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Downward GS, Vermeulen R. Ambient Air Pollution and All-Cause and Cause-Specific Mortality in an Analysis of Asian Cohorts. Res Rep Health Eff Inst 2023; 2016:1-53. [PMID: 37424069 PMCID: PMC7266370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
INTRODUCTION Much of what is currently known about the adverse effects of ambient air pollution comes from studies conducted in high-income regions, with relatively low air pollution levels. The aim of the current project is to examine the relationship between exposure to ambient air pollution (as predicted from satellite-based models) and all-cause and cause-specific mortality in several Asian cohorts. METHODS Cohorts were recruited from the Asia Cohort Consortium (ACC). The geocoded residences of participants were assigned levels of ambient particulate material with aerodynamic diameter of 2.5 μm or less (PM2.5) and nitrogen dioxide (NO2) utilizing global satellite-derived models and assigned for the year of enrollment (or closest available year). The association between ambient exposure and mortality was established with Cox proportional hazard models, after adjustment for common confounders. Both single- and two-pollutant models were generated. Model robustness was evaluated, and hazard ratios were calculated for each cohort separately and combined via random effect meta-analysis for pooled risk estimates. RESULTS Six cohort studies from the ACC participated: the Community-based Cancer Screening Program (CBCSCP, Taiwan), the Golestan Cohort Study (Iran), the Health Effects for Arsenic Longitudinal Study (HEALS, Bangladesh), the Japan Public Health Center-based Prospective Study (JPHC), the Korean Multi-center Cancer Cohort Study (KMCC), and the Mumbai Cohort Study (MCS, India). The cohorts represented over 340,000 participants. Mean exposures to PM2.5 ranged from 8 to 58 μg/m3. Mean exposures to NO2 ranged from 7 to 23 ppb. For PM2.5, a positive, borderline nonsignificant relationship was observed between PM2.5 and cardiovascular mortality. Other relationships with PM2.5 tended toward the null in meta-analysis. For NO2, an overall positive relationship was observed between exposure to NO2 and all cancers and lung cancer. A borderline association between NO2 and nonmalignant lung disease was also observed. The findings within individual cohorts remained consistent across a variety of subgroups and alternative analyses, including two-pollutant models. CONCLUSIONS In a pooled examination of cohort studies across Asia, ambient PM2.5 exposure appears to be associated with an increased risk of cardiovascular mortality and ambient NO2 exposure is associated with an increased cancer (and lung cancer) mortality. This project has shown that satellite-derived models of pollution can be used in examinations of mortality risk in areas with either incomplete or missing air pollution monitoring.
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Affiliation(s)
- G S Downward
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
| | - R Vermeulen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
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Zhang H, Zhang X, Wang Q, Xu Y, Feng Y, Yu Z, Huang C. Ambient air pollution and stillbirth: An updated systematic review and meta-analysis of epidemiological studies. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 278:116752. [PMID: 33689950 DOI: 10.1016/j.envpol.2021.116752] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 05/22/2023]
Abstract
Stillbirth has a great impact on contemporary and future generations. Increasing evidence show that ambient air pollution exposure is associated with stillbirth. However, previous studies showed inconsistent findings. To clarify the effect of maternal air pollution exposure on stillbirth, we searched for studies examining the associations between air pollutants, including particulate matter (diameter ≤ 2.5 μm [PM2.5] and ≤10 μm [PM10]) and gaseous pollutants (sulfur dioxide [SO2], nitrogen dioxide [NO2], carbon monoxide [CO] and ozone [O3]), and stillbirth published in PubMed, Web of Science, Embase and Cochrane Library until December 11, 2020. The pooled effect estimates and 95% confidence intervals (CI) were calculated, and the heterogeneity was evaluated using Cochran's Q test and I2 statistic. Publication bias was assessed using funnel plots and Egger's tests. Of 7546 records, 15 eligible studies were included in this review. Results of long-term exposure showed that maternal third trimester PM2.5 and CO exposure (per 10 μg/m3 increment) increased the odds of stillbirth, with estimated odds ratios (ORs) of 1.094 (95% CI: 1.008-1.180) and 1.0009 (95% CI: 1.0001-1.0017), respectively. Entire pregnancy exposure to PM2.5 was also associated with stillbirth (OR: 1.103, 95% CI: 1.074-1.131). A 10 μg/m3 increment in O3 in the first trimester was associated with stillbirth, and the estimated OR was 1.028 (95% CI: 1.001-1.055). Short-term exposure (on lag day 4) to O3 was also associated with stillbirth (OR: 1.002, 95% CI: 1.001-1.004). PM10, SO2 and NO2 exposure had no significant effects on the incidence of stillbirth. Additional well-designed cohort studies and investigations regarding potential biological mechanisms are warranted to elaborate the suggestive association that may help improve intergenerational inequality.
