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Shi T, Ma H, Li D, Pan L, Wang T, Li R, Ren X. Prenatal exposure to fine particulate matter chemical constituents and the risk of stillbirth and the mediating role of pregnancy complications: A cohort study. CHEMOSPHERE 2024; 349:140858. [PMID: 38048830 DOI: 10.1016/j.chemosphere.2023.140858] [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: 09/09/2023] [Revised: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 12/06/2023]
Abstract
Evidence on the association of fine particulate matter (PM2.5) exposure with stillbirth is limited and inconsistent, which is largely attributed to differences in PM2.5 constituents. Studies have found that the hazards of certain PM2.5 constituents to the fetus are comparable to or even higher than total PM2.5 mass. However, few studies have linked PM2.5 constituents to stillbirth. Moreover, the mediating role of pregnancy complications in PM2.5-related stillbirth remains unclear. To our knowledge, this study was the first to explore the individual and mixed associations of PM2.5 and its constituents with stillbirth in China. After matching the concentrations of PM2.5 and its constituents (sulfate [SO42-], nitrate [NO3-], ammonium [NH4+], organic matter [OM], and black carbon [BC]) for participants according to their geographical location, there were 170,507 participants included in this study. We found that stillbirth was associated with exposure to PM2.5 and its constituents in the year before pregnancy and during the entire pregnancy, and the associations in trimester 1 were strongest. The risk of stillbirth increased sharply when PM2.5 and its constituents during pregnancy exceeded the median concentrations. Moreover, stillbirth was associated with exposure to the mixtures of SO42-, NO3-, NH4+, OM, and BC before and during pregnancy (trimesters 1 and 2). Meanwhile, two-pollutant models also suggested stillbirth was associated with PM2.5 and its constituents in the year before and during pregnancy. The associations of PM2.5 and its constituents with stillbirth were stronger in mothers with advanced age and without cesarean delivery history. Additionally, hypertensive disorders in pregnancy, gestational diabetes, and placental abruption mediated the association of PM2.5 with stillbirth. Therefore, enhanced protection against PM2.5 for pregnant women before and during pregnancy and targeted interventions for pregnancy complications and anthropogenic sources of PM2.5 constituents are important to reduce stillbirth risk.
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Affiliation(s)
- Tianshan Shi
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, China
| | - Hanping Ma
- Lanzhou Maternal and Child Health Hospital, Lanzhou, Gansu, 730000, China
| | - Donghua Li
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, China
| | - Li Pan
- Lanzhou Maternal and Child Health Hospital, Lanzhou, Gansu, 730000, China
| | - Tingrong Wang
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, China
| | - Rui Li
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, China
| | - Xiaowei Ren
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, China.
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Shupler M, Huybrechts K, Leung M, Wei Y, Schwartz J, Li L, Koutrakis P, Hernández-Díaz S, Papatheodorou S. Short-Term Increases in NO 2 and O 3 Concentrations during Pregnancy and Stillbirth Risk in the U.S.: A Time-Stratified Case-Crossover Study. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:1097-1108. [PMID: 38175714 PMCID: PMC11152641 DOI: 10.1021/acs.est.3c05580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Associations between gaseous pollutant exposure and stillbirth have focused on exposures averaged over trimesters or gestation. We investigated the association between short-term increases in nitrogen dioxide (NO2) and ozone (O3) concentrations and stillbirth risk among a national sample of 116 788 Medicaid enrollees from 2000 to 2014. A time-stratified case-crossover design was used to estimate distributed (lag 0-lag 6) and cumulative lag effects, which were adjusted for PM2.5 concentration and temperature. Effect modification by race/ethnicity and proximity to hydraulic fracturing (fracking) wells was assessed. Short-term increases in the NO2 and O3 concentrations were not associated with stillbirth in the overall sample. Among American Indian individuals (n = 1694), a 10 ppb increase in NO2 concentrations was associated with increased stillbirth odds at lag 0 (5.66%, 95%CI: [0.57%, 11.01%], p = 0.03) and lag 1 (4.08%, 95%CI: [0.22%, 8.09%], p = 0.04) but not lag 0-6 (7.12%, 95%CI: [-9.83%, 27.27%], p = 0.43). Among participants living in zip codes within 15 km of active fracking wells (n = 9486), a 10 ppb increase in NO2 concentration was associated with increased stillbirth odds in single-day lags (2.42%, 95%CI: [0.37%, 4.52%], p = 0.02 for lag 0 and 1.83%, 95%CI: [0.25%, 3.43%], p = 0.03 for lag 1) but not the cumulative lag (lag 0-6) (4.62%, 95%CI: [-2.75%, 12.55%], p = 0.22). Odds ratios were close to the null in zip codes distant from fracking wells. Future studies should investigate the role of air pollutants emitted from fracking and potential racial disparities in the relationship between short-term increases in NO2 concentrations and stillbirth.
