xue
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Yuanyuan Chu
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Feifei Liu
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Yisi Liu
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Meng Ren
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Xi Chen
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Na Li
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Yuanan Lu
- Environmental Health Laboratory, Department of Public Health Sciences, University of Hawaii at Manoa, 1960 East-West Rd, Biomed Bldg, D105, Honolulu, HI, 96822, USA.
| | - Zongfu Mao
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Liqiao Tian
- State Key Laboratory of Information Engineering in Surveying, Mapping and Remote Sensing, Wuhan University, Wuhan, 430079, China.
| | - Hao Xiang
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
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Liu C, Sun J, Liu Y, Liang H, Wang M, Wang C, Shi T. Different exposure levels of fine particulate matter and preterm birth: a meta-analysis based on cohort studies. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2017; 24:17976-17984. [PMID: 28616740 DOI: 10.1007/s11356-017-9363-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 05/23/2017] [Indexed: 05/05/2023]
Abstract
The previous studies estimated the association between PM2.5 (particulate matter with aerodynamic diameter less than or equal to 2.5 μm) exposure during pregnancy and preterm birth, only considered and highlighted the hazard effects of high levels of air pollutant exposure, and underestimated that low levels of pollutant exposure might also affect pregnancy outcome. We conducted a meta-analysis of 11 cohort studies, a total of more than 1,500,000 subjects. The results of these studies were pooled by exposure levels and study periods. PM2.5 exposure during pregnancy was positively associated with preterm birth (OR = 1.15, 95% CI = 1.07-1.23), and during the first trimester of pregnancy, low levels of PM2.5 exposure were also positively associated with preterm birth (OR = 1.17, 95% CI = 1.04-1.30). It is important to protect pregnant women from PM2.5 exposures, especially during their first trimester of pregnancy even when the ambient PM2.5 concentration is relatively low. More relevant health policy should be carried out to prevent hazard effect of air pollutants.
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Affiliation(s)
- Chenchen Liu
- School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan, Hubei, 430071, China
| | - Jiantao Sun
- School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan, Hubei, 430071, China
| | - Yuewei Liu
- Hubei Provincial Center for Disease Control and Prevention, 6 Zhuodaoquan North Road, Wuhan, Hubei, 430079, China
| | - Hui Liang
- Medical Research Center for Structural Biology, School of Basic Medical Sciences, Wuhan University, 115 Donghu Road, Wuhan, Hubei, 430071, China
| | - Minsheng Wang
- School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan, Hubei, 430071, China
| | - Chunhong Wang
- School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan, Hubei, 430071, China.
| | - Tingming Shi
- Hubei Provincial Center for Disease Control and Prevention, 6 Zhuodaoquan North Road, Wuhan, Hubei, 430079, China.
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83
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Chen M, Wang X, Hu Z, Zhou H, Xu Y, Qiu L, Qin X, Zhang Y, Ying Z. Programming of mouse obesity by maternal exposure to concentrated ambient fine particles. Part Fibre Toxicol 2017; 14:20. [PMID: 28645299 PMCID: PMC5481884 DOI: 10.1186/s12989-017-0201-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 06/18/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Many diseases including obesity may originate through alterations in the early-life environment that interrupts fetal development. Increasing evidence has shown that exposure to ambient fine particles (PM2.5) is associated with abnormal fetal development. However, its long-term metabolic effects on offspring have not been systematically investigated. RESULTS To determine if maternal exposure to PM2.5 programs offspring obesity, female C57Bl/6j mice were exposed to filtered air (FA) or concentrated ambient PM2.5 (CAP) during pre-conception, pregnancy, and lactation, and the developmental and metabolic responses of offspring were assessed. The growth trajectory of offspring revealed that maternal exposure to CAP significantly decreased offspring birth weight but increased body weight of adult male but not female offspring, and the latter was expressed as increased adiposity. These adult male offspring had increased food intake, but were sensitive to exogenous leptin. Their hypothalamic expression of Socs3 and Pomc, two target genes of leptin, was not changed, and the hypothalamic expression of NPY, an orexigenic peptide that is inhibited by leptin, was significantly increased. These decreases in central anorexigenic signaling were accompanied by reduced plasma leptin and its expression in adipose tissues, the primary source of circulating leptin. In contrast, maternal exposure did not significantly change any of these indexes in adult female offspring. Pyrosequencing demonstrated that the leptin promoter methylation of adipocytes was significantly increased in CAP-exposed male but not female offspring. CONCLUSIONS Our data indicate that maternal exposure to ambient PM2.5 programs obesity in male offspring probably through alterations in the methylation of the promoter region of the leptin gene.