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Affiliation(s)
- Huanhuan Zhang
- School of Public Health, Zhengzhou University, Zhengzhou, China; Shanghai Typhoon Institute, China Meteorological Administration, Shanghai, China; Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China
| | - Xiaoan Zhang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiong Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuanzhi Xu
- Department of Clinical Medicine, Medical School of Zhengzhou University, Zhengzhou, China
| | - Yang Feng
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zengli Yu
- School of Public Health, Zhengzhou University, Zhengzhou, China.
| | - Cunrui Huang
- School of Public Health, Zhengzhou University, Zhengzhou, China; Shanghai Typhoon Institute, China Meteorological Administration, Shanghai, China; Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China; School of Public Health, Sun Yat-sen University, Guangzhou, China
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Abstract
Ambient air pollution is produced by sources including vehicular traffic, coal-fired power plants, hydraulic fracturing, agricultural production, and forest fires. It consists of primary pollutants generated by combustion and secondary pollutants formed in the atmosphere from precursor gases. Air pollution causes and exacerbates climate change, and climate change worsens health effects of air pollution. Infants and children are uniquely sensitive to air pollution, because their organs are developing and they have higher air per body weight intake. Health effects linked to air pollution include not only exacerbations of respiratory diseases but also reduced lung function development and increased asthma incidence. Additional outcomes of concern include preterm birth, low birth weight, neurodevelopmental disorders, IQ loss, pediatric cancers, and increased risks for adult chronic diseases. These effects are mediated by oxidative stress, chronic inflammation, endocrine disruption, and genetic and epigenetic mechanisms across the life span. Natural experiments demonstrate that with initiatives such as increased use of public transportation, both air quality and community health improve. Similarly, the Clean Air Act has improved air quality, although exposure inequities persist. Other effective strategies for reducing air pollution include ending reliance on coal, oil, and gas; regulating industrial emissions; reducing exposure with attention to proximity of residences, schools, and child care facilities to traffic; and a greater awareness of the Air Quality Index. This policy reviews both short- and long-term health consequences of ambient air pollution, especially in relation to developmental exposures. It examines individual, community, and legislative strategies to mitigate air pollution.
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Affiliation(s)
- Heather L Brumberg
- Division of Neonatology, Maria Fareri Children's Hospital, Westchester Medical Center and Departments of Pediatrics and Public Health, New York Medical College, Valhalla, New York; and
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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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Grippo A, Zhang J, Chu L, Guo Y, Qiao L, Zhang J, Myneni AA, Mu L. Air pollution exposure during pregnancy and spontaneous abortion and stillbirth. REVIEWS ON ENVIRONMENTAL HEALTH 2018; 33:247-264. [PMID: 29975668 PMCID: PMC7183911 DOI: 10.1515/reveh-2017-0033] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 06/08/2018] [Indexed: 05/18/2023]
Abstract
The developing fetus is particularly susceptible to environmental pollutants, and evidence has shown adverse effects of air pollutants on pregnancy and birth outcomes. Pregnancy loss, including spontaneous abortion (miscarriage) and stillbirth, is the most severe adverse pregnancy outcome. This review focuses on air pollution exposure during pregnancy in relation to spontaneous abortion and stillbirth. A total of 43 studies are included in this review, including 35 human studies and eight animal studies. Overall, these studies suggest that exposure to air pollutants such as particulate matter (PM), carbon monoxide (CO) and cooking smoke may be associated with higher risk for stillbirth and spontaneous abortion. PM10 exposure during an entire pregnancy was associated with increased risk of spontaneous abortion, and exposure to PM2.5 and PM10 in the third trimester might increase the risk of stillbirth. CO exposure during the first trimester of pregnancy was associated with an increased risk of spontaneous abortion and exposure during the third trimester was associated with an increased risk of stillbirth. Cooking smoke was found to increase the risk of stillbirths, and the evidence was consistent. Insufficient and conflicting evidence was found for various other pollutants, such as NO2 and SO2. Studies did not show clear evidence for associations between pregnancy loss and others pollutants such as heavy metals, organochlorine compounds, PAH and total dust count. Further research is warranted to better understand the relationship between air pollution exposure and pregnancy loss.
