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Mitku AA, Zewotir T, North D, Jeena P, Asharam K, Muttoo S, Tularam H, Naidoo RN. Impact of ambient air pollution exposure during pregnancy on adverse birth outcomes: generalized structural equation modeling approach. BMC Public Health 2023; 23:45. [PMID: 36609258 PMCID: PMC9824986 DOI: 10.1186/s12889-022-14971-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/29/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Air pollution and several prenatal factors, such as socio-demographic, behavioural, physical activity and clinical factors influence adverse birth outcomes. The study aimed to investigate the impact of ambient air pollution exposure during pregnancy adjusting prenatal risk factors on adverse birth outcomes among pregnant women in MACE birth cohort. METHODS Data for the study was obtained from the Mother and Child in the Environment (MACE) birth cohort study in Durban, South Africa from 2013 to 2017. Land use regression models were used to determine household level prenatal exposure to PM2.5, SO2 and NOx. Six hundred and fifty-six births of pregnant females were selected from public sector antenatal clinics in low socio-economic neighbourhoods. We employed a Generalised Structural Equation Model with a complementary log-log-link specification. RESULTS After adjustment for potential prenatal factors, the results indicated that exposure to PM2.5 was found to have both significant direct and indirect effects on the risk of all adverse birth outcomes. Similarly, an increased level of maternal exposure to SO2 during pregnancy was associated with an increased probability of being small for gestational age. Moreover, preterm birth act a mediating role in the relationship of exposure to PM2.5, and SO2 with low birthweight and SGA. CONCLUSIONS Prenatal exposure to PM2.5 and SO2 pollution adversely affected birth outcomes after controlling for other prenatal risk factors. This suggests that local government officials have a responsibility for better control of air pollution and health care providers need to advise pregnant females about the risks of air pollution during pregnancy.
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Affiliation(s)
- Aweke A. Mitku
- grid.16463.360000 0001 0723 4123School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa ,grid.16463.360000 0001 0723 4123Discipline of Occupational and Environmental Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa ,grid.442845.b0000 0004 0439 5951Department of Statistics, Bahir Dar University, Bahir Dar, Ethiopia
| | - Temesgen Zewotir
- grid.16463.360000 0001 0723 4123School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa
| | - Delia North
- grid.16463.360000 0001 0723 4123School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa
| | - Prakash Jeena
- grid.16463.360000 0001 0723 4123Discipline of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Kareshma Asharam
- grid.16463.360000 0001 0723 4123Discipline of Occupational and Environmental Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Sheena Muttoo
- grid.16463.360000 0001 0723 4123Discipline of Occupational and Environmental Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Hasheel Tularam
- grid.16463.360000 0001 0723 4123Discipline of Occupational and Environmental Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Rajen N. Naidoo
- grid.16463.360000 0001 0723 4123Discipline of Occupational and Environmental Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Li J, Wang Z, Lin S, Pei L, Zhang L, Wang X, Chen Z, Zheng C, Kang Y, Chen L, Zhou H, Gao R. Cross-level interaction between individual education and regional chemical fertilizer consumption on the risk of hypertension: evidence from the China hypertension survey. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:6390-6400. [PMID: 35999419 DOI: 10.1007/s11356-022-22441-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
Hypertension is a common and costly public health burden in China, while the interaction effects of individual and contextual level factors on the risk of hypertension remain unclear. This study aimed to investigate whether the interaction effects between individual education and regional chemical fertilizer consumption are associated with the risk of hypertension based on a cross-level interaction perspective. Data was from the China Hypertension Survey (CHS) study, which used a nationally representative sample, and was conducted between 2012 and 2015. A total of 379 467 participants aged over 18 years from 221 counties in 31 provinces were included. A cross-sectional study design and two-level logistic models were conducted to investigate the cross-level interaction between individual education and regional chemical fertilizer consumption on the risk of hypertension after adjusting for potential confounding variables. Compared to individuals with high education (college or more), the adjusted OR (95%CI) for hypertension among those in the high school, middle school, and elementary school or less was 1.16 (1.12-1.21), 1.25 (1.20-1.30), and 1.49 (1.43-1.55), respectively. The association between regional chemical fertilizer consumption and hypertension was not significant. Interaction analysis showed that regional chemical fertilizer consumption was associated with an increased risk of hypertension for individuals with lower education. These patterns were consistent after stratified by sex. This study provided evidence from the Chinese population that interaction between individual education and regional chemical fertilizer was associated with risk of hypertension. Future research and policy aimed to improve population health and reduce hypertension could address the regional context of population as well as individual factors.