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Affiliation(s)
- Matthew Shupler
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Krista Huybrechts
- Division of Pharmacoepidemiology & Pharmacoeconomics, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Michael Leung
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Yaguang Wei
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Joel Schwartz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Longxiang Li
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Sonia Hernández-Díaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Stefania Papatheodorou
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
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Comess S, Chang HH, Warren JL. A Bayesian framework for incorporating exposure uncertainty into health analyses with application to air pollution and stillbirth. Biostatistics 2023; 25:20-39. [PMID: 35984351 PMCID: PMC10724312 DOI: 10.1093/biostatistics/kxac034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/07/2022] [Accepted: 07/29/2022] [Indexed: 02/01/2023] Open
Abstract
Studies of the relationships between environmental exposures and adverse health outcomes often rely on a two-stage statistical modeling approach, where exposure is modeled/predicted in the first stage and used as input to a separately fit health outcome analysis in the second stage. Uncertainty in these predictions is frequently ignored, or accounted for in an overly simplistic manner when estimating the associations of interest. Working in the Bayesian setting, we propose a flexible kernel density estimation (KDE) approach for fully utilizing posterior output from the first stage modeling/prediction to make accurate inference on the association between exposure and health in the second stage, derive the full conditional distributions needed for efficient model fitting, detail its connections with existing approaches, and compare its performance through simulation. Our KDE approach is shown to generally have improved performance across several settings and model comparison metrics. Using competing approaches, we investigate the association between lagged daily ambient fine particulate matter levels and stillbirth counts in New Jersey (2011-2015), observing an increase in risk with elevated exposure 3 days prior to delivery. The newly developed methods are available in the R package KDExp.
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Affiliation(s)
- Saskia Comess
- Emmett Interdisciplinary Program in Environment and Resources, Stanford University, 473 Via Ortega, Stanford, CA 94305, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Rd., NE Atlanta, GA 30322, USA
| | - Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, Yale University, P.O. Box 208034, 60 College Street, New Haven, CT 06520, USA
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Tong M, Wang M, Li P, Gong J, Zhu T, Xue T. The short-term effect of ozone on pregnancy loss modified by temperature: Findings from a nationwide epidemiological study in the contiguous United States. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 902:166088. [PMID: 37549698 PMCID: PMC10592165 DOI: 10.1016/j.scitotenv.2023.166088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/18/2023] [Accepted: 08/04/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Pregnancy loss, a major health issue that affects human sustainability, has been linked to short-term exposure to ground-surface ozone (O3). However, the association is inconsistent, possibly because of the co-occurrence of O3 and heat episodes, as increased temperature is a risk factor for pregnancy loss. To explain this inconsistency, the effect of O3 on pregnancy loss needs to be examined jointly with that of high temperature. METHODS A total of 247,305 pregnancy losses during the warm season were extracted from fetal death certificates from the 386 counties in contiguous United