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Affiliation(s)
- Alexandra Grippo
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, The State University of New York (SUNY), Buffalo, NY, USA
| | | | - Li Chu
- Anzhen Hospital, Beijing, China
| | - Yanjun Guo
- Hang Tian General Hospital, Beijing, China
| | - Lihua Qiao
- Center of Global Health, Tsinghua University, Beijing, China
| | - Jun Zhang
- Center of Global Health, Tsinghua University, Beijing, China
| | - Ajay A Myneni
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, The State University of New York (SUNY), Buffalo, NY, USA
| | - Lina Mu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, The State University of New York (SUNY), Buffalo, NY, USA
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Chronic and Acute Ozone Exposure in the Week Prior to Delivery Is Associated with the Risk of Stillbirth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070731. [PMID: 28684711 PMCID: PMC5551169 DOI: 10.3390/ijerph14070731] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/26/2017] [Accepted: 06/29/2017] [Indexed: 01/06/2023]
Abstract
Chronic and acute air pollution has been studied in relation to stillbirth with inconsistent findings. We examined stillbirth risk in a retrospective cohort of 223,375 singleton deliveries from 12 clinical sites across the United States. Average criteria air pollutant exposure was calculated using modified Community Multiscale Air Quality models for the day of delivery and each of the seven days prior, whole pregnancy, and first trimester. Poisson regression models using generalized estimating equations estimated the relative risk (RR) of stillbirth and 95% confidence intervals (CI) in relation to an interquartile range increase in pollutant with adjustment for temperature, clinical, and demographic factors. Ozone (O3) was associated with a 13–22% increased risk of stillbirth on days 2, 3, and 5–7 prior to delivery in single pollutant models, and these findings persisted in multi-pollutant models for days 5 (RR = 1.22, CI = 1.07–1.38) and 6 (RR = 1.18, CI = 1.04–1.33). Whole pregnancy and first trimester O3 increased risk 18–39% in single pollutant models. Maternal asthma increased stillbirth risk associated with chronic PM2.5 and carbon monoxide exposures. Both chronic and acute O3 exposure consistently increased stillbirth risk, while the role of other pollutants varied. Approximately 8000 stillbirths per year in the US may be attributable to O3 exposure.
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Residential Proximity to Roadways and Ischemic Placental Disease in a Cape Cod Family Health Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070682. [PMID: 28672786 PMCID: PMC5551120 DOI: 10.3390/ijerph14070682] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/15/2017] [Accepted: 06/21/2017] [Indexed: 01/07/2023]
Abstract
Exposure to air pollution may adversely impact placental function through a variety of mechanisms; however, epidemiologic studies have found mixed results. We examined the association between traffic exposure and placental-related obstetric conditions in a retrospective cohort study on Cape Cod, MA, USA. We assessed exposure to traffic using proximity metrics (distance of residence to major roadways and length of major roadways within a buffer around the residence). The outcomes included self-reported ischemic placental disease (the presence of at least one of the following conditions: preeclampsia, placental abruption, small-for-gestational-age), stillbirth, and vaginal bleeding. We used log-binomial regression models to estimate risk ratios (RR) and 95% confidence intervals (CI), adjusting for potential confounders. We found no substantial association between traffic exposure and ischemic placental disease, small-for-gestational-age, preeclampsia, or vaginal bleeding. We found some evidence of an increased risk of stillbirth and placental abruption among women living the closest to major roadways (RRs comparing living <100 m vs. ≥200 m = 1.75 (95% CI: 0.82-3.76) and 1.71 (95% CI: 0.56-5.23), respectively). This study provides some support for the hypothesis that air pollution exposure adversely affects the risk of placental abruption and stillbirth; however, the results were imprecise due to the small number of cases, and may be impacted by non-differential exposure misclassification and selection bias.
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Thurston GD, Kipen H, Annesi-Maesano I, Balmes J, Brook RD, Cromar K, De Matteis S, Forastiere F, Forsberg B, Frampton MW, Grigg J, Heederik D, Kelly FJ, Kuenzli N, Laumbach R, Peters A, Rajagopalan ST, Rich D, Ritz B, Samet JM, Sandstrom T, Sigsgaard T, Sunyer J, Brunekreef B. A joint ERS/ATS policy statement: what constitutes an adverse health effect of air pollution? An analytical framework. Eur Respir J 2017; 49:13993003.00419-2016. [PMID: 28077473 DOI: 10.1183/13993003.00419-2016] [Citation(s) in RCA: 272] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 09/05/2016] [Indexed: 12/11/2022]
Abstract
The American Thoracic Society has previously published statements on what constitutes an adverse effect on health of air pollution in 1985 and 2000. We set out to update and broaden these past statements that focused primarily on effects on the respiratory system. Since then, many studies have documented effects of air pollution on other organ systems, such as on the cardiovascular and central nervous systems. In addition, many new biomarkers of effects have been developed and applied in air pollution studies.This current report seeks to integrate the latest science into a general framework for interpreting the adversity of the human health effects of air pollution. Rather than trying to provide a catalogue of what is and what is not an adverse effect of air pollution, we propose a set of considerations that can be applied in forming judgments of the adversity of not only currently documented, but also emerging and future effects of air pollution on human health. These considerations are illustrated by the inclusion of examples for different types of health effects of air pollution.