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Affiliation(s)
- Minjie Chen
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200032 China
- Department of Medicine Cardiology Division, University of Maryland School of Medicine, 20 Penn St. HSFII S022, Baltimore, MD 21201 USA
| | - Xiaoke Wang
- Department of Medicine Cardiology Division, University of Maryland School of Medicine, 20 Penn St. HSFII S022, Baltimore, MD 21201 USA
- Department of Occupational and Environmental Health, School of Public Health, Nantong University, Nantong, 226019 China
| | - Ziying Hu
- Department of Medicine Cardiology Division, University of Maryland School of Medicine, 20 Penn St. HSFII S022, Baltimore, MD 21201 USA
- Department of Endocrinology, the People’s Hospital of Zhengzhou University (Henan Provincial People’s Hospital), Zhengzhou, Henan 450003 China
| | - Huifen Zhou
- Department of Medicine Cardiology Division, University of Maryland School of Medicine, 20 Penn St. HSFII S022, Baltimore, MD 21201 USA
| | - Yanyi Xu
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200032 China
| | - Lianglin Qiu
- Department of Medicine Cardiology Division, University of Maryland School of Medicine, 20 Penn St. HSFII S022, Baltimore, MD 21201 USA
- Department of Occupational and Environmental Health, School of Public Health, Nantong University, Nantong, 226019 China
| | - Xiaobo Qin
- Department of Medicine Cardiology Division, University of Maryland School of Medicine, 20 Penn St. HSFII S022, Baltimore, MD 21201 USA
| | - Yuhao Zhang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, 200032 China
| | - Zhekang Ying
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200032 China
- Department of Medicine Cardiology Division, University of Maryland School of Medicine, 20 Penn St. HSFII S022, Baltimore, MD 21201 USA
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Malley CS, Kuylenstierna JCI, Vallack HW, Henze DK, Blencowe H, Ashmore MR. Preterm birth associated with maternal fine particulate matter exposure: A global, regional and national assessment. ENVIRONMENT INTERNATIONAL 2017; 101:173-182. [PMID: 28196630 DOI: 10.1016/j.envint.2017.01.023] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 05/22/2023]
Abstract
Reduction of preterm births (<37 completed weeks of gestation) would substantially reduce neonatal and infant mortality, and deleterious health effects in survivors. Maternal fine particulate matter (PM2.5) exposure has been identified as a possible risk factor contributing to preterm birth. The aim of this study was to produce the first estimates of ambient PM2.5-associated preterm births for 183 individual countries and globally. To do this, national, population-weighted, annual average ambient PM2.5 concentration, preterm birth rate and number of livebirths were combined to calculate the number of PM2.5-associated preterm births in 2010 for 183 countries. Uncertainty was quantified using Monte-Carlo simulations, and analyses were undertaken to investigate the sensitivity of PM2.5-associated preterm birth estimates to assumptions about the shape of the concentration-response function at low and high PM2.5 exposures, inclusion of provider-initiated preterm births, and exposure to indoor air pollution. Globally, in 2010, the number of PM2.5-associated preterm births was estimated as 2.7 million (1.8-3.5 million, 18% (12-24%) of total preterm births globally) with a low concentration cut-off (LCC) set at 10μgm-3, and 3.4 million (2.4-4.2 million, 23% (16-28%)) with a LCC of 4.3μgm-3. South and East Asia, North Africa/Middle East and West sub-Saharan Africa had the largest contribution to the global total, and the largest percentage of preterm births associated with PM2.5. Sensitivity analyses showed that PM2.5-associated preterm birth estimates were 24% lower when provider-initiated preterm births were excluded, 38-51% lower when risk was confined to the PM2.5 exposure range in the studies used to derive the effect estimate, and 56% lower when mothers who live in households that cook with solid fuels (and whose personal PM2.5 exposure is likely dominated by indoor air pollution) were excluded. The concentration-response function applied here derives from a meta-analysis of studies, most of which were conducted in the US and Europe, and its application to the areas of the world where we estimate the greatest effects on preterm births remains uncertain. Nevertheless, the substantial percentage of preterm births estimated to be associated with anthropogenic PM2.5 (18% (13%-24%) of total preterm births globally) indicates that reduction of maternal PM2.5 exposure through emission reduction strategies should be considered alongside mitigation of other risk factors associated with preterm births.