States from 1989 to 2005. We assessed environmental exposure based on the daily maximum 8 h average of O3 from Air Quality System monitors and the 24 h average temperature from the North American Regional Reanalysis product. We conducted a bidirectional, time-stratified case-crossover study of the association between pregnancy loss and exposures to O3 and temperature and their multiplicative interaction. The main time window for the exposure assessment was the day of case occurrence and the preceding 3 days. To estimate the association, we used conditional logistic regression with adjustment for relative humidity, height of the planetary boundary layer, and holidays. Sensitivity analyses were performed on the lagged structure, nonlinearity, and between-subpopulation heterogeneity of the estimated joint effect. RESULTS The joint effect was first estimated by the regression against categorical exposure by tertile. Compared to the low-low exposure group (O3 ≤ 78 μg/m3 and temperature ≤ 18 °C), the odds of pregnancy loss was significantly higher by 6.0 % (95 % confidence interval [CI] 2.4-9.7 %), 9.8 % (6.1-13.8 %), and 7.5 % (4.7-10.3 %) in the high-low (>104 μg/m3 and ≤18 °C), low-high (≤78 μg/m3 and >23 °C), and high-high (>104 μg/m3 and >23 °C) groups. The model of linear exposure and the multiplicative interaction yielded similar results. Each increment of 10 μg/m3 in O3 and 1 °C in temperature was associated with a 3.0 % (2.0 %-4.0 %) and 3.9 % (3.5 %-4.3 %), respectively, increase in the odds of pregnancy loss. A decrease in odds of 0.2 % (0.1 %-0.2 %) was associated with the temperature × O3 interaction. The finding of an antagonistic interaction between temperature and O3 was confirmed by models parametrizing the joint exposure as alternative nonlinear terms (i.e., a two-dimensional spline term or a varying-coefficient term) and was robust to a variety of exposure lags and stratifications. Therefore, the marginal effect of O3 was estimated to vary by climate zone. A significant association between O3 and pregnancy loss was observed in the northern, but not southern, United States. CONCLUSION Joint exposure to O3 and high temperature can increase the risk for pregnancy loss. The adverse effect of O3 is potentially modified by ambient temperature. In high-latitude cities, controlling for O3 pollution could protect maternal health.
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Affiliation(s)
- Mingkun Tong
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Center, Beijing, China
| | - Meng Wang
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, United States; Research and Education in Energy, Environment and Water Institute, University at Buffalo, Buffalo, NY 14214, United States; Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98115, United States
| | - Pengfei Li
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Center, Beijing, China; Advanced Institute of Information Technology, Peking University, Hangzhou, China; National Institute of Health Data Science, Peking University, Beijing, China
| | - Jicheng Gong
- College of Environmental Sciences and Engineering, Peking University, Beijing, China; State Environmental Protection Key Laboratory of Atmospheric Exposure and Health Risk Management and Center for Environment and Health, Peking University, Beijing, China
| | - Tong Zhu
- College of Environmental Sciences and Engineering, Peking University, Beijing, China; State Environmental Protection Key Laboratory of Atmospheric Exposure and Health Risk Management and Center for Environment and Health, Peking University, Beijing, China
| | - Tao Xue
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Center, Beijing, China; Advanced Institute of Information Technology, Peking University, Hangzhou, China; State Environmental Protection Key Laboratory of Atmospheric Exposure and Health Risk Management and Center for Environment and Health, Peking University, Beijing, China.