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Affiliation(s)
- George D Thurston
- Depts of Environmental Medicine and Population Health, New York University School of Medicine, New York, NY, USA
| | - Howard Kipen
- Environmental and Occupational Health Sciences Institute, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Isabella Annesi-Maesano
- Epidemiology of Allergic and Respiratory Diseases Dept (EPAR), Sorbonne Universités, UPMC Université Paris 06, INSERM, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Saint-Antoine Medical School, Paris, France
| | - John Balmes
- Dept of Medicine, University of California, San Francisco, CA, USA.,School of Public Health, University of California, Berkeley, CA, USA
| | - Robert D Brook
- Dept of Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Kevin Cromar
- Marron Institute of Urban Management, New York University, New York, NY, USA
| | - Sara De Matteis
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Bertil Forsberg
- Dept of Public Health and Clinical Medicine/Environmental Medicine, Umeå University, Umeå, Sweden
| | - Mark W Frampton
- Pulmonary and Critical Care, Depts of Medicine and Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Queen Mary University of London, London, UK
| | - Dick Heederik
- Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands
| | - Frank J Kelly
- National Institute for Health Research Health Protection Unit: Health Impact of Environmental Hazards, King's College London, London, UK
| | - Nino Kuenzli
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Robert Laumbach
- Environmental and Occupational Health Sciences Institute, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Annette Peters
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt Institute of Epidemiology II, Neuherberg, Germany
| | | | - David Rich
- Depts of Public Health Sciences and Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Beate Ritz
- Center for Occupational and Environmental Health, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | - Jonathan M Samet
- Dept of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Thomas Sandstrom
- Pulmonary and Critical Care, Depts of Medicine and Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Torben Sigsgaard
- University of Aarhus, Institute of Public Health, Aarhus, Denmark
| | - Jordi Sunyer
- CREAL (Center for Research on Environmental Epidemiology, Barcelona), Pompeu Fabra University, Barcelona, Spain
| | - Bert Brunekreef
- Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands .,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Siddika N, Balogun HA, Amegah AK, Jaakkola JJK. Prenatal ambient air pollution exposure and the risk of stillbirth: systematic review and meta-analysis of the empirical evidence. Occup Environ Med 2016; 73:573-81. [PMID: 27221104 DOI: 10.1136/oemed-2015-103086] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 02/05/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Individual studies on the relations between ambient air pollution and the risk of stillbirth have provided contradictory results. We conducted a systematic review and meta-analysis to summarise the existing evidence. METHODS We conducted a systematic search of three databases: PubMed, Scopus and Web of Science, from their time of inception to mid-April, 2015. Original studies of any epidemiological design were included. Data from eligible studies were extracted by two investigators. To calculate the summary effect estimates (EE), the random effects model was used with their corresponding 95% CI. RESULTS 13 studies met the inclusion criteria. Although not reaching statistical significance, all the summary effect estimates for the risk of stillbirth were systematically elevated in relation to mean prenatal exposure to NO2 per 10 ppb (EE=1.066, 95% CI 0.965 to 1.178, n=3), CO per 0.4 ppm (EE=1.025, 95% CI 0.985 to 1.066, n=3), SO2 per 3 ppb (EE=1.022, 95% CI 0.984 to 1.062, n=3,), PM2.5 per 4 μg/m(3) (EE=1.021, 95% CI 0.996 to 1.046, n=2) and PM10 per 10 μg/m(3) (EE=1.014, 95% CI 0.948 to 1.085, n=2). The effect estimates for SO2, CO, PM10 and O3 were highest for the third trimester exposure. Two time series studies used a lag term of not more than 6 days preceding stillbirth, and both found increased effect estimates for some pollutants. CONCLUSIONS The body of evidence suggests that exposure to ambient air pollution increases the risk of stillbirth. Further studies are needed to strengthen the evidence.
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Affiliation(s)
- Nazeeba Siddika
- Faculty of Medicine, Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland
| | - Hamudat A Balogun
- Faculty of Medicine, Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland
| | - Adeladza K Amegah
- Faculty of Medicine, Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland Department of Biomedical and Forensic Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Jouni J K Jaakkola
- Faculty of Medicine, Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
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Basu R, Sarovar V, Malig BJ. Association Between High Ambient Temperature and Risk of Stillbirth in California. Am J Epidemiol 2016; 183:894-901. [PMID: 27037268 DOI: 10.1093/aje/kwv295] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/19/2015] [Indexed: 01/29/2023] Open
Abstract
Recent studies have linked elevated apparent temperatures with adverse birth outcomes, such as preterm delivery, but other birth outcomes have not been well studied. We examined 8,510 fetal deaths (≥20 weeks' gestation) to estimate their association with mean apparent temperature, a combination of temperature and humidity, during the warm season in California (May-October) from 1999 to 2009. Mothers whose residential zip codes were within 10 km of a meteorological monitor were included. Meteorological data were provided by the California Irrigation Management Information System, the US Environmental Protection Agency, and the National Climatic Data Center, while the California Department of Public Health provided stillbirth data. Using a time-stratified case-crossover study design, we found a 10.4% change (95% confidence interval: 4.4, 16.8) in risk of stillbirth for every 10°F (5.6°C) increase in apparent temperature (cumulative average of lags 2-6 days). Risk varied by maternal race/ethnicity and was greater for younger mothers, less educated mothers, and male fetuses. The highest risks were observed during gestational weeks 20-25 and 31-33. No associations were found during the cold season (November-April), and the observed associations were independent of air pollutants. This study adds to the growing body of literature identifying pregnant women and their fetuses as subgroups vulnerable to heat exposure.