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Affiliation(s)
- Christopher S Malley
- Stockholm Environment Institute, Environment Department, University of York, York, United Kingdom.
| | - Johan C I Kuylenstierna
- Stockholm Environment Institute, Environment Department, University of York, York, United Kingdom
| | - Harry W Vallack
- Stockholm Environment Institute, Environment Department, University of York, York, United Kingdom
| | - Daven K Henze
- Department of Mechanical Engineering, University of Colorado, Boulder, CO, United States
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive, and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mike R Ashmore
- Stockholm Environment Institute, Environment Department, University of York, York, United Kingdom
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Giorgis-Allemand L, Pedersen M, Bernard C, Aguilera I, Beelen RMJ, Chatzi L, Cirach M, Danileviciute A, Dedele A, van Eijsden M, Estarlich M, Fernández-Somoano A, Fernández MF, Forastiere F, Gehring U, Grazuleviciene R, Gruzieva O, Heude B, Hoek G, de Hoogh K, van den Hooven EH, Håberg SE, Iñiguez C, Jaddoe VWV, Korek M, Lertxundi A, Lepeule J, Nafstad P, Nystad W, Patelarou E, Porta D, Postma D, Raaschou-Nielsen O, Rudnai P, Siroux V, Sunyer J, Stephanou E, Sørensen M, Eriksen KT, Tuffnell D, Varró MJ, Vrijkotte TGM, Wijga A, Wright J, Nieuwenhuijsen MJ, Pershagen G, Brunekreef B, Kogevinas M, Slama R. The Influence of Meteorological Factors and Atmospheric Pollutants on the Risk of Preterm Birth. Am J Epidemiol 2017; 185:247-258. [PMID: 28087514 DOI: 10.1093/aje/kww141] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 10/20/2016] [Indexed: 12/13/2022] Open
Abstract
Atmospheric pollutants and meteorological conditions are suspected to be causes of preterm birth. We aimed to characterize their possible association with the risk of preterm birth (defined as birth occurring before 37 completed gestational weeks). We pooled individual data from 13 birth cohorts in 11 European countries (71,493 births from the period 1994-2011, European Study of Cohorts for Air Pollution Effects (ESCAPE)). City-specific meteorological data from routine monitors were averaged over time windows spanning from 1 week to the whole pregnancy. Atmospheric pollution measurements (nitrogen oxides and particulate matter) were combined with data from permanent monitors and land-use data into seasonally adjusted land-use regression models. Preterm birth risks associated with air pollution and meteorological factors were estimated using adjusted discrete-time Cox models. The frequency of preterm birth was 5.0%. Preterm birth risk tended to increase with first-trimester average atmospheric pressure (odds ratio per 5-mbar increase = 1.06, 95% confidence interval: 1.01, 1.11), which could not be distinguished from altitude. There was also some evidence of an increase in preterm birth risk with first-trimester average temperature in the -5°C to 15°C range, with a plateau afterwards (spline coding, P = 0.08). No evidence of adverse association with atmospheric pollutants was observed. Our study lends support for an increase in preterm birth risk with atmospheric pressure.