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Affiliation(s)
- Jiajia Li
- Institute of Population Research, Peking University, Beijing, 100871, China
| | - Zengwu Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Peking Union Medical College &, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 102308, China.
| | - Shiqi Lin
- Institute of Population Research, Peking University, Beijing, 100871, China
| | - Lijun Pei
- Institute of Population Research, Peking University, Beijing, 100871, China.
| | - Linfeng Zhang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Peking Union Medical College &, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 102308, China
| | - Xin Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Peking Union Medical College &, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 102308, China
| | - Zuo Chen
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Peking Union Medical College &, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 102308, China
| | - Congyi Zheng
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Peking Union Medical College &, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 102308, China
| | - Yuting Kang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Peking Union Medical College &, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 102308, China
| | - Lu Chen
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Peking Union Medical College &, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 102308, China
| | - Haoqi Zhou
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Peking Union Medical College &, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 102308, China
| | - Runlin Gao
- Department of Cardiology, Peking Union Medical College &, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, China
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Muttoo S, Jeena PM, Röösli M, de Hoogh K, Meliefste K, Tularam H, Olin AC, Carlsen HK, Mentz G, Asharam K, Naidoo RN. Effect of short-term exposure to ambient nitrogen dioxide and particulate matter on repeated lung function measures in infancy: A South African birth cohort. ENVIRONMENTAL RESEARCH 2022; 213:113645. [PMID: 35700764 DOI: 10.1016/j.envres.2022.113645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The developing lung is highly susceptible to environmental toxicants, with both short- and long-term exposure to ambient air pollutants linked to early childhood effects. This study assessed the short-term exposure effects of nitrogen dioxide (NO2) and particulate matter (PM10) on lung function in infants aged 6 weeks, 6, 12 and 24 months, the early developmental phase of child growth. METHODS Lung function was determined by multiple breath washout and tidal breathing measurement in non-sedated infants. Individual exposure to NO2 and PM10 was determined by hybrid land use regression and dispersion modelling, with two-week average estimates (preceding the test date). Linear mixed models were used to adjust for the repeated measures design and an age*exposure interaction was introduced to obtain effect estimates for each age group. RESULTS There were 165 infants that had lung function testing, with 82 of them having more than one test occasion. Exposure to PM10 (μg/m3) resulted in a decline in tidal volume at 6 weeks [-0.4 ml (-0.9; 0.0), p = 0.065], 6 months [-0.5 ml (-1.0; 0.0), p = 0.046] and 12 months [-0.3 ml (-0.7; 0.0), p = 0.045]. PM10 was related to an increase in respiratory rate and minute ventilation, while a decline was observed for functional residual capacity for the same age groups, though not statistically significant for these outcomes. Such associations were however less evident for exposure to NO2, with inconsistent changes observed across measurement parameters and age groups. CONCLUSION Our study suggests that PM10 results in acute lung function impairments among infants from a low-socioeconomic setting, while the association with NO2 is less convincing.
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Affiliation(s)
- S Muttoo
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa.
| | - P M Jeena
- Discipline of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa.
| | - M Röösli
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - K de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - K Meliefste
- Institute for Risk Assessment Sciences, Utrecht, the Netherlands.
| | - H Tularam
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa.
| | - A C Olin
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - H K Carlsen
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - G Mentz
- University Michigan, Ann Arbor, MI, USA.
| | - K Asharam
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa.
| | - R N Naidoo
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa.
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Mitku AA, Zewotir T, North D, Jeena P, Naidoo RN. Effects of prenatal exposure factors on birth outcomes through mediation of favorable fetal growth conditions using structural equation modeling. PLoS One 2021; 16:e0249664. [PMID: 33905420 PMCID: PMC8078817 DOI: 10.1371/journal.pone.0249664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/22/2021] [Indexed: 11/19/2022] Open
Abstract
Background Birth weight, birth length, and gestational age are major indicators of newborn health. Several prenatal exposure factors influence the fetal environment. The aim of the study was to investigate the effect of prenatal exposure factors, including socio-demographic, behavioural, dietary, physical activity, clinical and environmental on birth outcomes through the mediation of Favourable Fetal Growth Conditions (FFGC). Methods Data was obtained from six hundred and fifty-six Mother and Child in the Environment birth cohort study in Durban, South Africa from 2013 to 2017. We adopted structural equation models which evaluate the direct and indirect effects by allowing multiple simultaneous equations to incorporate confounding and mediation. Results A significant direct and indirect effect of FFGC on newborn weight, length, and gestational age was seen. Gestational weight gain and maternal body mass index in the first trimester exerted a mediation effect between maternal behavioural risk factors and FFGC. Similarly, the level of physical activity during pregnancy was associated with decreased gestational weight gain. The effects of maternal characteristics on newborn weight, length, and gestational age were largely indirect, operating through FFGC as a latent variable. Conclusions Gestational weight gain and maternal pre-gestational BMI were observed to mediate the association between prenatal behavioural risk factors and favourable fetal growth conditions. Trial registration Retrospectively registered from 01 March 2013.