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Abstract
The DOHaD research field has successfully associated adult non-communicable diseases with inadequate nutrition in early periods of life. More recently, different types of exposure have been linked with impaired developmental outcomes and later health consequences, such as cesarean section at delivery, air pollution and domestic violence during pregnancy. The aim of this work is to bring up this issue looking at the published evidence on these three highly prevalent hazards in Latin American countries.
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Vieira SE. The health burden of pollution: the impact of prenatal exposure to air pollutants. Int J Chron Obstruct Pulmon Dis 2015; 10:1111-21. [PMID: 26089661 PMCID: PMC4468952 DOI: 10.2147/copd.s40214] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Exposure to atmospheric pollutants in both open and closed environments is a major cause of morbidity and mortality that may be both controlled and minimized. Despite growing evidence, several controversies and disagreements exist among the studies that have analyzed the effects of prenatal pollutant exposure. This review article aims to analyze primary scientific evidence of the effects of air pollution during pregnancy and the impact of these effects on the fetus, infant health, and in particular, the respiratory system. We performed a review of articles from the PubMed and Web of Science databases that were published in English within the past 5 years, particularly those related to birth cohorts that began in pregnancy with follow-up until the first years of life. The largest reported effects are associated with prenatal exposure to particulate matter, nitrogen dioxide, and tobacco smoke. The primary effects affect birth weight and other parameters of fetal biometry. There is strong evidence regarding the impact of pollutants on morbidity secondary to respiratory problems. Growing evidence links maternal smoking to childhood asthma and wheezing. The role of passive maternal smoking is less clear. Great heterogeneity exists among studies. There is a need for additional studies on birth cohorts to monitor the relationship between the exposure of pregnant women to pollutants and their children’s progress during the first years of life.
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Affiliation(s)
- Sandra E Vieira
- Pediatrics Department, Medical School, University of São Paulo, São Paulo, Brazil
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13
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Green R, Sarovar V, Malig B, Basu R. Association of stillbirth with ambient air pollution in a California cohort study. Am J Epidemiol 2015; 181:874-82. [PMID: 25861815 DOI: 10.1093/aje/kwu460] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 12/15/2014] [Indexed: 11/14/2022] Open
Abstract
Recent studies have suggested an association between air pollution and stillbirth. In this California study, we examined the records of 13,999 stillbirths and 3,012,270 livebirths occurring between 1999 and 2009. Using a retrospective cohort design and logistic regression models, we calculated the odds of stillbirth associated with each pollutant exposure by trimester and throughout the entire pregnancy. Covariates considered in the model included infant sex, maternal demographic characteristics, season of last menstrual period, apparent temperature, air basin of mother's residence, and year of conception. In single-pollutant models, we found that a 10-µg/m(3) increase in particulate matter with an aerodynamic diameter less than or equal to 2.5 µm (odds ratio (OR) = 1.06, 95% confidence interval (CI): 0.99, 1.13) and a 10-ppb increase in nitrogen dioxide (OR = 1.08, 95% CI: 1.03, 1.13) during the entire pregnancy were associated with stillbirth. A 10-ppb increase in ozone exposure during the third trimester was also associated with a slightly elevated risk (OR = 1.03, 95% CI: 1.01, 1.05). These ozone and nitrogen dioxide findings were fairly stable after adjustment in 2-pollutant models. However, adjustment for nitrogen dioxide attenuated the full-pregnancy-particulate matter relationship. No significant associations were found for sulfur dioxide or carbon monoxide. These findings support growing evidence of an association between air pollution and adverse birth outcomes.