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Affiliation(s)
- Lise Giorgis-Allemand
- Inserm and Univ. Grenoble Alpes, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Grenoble, France
| | - Marie Pedersen
- Department of Cancer and Inflammation Research, Institute of Molecular Medicine, University of Southern Denmark, Odense C, Denmark
| | - Claire Bernard
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Inmaculada Aguilera
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Rob M J Beelen
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD, Utrecht, The Netherlands
- Center for Sustainability, Environment and Health, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Leda Chatzi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Marta Cirach
- Campus MAR, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Asta Danileviciute
- Department of Environmental Science, Vytauto Didziojo Universitetas, K. Donelaicio 58, Kaunas 44248, Lithuania
| | - Audrius Dedele
- Department of Environmental Sciences , Vytautas Magnus University , Kaunas , Lithuania
| | - Manon van Eijsden
- Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands
| | | | - Ana Fernández-Somoano
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Dept of Medicine, University of Oviedo, Asturias, Spain
| | - Mariana F Fernández
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Hospitales Universitarios de Granada, Spain
| | | | - Ulrike Gehring
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Regina Grazuleviciene
- Department of Environmental Sciences , Vytautas Magnus University , Kaunas , Lithuania
| | - Olena Gruzieva
- Department of Environmental Sciences , Vytautas Magnus University , Kaunas , Lithuania
| | - Barbara Heude
- Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences (IRAS), University of Utrecht, Utrecht, The Netherlands
| | - Kees de Hoogh
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Environmental Science, Vytauto Didziojo Universitetas, K. Donelaicio 58, Kaunas 44248, Lithuania
| | - Edith H van den Hooven
- Department of Environmental Sciences , Vytautas Magnus University , Kaunas , Lithuania
- Department of Environmental Sciences , Vytautas Magnus University , Kaunas , Lithuania
- Department of Environmental Sciences , Vytautas Magnus University , Kaunas , Lithuania
| | - Siri E Håberg
- Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands
| | - Carmen Iñiguez
- University of Malaga, Department of Ecology, Faculty of Sciences, Boulevard Louis Pasteur s/n, 29010 Málaga, Spain
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Paediatrics, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michal Korek
- Department of Environmental Sciences , Vytautas Magnus University , Kaunas , Lithuania
| | - Aitana Lertxundi
- Universidad del País Vasco UPV-EUH, Spain; Health Research Institute, Biodonostia, San Sebastián, Spain
| | - Johanna Lepeule
- Université Grenoble Alpes, CNRS UMR 5309, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Grenoble, France
- INSERM U1209, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Grenoble, France
- CHU de Grenoble, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Grenoble, France
| | - Per Nafstad
- Institute of Health and Society, University of Oslo, P.O. Box 1130 Blindern, Oslo, 0318 Norway
| | | | - Evridiki Patelarou
- Department of Adult Nursing, Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Daniela Porta
- Department of Epidemiology, Lazio Regional Health System, Rome, Italy
| | - Dirkje Postma
- Dept of Pulmonary Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center , Copenhagen , Denmark
- Department of Environmental Science , Aarhus University , Roskilde , Denmark
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Peter Rudnai
- National Public Health Center, National Directorate of Environmental Health, 1097 Budapest, Hungary
| | - Valérie Siroux
- Inserm, Institut Albert Bonniot (IAB),Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Grenoble F-38042,France
| | - Jordi Sunyer
- Campus MAR, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Euripides Stephanou
- Environmental Chemical Processes Laboratory (ECPL), Department of Chemistry, University of Crete, 71003, Heraklion, Greece
| | - Mette Sørensen
- Department of Pathology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kirsten Thorup Eriksen