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Guilbert A, Bernard JY, Peyre H, Costet N, Hough I, Seyve E, Monfort C, Philippat C, Slama R, Kloog I, Chevrier C, Heude B, Ramus F, Lepeule J. Prenatal and childhood exposure to ambient air pollution and cognitive function in school-age children: Examining sensitive windows and sex-specific associations. ENVIRONMENTAL RESEARCH 2023; 235:116557. [PMID: 37423370 DOI: 10.1016/j.envres.2023.116557] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/16/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Combined effect of both prenatal and early postnatal exposure to ambient air pollution on child cognition has rarely been investigated and periods of sensitivity are unknown. This study explores the temporal relationship between pre- and postnatal exposure to PM10, PM2.5, NO2 and child cognitive function. METHODS Using validated spatiotemporally resolved exposure models, pre- and postnatal daily PM2.5, PM10 (satellite based, 1 km resolution) and NO2 (chemistry-transport model, 4 km resolution) concentrations at the mother's residence were estimated for 1271 mother-child pairs from the French EDEN and PELAGIE cohorts. Scores representative of children's General, Verbal and Non-Verbal abilities at 5-6 years were constructed based on subscale scores from the WPPSI-III, WISC-IV or NEPSY-II batteries, using confirmatory factor analysis (CFA). Associations of both prenatal (first 35 gestational weeks) and postnatal (60 months after birth) exposure to air pollutants with child cognition were explored using Distributed Lag Non-linear Models adjusted for confounders. RESULTS Increased maternal exposure to PM10, PM2.5 and NO2, during sensitive windows comprised between the 15th and the 33rd gestational weeks, was associated with lower males' General and Non-verbal abilities. Higher postnatal exposure to PM2.5 between the 35th and 52nd month of life was associated with lower males' General, Verbal and Non-verbal abilities. Some protective associations were punctually observed for the very first gestational weeks or months of life for both males and females and the different pollutants and cognitive scores. DISCUSSION These results suggest poorer cognitive function at 5-6 years among males following increased maternal exposure to PM10, PM2.5 and NO2 during mid-pregnancy and child exposure to PM2.5 around 3-4 years. Apparent protective associations observed are unlikely to be causal and might be due to live birth selection bias, chance finding or residual confounding.
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Affiliation(s)
- Ariane Guilbert
- Team of Environmental Epidemiology Applied to Development and Respiratory Health, Institute for Advanced Biosciences (IAB), Université Grenoble Alpes, Inserm, CNRS, 38700, La Tronche, France.
| | - Jonathan Y Bernard
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), 75004, Paris, France
| | - Hugo Peyre
- Centre de Ressources Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-développementaux, CHU Montpellier, 34090, Montpellier, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France; Laboratoire de Sciences Cognitives et Psycholinguistique, Département d'Etudes Cognitives, Ecole Normale Supérieure, PSL University, EHESS, CNRS, 75005, Paris, France
| | - Nathalie Costet
- Team of Epidemiology and Exposure Science in Health and Environment, Research Center on Environmental and Occupational Health (IRSET), Inserm, Université Rennes, EHESP, 35000, Rennes, France
| | - Ian Hough
- Team of Environmental Epidemiology Applied to Development and Respiratory Health, Institute for Advanced Biosciences (IAB), Université Grenoble Alpes, Inserm, CNRS, 38700, La Tronche, France; Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Be'er Sheva, Israel; Institute of Environmental Geosciences (IGE), Université Grenoble Alpes, 38400, Saint Martin D'Hères, France
| | - Emie Seyve
- Team of Environmental Epidemiology Applied to Development and Respiratory Health, Institute for Advanced Biosciences (IAB), Université Grenoble Alpes, Inserm, CNRS, 38700, La Tronche, France
| | - Christine Monfort
- Team of Epidemiology and Exposure Science in Health and Environment, Research Center on Environmental and Occupational Health (IRSET), Inserm, Université Rennes, EHESP, 35000, Rennes, France
| | - Claire Philippat
- Team of Environmental Epidemiology Applied to Development and Respiratory Health, Institute for Advanced Biosciences (IAB), Université Grenoble Alpes, Inserm, CNRS, 38700, La Tronche, France
| | - Rémy Slama
- Team of Environmental Epidemiology Applied to Development and Respiratory Health, Institute for Advanced Biosciences (IAB), Université Grenoble Alpes, Inserm, CNRS, 38700, La Tronche, France
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Cécile Chevrier
- Team of Epidemiology and Exposure Science in Health and Environment, Research Center on Environmental and Occupational Health (IRSET), Inserm, Université Rennes, EHESP, 35000, Rennes, France
| | - Barbara Heude
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), 75004, Paris, France
| | - Franck Ramus
- Laboratoire de Sciences Cognitives et Psycholinguistique, Département d'Etudes Cognitives, Ecole Normale Supérieure, PSL University, EHESS, CNRS, 75005, Paris, France
| | - Johanna Lepeule
- Team of Environmental Epidemiology Applied to Development and Respiratory Health, Institute for Advanced Biosciences (IAB), Université Grenoble Alpes, Inserm, CNRS, 38700, La Tronche, France.