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Air pollution and stillbirth risk: exposure to airborne particulate matter during pregnancy is associated with fetal death. PLoS One 2015; 10:e0120594. [PMID: 25794052 PMCID: PMC4368103 DOI: 10.1371/journal.pone.0120594] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 01/24/2015] [Indexed: 11/19/2022] Open
Abstract
Objective To test the hypothesis that exposure to fine particulate air pollution (PM2.5) is associated with stillbirth. Study Design Geo-spatial population-based cohort study using Ohio birth records (2006-2010) and local measures of PM2.5, recorded by the EPA (2005-2010) via 57 monitoring stations across Ohio. Geographic coordinates of the mother’s residence for each birth were linked to the nearest PM2.5 monitoring station and monthly exposure averages calculated. The association between stillbirth and increased PM2.5 levels was estimated, with adjustment for maternal age, race, education level, quantity of prenatal care, smoking, and season of conception. Results There were 349,188 live births and 1,848 stillbirths of non-anomalous singletons (20-42 weeks) with residence ≤10 km of a monitor station in Ohio during the study period. The mean PM2.5 level in Ohio was 13.3 μg/m3 [±1.8 SD, IQR(Q1: 12.1, Q3: 14.4, IQR: 2.3)], higher than the current EPA standard of 12 μg/m3. High average PM2.5 exposure through pregnancy was not associated with a significant increase in stillbirth risk, adjOR 1.21(95% CI 0.96,1.53), nor was it increased with high exposure in the 1st or 2nd trimester. However, exposure to high levels of PM2.5 in the third trimester of pregnancy was associated with 42% increased stillbirth risk, adjOR 1.42(1.06,1.91). Conclusions Exposure to high levels of fine particulate air pollution in the third trimester of pregnancy is associated with increased stillbirth risk. Although the risk increase associated with high PM2.5 levels is modest, the potential impact on overall stillbirth rates could be robust as all pregnant women are potentially at risk.
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Hall ES, Connolly N, Jones DE, DeFranco EA. Integrating public data sets for analysis of maternal airborne environmental exposures and stillbirth. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2014; 2014:599-605. [PMID: 25954365 PMCID: PMC4419928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Efforts to study relationships between maternal airborne pollutant exposures and poor pregnancy outcomes have been frustrated by data limitations. Our objective was to report the proportion of Ohio women in 2006-2010 experiencing stillbirth whose pregnancy exposure to six criteria airborne pollutants could be approximated by applying a geospatial approach to vital records and Environmental Protection Agency air monitoring data. In addition, we characterized clinical and socio-demographic differences among women who lived within 10 km of monitoring stations compared to women who did not live within proximity of monitoring stations. For women who experienced stillbirth, 10.8% listed a residence within 10 km of each type of monitoring station. Maternal race, education, and marital status were significantly different (p<0.0001) comparing those within proximity to monitoring stations to those outside of monitoring range. No significant differences were identified in maternal age, ethnicity, smoking status, hypertension, or diabetes between groups.
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Affiliation(s)
- Eric S Hall
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati Cincinnati, Ohio ; Biomedical Informatics, Cincinnati Children's Hospital Medical Center, University of Cincinnati Cincinnati, Ohio
| | - Natalia Connolly
- Biomedical Informatics, Cincinnati Children's Hospital Medical Center, University of Cincinnati Cincinnati, Ohio
| | - David E Jones
- Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati Cincinnati, Ohio
| | - Emily A DeFranco
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati Cincinnati, Ohio ; Maternal-Fetal Medicine, University of Cincinnati Cincinnati, Ohio
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Glinianaia SV, Ghosh R, Rankin J, Pearce MS, Parker L, Pless-Mulloli T. No improvement in socioeconomic inequalities in birthweight and preterm birth over four decades: a population-based cohort study. BMC Public Health 2013; 13:345. [PMID: 23587186 PMCID: PMC3651338 DOI: 10.1186/1471-2458-13-345] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 04/09/2013] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Birthweight and gestational age are associated with socioeconomic deprivation, but the evidence in relation to temporal changes in these associations is sparse. We investigated changes in the associations between socioeconomic status (SES) and birthweight and gestational age in Newcastle upon Tyne, North of England, during 1961-2000. METHODS We used population-based data from hospital neonatal records on all singleton births to mothers resident in Newcastle (births with complete covariate information n = 113,182). We used linear regression to analyse the associations between neighbourhood SES and birthweight over the entire 40-year period and by decade, and logistic regression for associations with low birthweight (LBW) and preterm birth, adjusting for potential confounders. RESULTS There was a significant interaction between SES and decade of birth for birthweight (p = 0.028) and preterm birth (p < 0.001). Socioeconomic gradients were similar in each decade for birthweight outcomes, but for preterm birth, socioeconomic disparities were more evident in the later decades [for 1961-70, odds ratio (OR) was 1.1, 95% CI 0.9, 1.3, for the most deprived versus the least deprived quartile, while for 1991-2000, the corresponding OR was 1.5, 95% CI 1.3, 1.7]. In each decade, there was a significant decrease in birthweight adjusted for gestational age for the most deprived compared to the least deprived SES group [1961-1970: -113.4 g (95% CI-133.0, -93.8); 1991-2000: -97.5 g (95% CI-113.0, -82.0)], while there was a significant increase in birthweight in each SES group over time. CONCLUSIONS Socioeconomic inequalities did not narrow over the four decades for birthweight and widened for preterm birth. Mean birthweight adjusted for gestational age increased in all socioeconomic groups, suggesting an overall increase in fetal growth.