- Diet Genes Environment Unit, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark
| | - Derek Tuffnell
- Bradford Women's and Newborn Unit, Bradford Teaching Hospitals NHS Foundation, Bradford, UK
| | - Mihály J Varró
- Department of Community Health,National Institute of Environmental Health,Hungary
| | - Tanja G M Vrijkotte
- Academic Medical Centre, Amsterdam Public Health research institute, Department of Public Health, Amsterdam, The Netherlands
| | - Alet Wijga
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Hospitales Universitarios de Granada, Spain
| | - John Wright
- Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Dept of Medicine, University of Oviedo, Asturias, Spain
| | - Mark J Nieuwenhuijsen
- Joint Research Unit for Epidemiology and Environmental Health, FISABIO-Universitat de València-Universitat Jaume I, Valencia, Spain
- Joint Research Unit for Epidemiology and Environmental Health, FISABIO-Universitat de València-Universitat Jaume I, Valencia, Spain
| | - Göran Pershagen
- Institute for Risk Assessment Sciences (IRAS), University of Utrecht, Utrecht, The Netherlands
| | - Bert Brunekreef
- Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands
| | - Manolis Kogevinas
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Environmental Science, Vytauto Didziojo Universitetas, K. Donelaicio 58, Kaunas 44248, Lithuania
- Department of Environmental Sciences , Vytautas Magnus University , Kaunas , Lithuania
| | - Rémy Slama
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
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86
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Chen M, Liang S, Zhou H, Xu Y, Qin X, Hu Z, Wang X, Qiu L, Wang W, Zhang Y, Ying Z. Prenatal and postnatal mothering by diesel exhaust PM 2.5-exposed dams differentially program mouse energy metabolism. Part Fibre Toxicol 2017; 14:3. [PMID: 28100227 PMCID: PMC5423412 DOI: 10.1186/s12989-017-0183-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/11/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Obesity is one of the leading threats to global public health. It is consequent to abnormal energy metabolism. Currently, it has been well established that maternal exposure to environmental stressors that cause inappropriate fetal development may have long-term adverse effects on offspring energy metabolism in an exposure timing-dependent manner, known as developmental programming of health and diseases paradigm. Rapidly increasing evidence has indicated that maternal exposure to ambient fine particles (PM2.5) correlates to abnormal fetal development. In the present study, we therefore assessed whether maternal exposure to diesel exhaust PM2.5 (DEP), the major component of ambient PM2.5 in urban areas, programs offspring energy metabolism, and further examined how the timing of exposure impacts this programming. RESULTS The growth trajectory of offspring shows that although prenatal maternal exposure to DEP did not impact the birth weight of offspring, it significantly decreased offspring body weight from postnatal week 2 until the end of observation. This weight loss effect of prenatal maternal exposure to DEP coincided with decreased food intake but not alteration in brown adipose tissue (BAT) morphology. The hypophagic effect of prenatal maternal exposure to DEP was in concord with decreased hypothalamic expression of an orexigenic peptide NPY, suggesting that the prenatal maternal exposure to DEP impacts offspring energy balance primarily through programming of food intake. Paradoxically, the reduced body weight resulted from prenatal maternal exposure to DEP was accompanied by increased mass of epididymal adipose tissue, which was due to hyperplasia as morphological analysis did not observe any hypertrophy. In direct contrast, the postnatal mothering by DEP-exposed dams increased offspring body weight during lactation and adulthood, paralleled by markedly increased fat accumulation and decreased UCP1 expression in BAT but not alteration in food intake. The weight gain induced by postnatal mothering by DEP-exposed dams was also expressed as an increased adiposity. But it concurred with a marked hypertrophy of adipocytes. CONCLUSION Prenatal and postnatal mothering by DEP-exposed dams differentially program offspring energy metabolism, underscoring consideration of the exposure timing when examining the adverse effects of maternal exposure to ambient PM2.5.