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Yao Y, Yang F. Overcoming personal information protection challenges involving real-world data to support public health efforts in China. Front Public Health 2023; 11:1265050. [PMID: 37808971 PMCID: PMC10559907 DOI: 10.3389/fpubh.2023.1265050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
In the information age, real-world data-based evidence can help extrapolate and supplement data from randomized controlled trials, which can benefit clinical trials and drug development and improve public health decision-making. However, the legitimate use of real-world data in China is limited due to concerns over patient confidentiality. The use of personal information is a core element of data governance in public health. In China's public health data governance, practical problems exist, such as balancing personal information protection and public value conflict. In 2021, China adopted the Personal Information Protection Law (PIPL) to provide a consistent legal framework for protecting personal information, including sensitive medical health data. Despite the PIPL offering critical legal safeguards for processing health data, further clarification is needed regarding specific issues, including the meaning of "separate consent," cross-border data transfer requirements, and exceptions for scientific research. A shift in the law and regulatory framework is necessary to advance public health research further and realize the potential benefits of combining real-world evidence and digital health while respecting privacy in the technological and demographic change era.
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Affiliation(s)
| | - Fei Yang
- School of Law, China Jiliang University, Hangzhou, China
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Tan Y, Yang Y, Zhang Y, Peng C, Zhang Y, He M, Peng A. Prenatal ambient air pollutants exposure and the risk of stillbirth in Wuhan, central of China. ENVIRONMENTAL RESEARCH 2023; 228:115841. [PMID: 37028538 DOI: 10.1016/j.envres.2023.115841] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/26/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND The existing studies on the relationships of prenatal ambient air pollutants exposure with stillbirth in the Chinese population are very limited and the results are inconsistent, and the susceptible windows and potential modifiers for air pollutants exposure on stillbirth remain unanswered. OBJECTIVE We aimed to determine the relationships between exposure to ambient air pollutants and stillbirth, and explored the susceptible windows and potential modifiers for air pollutants exposure on stillbirth. METHODS A population-based cohort was established through the Wuhan Maternal and Child Health Management Information System involving 509,057 mother-infant pairs in Wuhan from January 1, 2011 through September 30, 2017. Personal exposure concentrations of fine particles (PM2.5), inhalable particles (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) for mothers were estimated based on their residential address during pregnancy using the inverse distance weighted (IDW) method. We used the logistic regression models to determine the associations at different stages of pregnancy with adjustment for confounding factors. RESULTS There were 3218 stillbirths and 505,839 live births among the participants. For each 100 μg/m3 of CO and 10 μg/m3 of O3 increase in the first trimester (conception to 13+6 weeks), the risk of stillbirth increased by 1.0% (OR = 1.01, 95%CI: 1.00-1.03) and 7.0% (OR = 1.07, 95%CI: 1.05-1.09). In the second trimester (14 weeks-27+6 weeks), PM2.5, PM10, CO, and O3 exposure were closely related to the risk of stillbirth (P<0.05). In the third trimester (28 weeks to delivery), for each 10 μg/m3 increase in exposure concentrations of PM2.5, SO2, and O3, the risk of stillbirth increased by 3.4%, 5.9%, and 4.0%, respectively. O3 exposure was positively relevant to the risk of stillbirth (OR = 1.11, 95%CI: 1.08-1.14) in the whole pregnancy. Exposure to NO2 was not significantly associated with the risk of stillbirth. Stratified analyses also presented a stronger association among mothers with boy infant, living in rural areas, delivering between 2011 and 2013, and those without gestational hypertension and history of stillbirth. CONCLUSION This study provides evidence that maternal exposure to PM2.5, PM10, SO2, CO, and O3 were related to the increased risk of stillbirth. Both the second and third trimesters might be vital susceptible windows for stillbirth. Our findings expand the evidence base for the important impacts of air pollution on fetal growth.