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Affiliation(s)
- Aweke A. Mitku
- School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa
- Department of Statistics, College of Science, Bahir Dar University, Bahir Dar, Ethiopia
- * E-mail:
| | - Temesgen Zewotir
- School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa
| | - Delia North
- School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa
| | - Prakash Jeena
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Rajen N. Naidoo
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Nyadanu SD, Tessema GA, Mullins B, Kumi-Boateng B, Bell ML, Pereira G. Ambient Air Pollution, Extreme Temperatures and Birth Outcomes: A Protocol for an Umbrella Review, Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:8658. [PMID: 33561059 PMCID: PMC7700558 DOI: 10.3390/ijerph17228658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023]
Abstract
Prenatal exposure to ambient air pollution and extreme temperatures are among the major risk factors of adverse birth outcomes and with potential long-term effects during the life course. Although low- and middle-income countries (LMICs) are most vulnerable, there is limited synthesis of evidence in such settings. This document describes a protocol for both an umbrella review (Systematic Review 1) and a focused systematic review and meta-analysis of studies from LMICs (Systematic Review 2). We will search from start date of each database to present, six major academic databases (PubMed, CINAHL, Scopus, MEDLINE/Ovid, EMBASE/Ovid and Web of Science Core Collection), systematic reviews repositories and references of eligible studies. Additional searches in grey literature will also be conducted. Eligibility criteria include studies of pregnant women exposed to ambient air pollutants and/or extreme temperatures during pregnancy with and without adverse birth outcomes. The umbrella review (Systematic Review 1) will include only previous systematic reviews while Systematic Review 2 will include quantitative observational studies in LMICs. Searches will be restricted to English language using comprehensive search terms to consecutively screen the titles, abstracts and full-texts to select eligible studies. Two independent authors will conduct the study screening and selection, risk of bias assessment and data extraction using JBI SUMARI web-based software. Narrative and semi-quantitative syntheses will be employed for the Systematic Review 1. For Systematic Review 2, we will perform meta-analysis with two alternative meta-analytical methods (quality effect and inverse variance heterogeneity) as well as the classic random effect model. If meta-analysis is infeasible, narrative synthesis will be presented. Confidence in cumulative evidence and the strength of the evidence will be assessed. This protocol is registered with PROSPERO (CRD42020200387).
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Affiliation(s)
- Sylvester Dodzi Nyadanu
- Education, Culture and Health Opportunities (ECHO) Ghana, ECHO Research Group International, P. O. Box 424, Aflao, Ghana
- School of Public Health, Curtin University, Perth, Kent Street, Bentley, Western Australia 6102, Australia; (G.A.T.); (B.M.); (G.P.)
| | - Gizachew Assefa Tessema
- School of Public Health, Curtin University, Perth, Kent Street, Bentley, Western Australia 6102, Australia; (G.A.T.); (B.M.); (G.P.)
- School of Public Health, University of Adelaide, Adelaide, South Australia 5000, Australia
| | - Ben Mullins
- School of Public Health, Curtin University, Perth, Kent Street, Bentley, Western Australia 6102, Australia; (G.A.T.); (B.M.); (G.P.)
| | - Bernard Kumi-Boateng
- Department of Geomatic Engineering, University of Mines and Technology, P.O. Box 237, Tarkwa, Ghana;
| | - Michelle Lee Bell
- School of the Environment, Yale University, New Haven, CT 06511, USA;
| | - Gavin Pereira
- School of Public Health, Curtin University, Perth, Kent Street, Bentley, Western Australia 6102, Australia; (G.A.T.); (B.M.); (G.P.)
- Telethon Kids Institute, Northern Entrance, Perth Children’s Hospital, Nedlands, Western Australia 6009, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, 0473 Oslo, Norway
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Mitku AA, Zewotir T, North D, Naidoo RN. Exploratory Data Analysis of Adverse Birth Outcomes and Exposure to Oxides of Nitrogen Using Interactive Parallel Coordinates Plot Technique. Sci Rep 2020; 10:7363. [PMID: 32355230 PMCID: PMC7193633 DOI: 10.1038/s41598-020-64471-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/16/2020] [Indexed: 11/08/2022] Open
Abstract
We propose that a parallel coordinates plot can be used to study multidimensional data particularly to explore discovery of patterns across the variables. This can assist researchers from the health sciences to visualize their cohort data with interactive data analysis. The study used data from Mother and Child in the Environment birth cohort in Durban, South Africa for the period 2013 to 2017 retrospectively registered. In this paper, we demonstrate that the exploration of multidimensional data with parallel coordinates plot and use of brushing using different colours assists with the identification of relationships and patterns. Parallel coordinates plot visualization facilitates the researcher's skills to find trends, identify outliers and perform quality checks in large multivariate data. We have identified trends in the data that provide directions for further research, and illustrated thereby the potential of parallel coordinates plot to explore patterns and relationships of prenatal oxides of nitrogen exposure with multidimensional birth outcomes. The study recognized the co-occurrence of adverse birth outcomes among infants and these infants had mothers with moderate to high level of NOx exposure during pregnancy. Brushing using different colours facilitated the detection of patterns of relationships to perform basic and advanced statistical model-based analysis.
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Affiliation(s)
- Aweke A Mitku
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa.
- Department of Statistics, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Temesgen Zewotir
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| | - Delia North
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| | - Rajen N Naidoo
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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