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Affiliation(s)
- Minjie Chen
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200032 China
- Department of Medicine Cardiology Division, School of Medicine, University of Maryland, 20 Penn St. HSFII S022, Baltimore, MD 21201 USA
| | - Shuai Liang
- Department of Medicine Cardiology Division, School of Medicine, University of Maryland, 20 Penn St. HSFII S022, Baltimore, MD 21201 USA
- Department of Bile Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008 China
| | - Huifen Zhou
- Department of Medicine Cardiology Division, School of Medicine, University of Maryland, 20 Penn St. HSFII S022, Baltimore, MD 21201 USA
- Department of Pathology, Hubei University of Science and Technology, Xianning, Hubei 437100 China
| | - Yanyi Xu
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200032 China
| | - Xiaobo Qin
- Department of Medicine Cardiology Division, School of Medicine, University of Maryland, 20 Penn St. HSFII S022, Baltimore, MD 21201 USA
| | - Ziying Hu
- Department of Medicine Cardiology Division, School of Medicine, University of Maryland, 20 Penn St. HSFII S022, Baltimore, MD 21201 USA
- Department of Endocrinology, the People’s Hospital of Zhengzhou University (Henan Provincial People’s Hospital), Zhengzhou, Henan 450003 China
| | - Xiaoke Wang
- Department of Medicine Cardiology Division, School of Medicine, University of Maryland, 20 Penn St. HSFII S022, Baltimore, MD 21201 USA
- Department of Occupational and Environmental Health, School of Public Health, Nantong University, Nantong, 226019 China
| | - Lianglin Qiu
- Department of Medicine Cardiology Division, School of Medicine, University of Maryland, 20 Penn St. HSFII S022, Baltimore, MD 21201 USA
- Department of Occupational and Environmental Health, School of Public Health, Nantong University, Nantong, 226019 China
| | - Wanjun Wang
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200032 China
| | - Yuhao Zhang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, 200032 China
| | - Zhekang Ying
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200032 China
- Department of Medicine Cardiology Division, School of Medicine, University of Maryland, 20 Penn St. HSFII S022, Baltimore, MD 21201 USA
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87
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Cai Y, Zhang B, Ke W, Feng B, Lin H, Xiao J, Zeng W, Li X, Tao J, Yang Z, Ma W, Liu T. Associations of Short-Term and Long-Term Exposure to Ambient Air Pollutants With Hypertension. Hypertension 2016; 68:62-70. [DOI: 10.1161/hypertensionaha.116.07218] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 04/05/2016] [Indexed: 01/01/2023]
Abstract
Hypertension is a major disease of burden worldwide. Previous studies have indicated that air pollution might be a risk factor for hypertension, but the results were controversial. To fill this gap, we performed a meta-analysis of epidemiological studies to investigate the associations of short-term and long-term exposure to ambient air pollutants with hypertension. We searched all of the studies published before September 1, 2015, on the associations of ozone (O
3
), carbon monoxide (CO), nitrogen oxide (NO
2
and NO
X
), sulfur dioxide (SO
2
), and particulate matter (PM
10
and PM
2.5
) with hypertension in the English electronic databases. A pooled odds ratio (OR) for hypertension in association with each 10 μg/m
3
increase in air pollutant was calculated by a random-effects model (for studies with significant heterogeneity) or a fixed-effect model (for studies without significant heterogeneity). A total of 17 studies examining the effects of short-term (n=6) and long-term exposure (n=11) to air pollutants were identified. Short-term exposure to SO
2
(OR=1.046, 95% confidence interval [CI]: 1.012–1.081), PM
2.5
(OR=1.069, 95% CI: 1.003–1.141), and PM
10
(OR=1.024, 95% CI: 1.016–1.032) were significantly associated with hypertension. Long-term exposure (a 10 μg/m
3
increase) to NO
2
(OR=1.034, 95% CI: 1.005–1.063) and PM
10
(OR=1.054, 95% CI: 1.036–1.072) had significant associations with hypertension. Exposure to other ambient air pollutants (short-term exposure to NO
2
, O
3
, and CO and long-term exposure to NO
x
, PM
2.5
, and SO
2
) also had positive relationships with hypertension, but lacked statistical significance. Our results suggest that short-term or long-term exposure to some air pollutants may increase the risk of hypertension.