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Affiliation(s)
- Yafei Tan
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No. 100 Hongkong Road, Jiangan District, Wuhan, 430016, Hubei, China
| | - Yifan Yang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No. 100 Hongkong Road, Jiangan District, Wuhan, 430016, Hubei, China
| | - Yu Zhang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No. 100 Hongkong Road, Jiangan District, Wuhan, 430016, Hubei, China
| | - Chang Peng
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Qiaokou District, Wuhan, 430030, Hubei, China
| | - Yan Zhang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No. 100 Hongkong Road, Jiangan District, Wuhan, 430016, Hubei, China
| | - Meian He
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Qiaokou District, Wuhan, 430030, Hubei, China.
| | - Anna Peng
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No. 100 Hongkong Road, Jiangan District, Wuhan, 430016, Hubei, China.
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Fan W, Zlatnik MG. Climate Change and Pregnancy: Risks, Mitigation, Adaptation, and Resilience. Obstet Gynecol Surv 2023; 78:223-236. [PMID: 37043299 PMCID: PMC10508966 DOI: 10.1097/ogx.0000000000001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Importance Climate change is affecting the earth, resulting in more extreme temperatures and weather, rising sea levels, more frequent natural disasters, and displacement of populations of plants and animals, including people and insects. These changes affect food and housing security, vector-borne illnesses, and access to clean air and water, all of which influence human health. Evidence and Results There are a number of adverse health outcomes linked to heat, air pollution from wildfires, stress from natural disasters, and other elements of climate change. Pregnant people are especially vulnerable to the health harms resulting from climate change, namely, preterm birth, small for gestational age, hypertensive disorders of pregnancy, and other adverse reproductive health and birth outcomes. Strategies to minimize these harms include mitigation and adaptation. Conclusions and Relevance Physicians are in a unique position to protect the health of pregnant persons and children by advocating for policy changes that address climate change and providing clinical recommendations for patients to protect themselves from the health impacts of climate hazards.
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Affiliation(s)
| | - Marya G Zlatnik
- Professor, Maternal Fetal Medicine, Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, Western States Pediatric Environmental Health Specialty Unit, University of California San Francisco, San Francisco, CA
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Veenema RJ, Hoepner LA, Geer LA. Climate Change-Related Environmental Exposures and Perinatal and Maternal Health Outcomes in the U.S. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1662. [PMID: 36767030 PMCID: PMC9914610 DOI: 10.3390/ijerph20031662] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE Climate change poses one of the greatest risks to human health as air pollution increases, surface temperatures rise, and extreme weather events become more frequent. Environmental exposures related to climate change have a disproportionate effect on pregnant women through influencing food and water security, civil conflicts, extreme weather events, and the spread of disease. Our research team sought to identify the current peer-reviewed research on the effects of climate change-related environmental exposures on perinatal and maternal health in the United States. DESIGN AND METHODS A systematic literature review of publications identified through a comprehensive search of the PubMed and Web of Science databases was conducted using a modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. The initial search across both databases identified a combined total of 768 publications. We removed 126 duplicates and 1 quadruplet, and the remaining 639 publications were subjected to our pre-set inclusion and exclusion criteria. We excluded studies outside of the United States. A total of 39 studies met our inclusion criteria and were retained for thematic analysis. FINDINGS A total of 19 studies investigated the effect of either hot or cold temperature exposure on perinatal and maternal health outcomes. The effect of air pollution on perinatal outcomes was examined in five studies. A total of 19 studies evaluated the association between natural disasters (hurricanes, flash floods, and tropical cyclones) and perinatal and maternal health outcomes. High and low temperature extremes were found to negatively influence neonate and maternal health. Significant associations were found between air pollutant exposure and adverse pregnancy outcomes. Adverse pregnancy outcomes were linked to hurricanes, tropical cyclones, and flash floods. CONCLUSIONS This systematic review suggests that climate change-related environmental exposures, including extreme temperatures, air pollution, and natural disasters, are significantly associated with adverse perinatal and maternal health outcomes across the United States.