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Affiliation(s)
- Svetlana V Glinianaia
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, England, UK
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Rakesh Ghosh
- Department of Public Health Sciences, University of California, Davis, USA
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, England, UK
| | - Mark S Pearce
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, England, UK
| | - Louise Parker
- Departments of Medicine and Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Tanja Pless-Mulloli
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, England, UK
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Pearce MS, Glinianaia SV, Ghosh R, Rankin J, Rushton S, Charlton M, Parker L, Pless-Mulloli T. Particulate matter exposure during pregnancy is associated with birth weight, but not gestational age, 1962-1992: a cohort study. Environ Health 2012; 11:13. [PMID: 22404858 PMCID: PMC3324390 DOI: 10.1186/1476-069x-11-13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 03/09/2012] [Indexed: 05/31/2023]
Abstract
BACKGROUND Exposure to air pollutants is suggested to adversely affect fetal growth, but the evidence remains inconsistent in relation to specific outcomes and exposure windows. METHODS Using birth records from the two major maternity hospitals in Newcastle upon Tyne in northern England between 1961 and 1992, we constructed a database of all births to mothers resident within the city. Weekly black smoke exposure levels from routine data recorded at 20 air pollution monitoring stations were obtained and individual exposures were estimated via a two-stage modeling strategy, incorporating temporally and spatially varying covariates. Regression analyses, including 88,679 births, assessed potential associations between exposure to black smoke and birth weight, gestational age and birth weight standardized for gestational age and sex. RESULTS Significant associations were seen between black smoke and both standardized and unstandardized birth weight, but not for gestational age when adjusted for potential confounders. Not all associations were linear. For an increase in whole pregnancy black smoke exposure, from the 1(st) (7.4 μg/m(3)) to the 25(th) (17.2 μg/m(3)), 50(th) (33.8 μg/m(3)), 75(th) (108.3 μg/m(3)), and 90(th) (180.8 μg/m(3)) percentiles, the adjusted estimated decreases in birth weight were 33 g (SE 1.05), 62 g (1.63), 98 g (2.26) and 109 g (2.44) respectively. A significant interaction was observed between socio-economic deprivation and black smoke on both standardized and unstandardized birth weight with increasing effects of black smoke in reducing birth weight seen with increasing socio-economic disadvantage. CONCLUSIONS The findings of this study progress the hypothesis that the association between black smoke and birth weight may be mediated through intrauterine growth restriction. The associations between black smoke and birth weight were of the same order of magnitude as those reported for passive smoking. These findings add to the growing evidence of the harmful effects of air pollution on birth outcomes.
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Affiliation(s)
- Mark S Pearce
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England, UK
| | - Svetlana V Glinianaia
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England, UK
| | - Rakesh Ghosh
- Department of Public Health Sciences, University of California, Davis, California, USA
| | - Judith Rankin
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England, UK
| | - Steven Rushton
- Newcastle Institute for Research on Sustainability, Newcastle University, Newcastle upon Tyne, England, UK
| | - Martin Charlton
- National Centre for Geocomputation, National University of Ireland, Maynooth, Ireland
| | - Louise Parker
- Departments of Medicine and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tanja Pless-Mulloli
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England, UK
- Newcastle Institute for Research on Sustainability, Newcastle University, Newcastle upon Tyne, England, UK
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Hwang BF, Lee YL, Jaakkola JJK. Air pollution and stillbirth: a population-based case-control study in Taiwan. ENVIRONMENTAL HEALTH PERSPECTIVES 2011; 119:1345-9. [PMID: 21447454 PMCID: PMC3230395 DOI: 10.1289/ehp.1003056] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 03/28/2011] [Indexed: 05/21/2023]
Abstract
BACKGROUND There is limited evidence suggesting that prenatal exposure to ambient air pollutants may increase the risk of stillbirth, but previous epidemiological studies have not elaborated the most susceptible gestational period for the effects of air pollution exposure on stillbirth. OBJECTIVES We estimated associations between exposure to ambient air pollutants and stillbirth, with special reference to the assessment of gestational periods when the fetus is most susceptible. METHODS We conducted a population-based case-control study in Taiwan. The case group consisted of 9,325 stillbirths, and the control group included 93,250 births randomly selected from 1,510,064 Taiwanese singleton newborns in 2001-2007. Adjusted logistic regression models were used to estimate odds ratios (ORs) per 10-ppb change for ozone and nitrogen dioxide, 1-ppb change for sulfur dioxide (SO2), 10-μg/m3 change for particulate matter with aerodynamic diameter ≤ 10 μm (PM10), and 100-ppb change for carbon monoxide during different gestational periods and according to term or preterm (< 37 weeks) birth status. RESULTS Stillbirth increased in association with a 1-ppb increase in first-trimester SO2 [adjusted OR = 1.02; 95% confidence interval (CI), 1.00-1.04], particularly among preterm births (adjusted OR = 1.04; 95% CI, 1.01-1.07). Stillbirth was also associated with a 10-μg/m3 increase in PM10 during the first (adjusted OR = 1.02; 95% CI, 1.00-1.05) and second (adjusted OR = 1.02; 95% CI, 1.00-1.04) month of gestation, and, as with SO2, associations appeared to be restricted to preterm births (first-trimester adjusted OR = 1.03; 95% CI, 1.00-1.07). CONCLUSION The study provides evidence that exposure to outdoor air SO2 and PM10 may increase the risk of stillbirth, especially among preterm births, and that the most susceptible time periods for exposure are during the first trimester of gestation.