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Affiliation(s)
- Yuanyuan Cai
- From the Department of Preventive Medicine, School of Public Health, Sun Yat-Sen University, Guangzhou, China (Y.C., B.Z.); Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangzhou, China (Y.C., B.Z.); Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China (W.K., B.F., H.L., J.X., W.Z., X.L., W.M., T.L.); South China Institute of Environmental Sciences, Ministry of Environmental Protection,
| | - Bo Zhang
- From the Department of Preventive Medicine, School of Public Health, Sun Yat-Sen University, Guangzhou, China (Y.C., B.Z.); Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangzhou, China (Y.C., B.Z.); Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China (W.K., B.F., H.L., J.X., W.Z., X.L., W.M., T.L.); South China Institute of Environmental Sciences, Ministry of Environmental Protection,
| | - Weixia Ke
- From the Department of Preventive Medicine, School of Public Health, Sun Yat-Sen University, Guangzhou, China (Y.C., B.Z.); Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangzhou, China (Y.C., B.Z.); Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China (W.K., B.F., H.L., J.X., W.Z., X.L., W.M., T.L.); South China Institute of Environmental Sciences, Ministry of Environmental Protection,
| | - Baixiang Feng
- From the Department of Preventive Medicine, School of Public Health, Sun Yat-Sen University, Guangzhou, China (Y.C., B.Z.); Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangzhou, China (Y.C., B.Z.); Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China (W.K., B.F., H.L., J.X., W.Z., X.L., W.M., T.L.); South China Institute of Environmental Sciences, Ministry of Environmental Protection,
| | - Hualiang Lin
- From the Department of Preventive Medicine, School of Public Health, Sun Yat-Sen University, Guangzhou, China (Y.C., B.Z.); Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangzhou, China (Y.C., B.Z.); Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China (W.K., B.F., H.L., J.X., W.Z., X.L., W.M., T.L.); South China Institute of Environmental Sciences, Ministry of Environmental Protection,
| | - Jianpeng Xiao
- From the Department of Preventive Medicine, School of Public Health, Sun Yat-Sen University, Guangzhou, China (Y.C., B.Z.); Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangzhou, China (Y.C., B.Z.); Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China (W.K., B.F., H.L., J.X., W.Z., X.L., W.M., T.L.); South China Institute of Environmental Sciences, Ministry of Environmental Protection,
| | - Weilin Zeng
- From the Department of Preventive Medicine, School of Public Health, Sun Yat-Sen University, Guangzhou, China (Y.C., B.Z.); Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangzhou, China (Y.C., B.Z.); Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China (W.K., B.F., H.L., J.X., W.Z., X.L., W.M., T.L.); South China Institute of Environmental Sciences, Ministry of Environmental Protection,
| | - Xing Li
- From the Department of Preventive Medicine, School of Public Health, Sun Yat-Sen University, Guangzhou, China (Y.C., B.Z.); Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangzhou, China (Y.C., B.Z.); Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China (W.K., B.F., H.L., J.X., W.Z., X.L., W.M., T.L.); South China Institute of Environmental Sciences, Ministry of Environmental Protection,
| | - Jun Tao
- From the Department of Preventive Medicine, School of Public Health, Sun Yat-Sen University, Guangzhou, China (Y.C., B.Z.); Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangzhou, China (Y.C., B.Z.); Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China (W.K., B.F., H.L., J.X., W.Z., X.L., W.M., T.L.); South China Institute of Environmental Sciences, Ministry of Environmental Protection,
| | - Zuyao Yang
- From the Department of Preventive Medicine, School of Public Health, Sun Yat-Sen University, Guangzhou, China (Y.C., B.Z.); Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangzhou, China (Y.C., B.Z.); Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China (W.K., B.F., H.L., J.X., W.Z., X.L., W.M., T.L.); South China Institute of Environmental Sciences, Ministry of Environmental Protection,
| | - Wenjun Ma
- From the Department of Preventive Medicine, School of Public Health, Sun Yat-Sen University, Guangzhou, China (Y.C., B.Z.); Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangzhou, China (Y.C., B.Z.); Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China (W.K., B.F., H.L., J.X., W.Z., X.L., W.M., T.L.); South China Institute of Environmental Sciences, Ministry of Environmental Protection,