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Outdoor Air Pollution and Pregnancy Loss: a Review of Recent Literature. CURR EPIDEMIOL REP 2022. [DOI: 10.1007/s40471-022-00304-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Purpose of Review
This review summarizes recent literature about the impacts of outdoor air pollution on pregnancy loss (spontaneous abortion/miscarriage and stillbirth), identifies challenges and opportunities, and provides recommendations for actions.
Recent Findings
Both short- and long-term exposures to ubiquitous air pollutants, including fine particulate matter < 2.5 and < 10 μm, may increase pregnancy loss risk. Windows of susceptibility include the entire gestational period, especially early pregnancy, and the week before event. Vulnerable subpopulations were not consistently explored, but some evidence suggests that pregnant parents from more disadvantaged populations may be more impacted even at the same exposure level.
Summary
Given environmental conditions conductive to high air pollution exposures become more prevalent as the climate shifts, air pollution’s impacts on pregnancy is expected to become a growing public health concern. While awaiting larger preconception studies to further understand causal impacts, multi-disciplinary efforts to minimize exposures among pregnant women are warranted.
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Ambient Air Pollution Exposure Assessments in Fertility Studies: a Systematic Review and Guide for Reproductive Epidemiologists. CURR EPIDEMIOL REP 2022; 9:87-107. [DOI: 10.1007/s40471-022-00290-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Abstract
Purpose of Review
We reviewed the exposure assessments of ambient air pollution used in studies of fertility, fecundability, and pregnancy loss.
Recent Findings
Comprehensive literature searches were performed in the PUBMED, Web of Science, and Scopus databases. Of 168 total studies, 45 met the eligibility criteria and were included in the review. We find that 69% of fertility and pregnancy loss studies have used one-dimensional proximity models or surface monitor data, while only 35% have used the improved models, such as land-use regression models (4%), dispersion/chemical transport models (11%), or fusion models (20%). No published studies have used personal air monitors.
Summary
While air pollution exposure models have vastly improved over the past decade from a simple, one-dimensional distance or air monitor data to models that incorporate physiochemical properties leading to better predictive accuracy, precision, and increased spatiotemporal variability and resolution, the fertility literature has yet to fully incorporate these new methods. We provide descriptions of each of these air pollution exposure models and assess the strengths and limitations of each model, while summarizing the findings of the literature on ambient air pollution and fertility that apply each method.