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Affiliation(s)
- Bing-Fang Hwang
- Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan.
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Parker JD, Rich DQ, Glinianaia SV, Leem JH, Wartenberg D, Bell ML, Bonzini M, Brauer M, Darrow L, Gehring U, Gouveia N, Grillo P, Ha E, van den Hooven EH, Jalaludin B, Jesdale BM, Lepeule J, Morello-Frosch R, Morgan GG, Slama R, Pierik FH, Pesatori AC, Sathyanarayana S, Seo J, Strickland M, Tamburic L, Woodruff TJ. The International Collaboration on Air Pollution and Pregnancy Outcomes: initial results. ENVIRONMENTAL HEALTH PERSPECTIVES 2011; 119:1023-8. [PMID: 21306972 PMCID: PMC3222970 DOI: 10.1289/ehp.1002725] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 02/09/2011] [Indexed: 05/05/2023]
Abstract
BACKGROUND The findings of prior studies of air pollution effects on adverse birth outcomes are difficult to synthesize because of differences in study design. OBJECTIVES The International Collaboration on Air Pollution and Pregnancy Outcomes was formed to understand how differences in research methods contribute to variations in findings. We initiated a feasibility study to a) assess the ability of geographically diverse research groups to analyze their data sets using a common protocol and b) perform location-specific analyses of air pollution effects on birth weight using a standardized statistical approach. METHODS Fourteen research groups from nine countries participated. We developed a protocol to estimate odds ratios (ORs) for the association between particulate matter ≤ 10 μm in aerodynamic diameter (PM₁₀) and low birth weight (LBW) among term births, adjusted first for socioeconomic status (SES) and second for additional location-specific variables. RESULTS Among locations with data for the PM₁₀ analysis, ORs estimating the relative risk of term LBW associated with a 10-μg/m³ increase in average PM₁₀ concentration during pregnancy, adjusted for SES, ranged from 0.63 [95% confidence interval (CI), 0.30-1.35] for the Netherlands to 1.15 (95% CI, 0.61-2.18) for Vancouver, with six research groups reporting statistically significant adverse associations. We found evidence of statistically significant heterogeneity in estimated effects among locations. CONCLUSIONS Variability in PM₁₀-LBW relationships among study locations remained despite use of a common statistical approach. A more detailed meta-analysis and use of more complex protocols for future analysis may uncover reasons for heterogeneity across locations. However, our findings confirm the potential for a diverse group of researchers to analyze their data in a standardized way to improve understanding of air pollution effects on birth outcomes.
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Affiliation(s)
- Jennifer D Parker
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA.
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Abstract
PURPOSE OF REVIEW Summarize recent studies exploring the relationship between paternal and maternal environmental exposures to chemicals before, at the time of and after conception to adverse developmental outcomes including preterm birth, death, structural and functional abnormalities and growth restriction. RECENT FINDINGS Recent studies have demonstrated that human pregnancy and development are vulnerable to environmental exposures of the father and mother to chemical, biological and physical agents. Exposures associated with adverse developmental outcomes include air and water pollution, chemicals in foods, occupational exposures, agricultural chemicals, metals, persistent and volatile organics. Developmental endpoints which are linked with these exposures include growth restriction, functional abnormalities, structural abnormalities, preterm delivery and death. Despite this general understanding we still have incomplete knowledge concerning most exposures and the biological interactions responsible for impaired development and preterm delivery. SUMMARY Whereas single genes and individual chemical exposures are responsible for some instances of adverse pregnancy outcome or developmental disease, gene-environment interactions are responsible for the majority. These gene-environment interactions may occur in the father, mother, placenta or fetus, suggesting that critical attention be given to maternal and paternal exposures and gene expression as they relate to the mode of action of the putative developmental toxicant both prior to and during pregnancy.
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