| | - Tao Liu
- From the Department of Preventive Medicine, School of Public Health, Sun Yat-Sen University, Guangzhou, China (Y.C., B.Z.); Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangzhou, China (Y.C., B.Z.); Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China (W.K., B.F., H.L., J.X., W.Z., X.L., W.M., T.L.); South China Institute of Environmental Sciences, Ministry of Environmental Protection,
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88
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Lavigne E, Yasseen AS, Stieb DM, Hystad P, van Donkelaar A, Martin RV, Brook JR, Crouse DL, Burnett RT, Chen H, Weichenthal S, Johnson M, Villeneuve PJ, Walker M. Ambient air pollution and adverse birth outcomes: Differences by maternal comorbidities. ENVIRONMENTAL RESEARCH 2016; 148:457-466. [PMID: 27136671 DOI: 10.1016/j.envres.2016.04.026] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/24/2016] [Accepted: 04/20/2016] [Indexed: 05/22/2023]
Abstract
BACKGROUND Prenatal exposure to ambient air pollution has been associated with adverse birth outcomes, but the potential modifying effect of maternal comorbidities remains understudied. Our objective was to investigate whether associations between prenatal air pollution exposures and birth outcomes differ by maternal comorbidities. METHODS A total of 818,400 singleton live births were identified in the province of Ontario, Canada from 2005 to 2012. We assigned exposures to fine particulate matter (PM2.5), nitrogen dioxide (NO2) and ozone (O3) to maternal residences during pregnancy. We evaluated potential effect modification by maternal comorbidities (i.e. asthma, hypertension, pre-existing diabetes mellitus, heart disease, gestational diabetes and preeclampsia) on the associations between prenatal air pollution and preterm birth, term low birth weight and small for gestational age. RESULTS Interquartile range (IQR) increases in PM2.5 (2μg/m(3)), NO2 (9ppb) and O3 (5ppb) over the entire pregnancy were associated with a 4% (95% CI: 2.4-5.6%), 8.4% (95% CI: 5.5-10.3%) and 2% (95% CI: 0.5-4.1%) increase in the odds of preterm birth, respectively. Increases of 10.6% (95% CI: 0.2-2.1%) and 23.8% (95% CI: 5.5-44.8%) in the odds of preterm birth were observed among women with pre-existing diabetes while the increases were of 3.8% (95% CI: 2.2-5.4%) and 6.5% (95% CI: 3.7-8.4%) among women without this condition for pregnancy exposure to PM2.5 and NO2, respectively (Pint<0.01). The increase in the odds of preterm birth for exposure to PM2.5 during pregnancy was higher among women with preeclampsia (8.3%, 95% CI: 0.8-16.4%) than among women without (3.6%, 95% CI: 1.8-5.3%) (Pint=0.04). A stronger increase in the odds of preterm birth was found for exposure to O3 during pregnancy among asthmatic women (12.0%, 95% CI: 3.5-21.1%) compared to non-asthmatic women (2.0%, 95% CI: 0.1-3.5%) (Pint<0.01). We did not find statistically significant effect modification for the other outcomes investigated. CONCLUSIONS Findings of this study suggest that associations of ambient air pollution with preterm birth are stronger among women with pre-existing diabetes, asthma, and preeclampsia.
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Affiliation(s)
- Eric Lavigne
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Abdool S Yasseen
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Better Outcomes Registry and Network Ontario, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - David M Stieb
- Population Studies Division, Health Canada, Vancouver, British Columbia, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffrey R Brook
- Air Quality Research Division, Environment Canada, Downsview, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Daniel L Crouse
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | | | - Hong Chen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Scott Weichenthal
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada; Institute of Health: Science, Technology and Policy, Carleton University, Ottawa, Ontario, Canada
| | - Markey Johnson
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada
| | - Paul J Villeneuve
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
| | - Mark Walker
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Better Outcomes Registry and Network Ontario, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada
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