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Ha S, Martinez V, Chan-Golston AM. Air pollution and preterm birth: A time-stratified case-crossover study in the San Joaquin Valley of California. Paediatr Perinat Epidemiol 2022; 36:80-89. [PMID: 34872160 DOI: 10.1111/ppe.12836] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/23/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Air pollution is linked to preterm birth (PTB), but existing studies are primarily focused on chronic exposures, conducted in areas with moderate pollution, and/or subject to confounding. OBJECTIVES We investigated short-term associations between two pollutants [particulate matter <2.5 microns (PM2.5 ) and ozone] and PTB, and estimated excess PTB cases potentially attributed to these pollutants. METHODS This time-stratified case-crossover study includes 196,970 singleton pregnancies affected by PTB and early term birth from the San Joaquin Valley (SJV), California, USA (2007-2015). Daily ozone and PM2.5 concentrations were estimated by the SJV Air Pollution Control District and geospatially linked to maternal zip code. We used conditional logistic regression models to estimate the odds ratio (OR) and 95% confidence intervals (CI) for the associations between an interquartile range (IQR) increase in pollutants and very preterm (VPTB, 20-34 weeks), moderate preterm (MPTB, 34-36 weeks) and early term births (ETB, 37-38 weeks). We adjusted all models for co-pollutants and meteorological factors. RESULTS During warm seasons (May-October), an IQR increase in ozone was associated with 9-11% increased odds of VPTB from lag 0 (ORlag0 1.09, 95% CI 1.04,1.16) to lag 7 (ORlag7 1.11, 95% CI 1.04,1.16). Findings were consistent for MPTB and ETB. Ozone was potentially responsible for an excess of 3-6 VPTBs, 7-9 PTBs and 24-42 ETBs per 1,000 singleton deliveries. During cold seasons (November-April), increased PM2.5 exposure was associated with 5-6% increased odds of VPTB beginning at lag 3 (ORlag3 1.06, 95% CI 1.02,1.11). PM2.5 was associated with an excess of 1-3 VPTBs, 0-3 MPTBs and 6-18 ETBs per 1,000 singleton deliveries. CONCLUSIONS PM2.5 and ozone are associated with increased risk of VPTB, MPTB and ETB within one week of exposure and are potential contributors to the increasing PTB trend. More research is needed to further understand the role of air pollution on PTB risk.
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Affiliation(s)
- Sandie Ha
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, California, USA.,Health Sciences Research Institute, University of California, Merced
| | - Valerie Martinez
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, California, USA.,Health Sciences Research Institute, University of California, Merced
| | - Alec M Chan-Golston
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, California, USA
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Liang Z, Xu C, Liang S, Cai TJ, Yang N, Li SD, Wang WT, Li YF, Wang D, Ji AL, Zhou LX, Liang ZQ. Short-term ambient nitrogen dioxide exposure is associated with increased risk of spontaneous abortion: A hospital-based study. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 224:112633. [PMID: 34411816 DOI: 10.1016/j.ecoenv.2021.112633] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
There are increasing concerns with regard to spontaneous abortion (SAB), the loss of pregnancy without external intervention before 20 weeks of gestation, among reproductive-aged women. To date, limited evidence is available concerning the association between SAB and air pollutants, especially in developing countries. Daily baseline outpatient data for SAB from January 1, 2014, to December 31, 2018 (1826 days) were obtained in Chongqing, a metropolis of southwest China. The over-dispersed Poisson generalized additive model with control of meteorological conditions and day of week was used to estimate the short-term effects of ambient air pollution on the daily number of SAB outpatients. A total of 42,334 SAB outpatient visits for SAB were recorded. No statistically significant association was observed between SAB and CO, PM2.5, PM10, O3, and SO2. The positive association only appeared for NO2: positive associations between SAB and NO2 were observed in both single-day models (lag 0, lag 1, lag 3, and lag 4) and cumulative exposure models (lag 01, lag 03, and lag 05) and the most significant effects were observed at lag 05 (3.289%; 95% CI: 1.568%, 5.011%). Moreover, the women with higher ages (30-39 and > 39) were more sensitive than those with lower ages (18-29), and the effect estimates were more evident in cool seasons. Collectively, our results suggested that short-term NO2 exposure was associated with higher risk of SAB, especially in elder women and cool seasons, which may contribute to further understand the role of air pollution on SAB and other adverse obstetric outcomes.
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Affiliation(s)
- Zhen Liang
- Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chen Xu
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China; Department of Hepatobiliary Surgery, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Shi Liang
- Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Chemistry, Brigham Young University-Idaho, Rexburg, ID, USA
| | - Tong-Jian Cai
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China.
| | - Neng Yang
- Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Si-Di Li
- Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wen-Ting Wang
- Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ya-Fei Li
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Dan Wang
- Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ai-Ling Ji
- Department of Preventive Medicine, Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Lai-Xin Zhou
- Medical Department, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhi-Qing Liang
- Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
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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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