Exposure to fine particulate matter during pregnancy and risk of preterm birth among women in New Jersey, Ohio, and Pennsylvania, 2000-2005

Prenatal exposure to PM2.5 components and the risk of different types of preterm birth and the mediating effect of pregnancy complications: a cohort study

OBJECTIVES

This study aims to reveal the single and mixed associations of PM2.5 and its components with very, moderately, and late preterm births and to explore the potential mediating role of pregnancy complications in PM2.5-induced preterm birth.

STUDY DESIGN

This was a retrospective cohort study.

METHODS

We enrolled 168,852 mothers and matched the concentrations of PM2.5 and its five components (OM, SO42-, BC, NO3-, and NH4+) based on their geographical location. Next, we used generalized linear models, quantile g-computation, and mediation analysis to evaluate the associations of PM2.5 and its components with very, moderately, and late preterm births and the mediating role of pregnancy complications.

RESULTS

Prenatal exposure to PM2.5 and its components was associated with preterm birth, and the association was strongest in the third trimester. Preterm birth was associated with co-exposure to a mixture of PM2.5 components in the third trimester, and the contributions of NO3-, NH4+, and BC to the risk of preterm birth were positive. Meanwhile, pregnancy complications mediated PM2.5-induced preterm birth. Moreover, very and moderately preterm births were associated with PM2.5 and its components in the second and third trimesters, and very and late preterm births were associated with co-exposure to a mixture of PM2.5 components in the third trimester.

CONCLUSIONS

Later exposure to PM2.5 during pregnancy will cause earlier preterm birth. Targeted and positive interventions for anthropogenic sources of specific PM2.5 components and pregnancy complications are helpful for preterm birth prevention.

Prenatal Exposure to Air Pollution and Respiratory Distress in Term Newborns: Results from the MIREC Prospective Pregnancy Cohort

BACKGROUND

Respiratory distress is the leading cause of neonatal morbidity and mortality worldwide, and prenatal exposure to air pollution is associated with adverse long-term respiratory outcomes; however, the impact of prenatal air pollution exposure on neonatal respiratory distress has not been well studied.

OBJECTIVES

We examined associations between prenatal exposures to fine particular matter (PM 2.5 ) and nitrogen dioxide (NO 2 ) with respiratory distress and related neonatal outcomes.

METHODS

We used data from the Maternal-Infant Research on Environmental Chemicals (MIREC) Study, a prospective pregnancy cohort (n = 2,001 ) recruited in the first trimester from 10 Canadian cities. Prenatal exposures to PM 2.5 (n = 1,321 ) and NO 2 (n = 1,064 ) were estimated using land-use regression and satellite-derived models coupled with ground-level monitoring and linked to participants based on residential location at birth. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for associations between air pollution and physician-diagnosed respiratory distress in term neonates in hierarchical logistic regression models adjusting for detailed maternal and infant covariates.

RESULTS

Approximately 7 % of newborns experienced respiratory distress. Neonates received clinical interventions including oxygen therapy (6%), assisted ventilation (2%), and systemic antibiotics (3%). Two percent received multiple interventions and 4% were admitted to the neonatal intensive care unit (NICU). Median PM 2.5 and NO 2 concentrations during pregnancy were 8.81   μ g / m 3 and 18.02  ppb , respectively. Prenatal exposures to air pollution were not associated with physician-diagnosed respiratory distress, oxygen therapy, or NICU admissions. However, PM 2.5 exposures were strongly associated with assisted ventilation (OR per 1 - μ g / m 3 increase in PM 2.5 = 1.17 ; 95% CI: 1.02, 1.35), multiple clinical interventions (OR per 1 - μ g / m 3 increase in PM 2.5 = 1.16 ; 95% CI: 1.07, 1.26), and systemic antibiotics, (OR per 1 - μ g / m 3 increase in PM 2.5 = 1.12 ; 95% CI: 1.04, 1.21). These associations were consistent across exposure periods-that is, during prepregnancy, individual trimesters, and total pregnancy-and robust to model specification. NO 2 exposure was associated with administration of systemic antibiotics (OR per 1-ppb increase in NO 2 = 1.03 ; 95% CI: 1.00, 1.06).

DISCUSSION

Prenatal exposures to PM 2.5 increased the risk of severe respiratory distress among term newborns. These findings support the development and prioritization of public health and prenatal care strategies to increase awareness and minimize prenatal exposures to air pollution. https://doi.org/10.1289/EHP12880.

Air Pollution and Aeroallergens as Possible Triggers in Preterm Birth Delivery

Preterm birth (PTB) identifies infants prematurely born <37 weeks/gestation and is one of the main causes of infant mortality. PTB has been linked to air pollution exposure, but its timing is still unclear and neglects the acute nature of delivery and its association with short-term effects. We analyzed 3 years of birth data (2015−2017) in Turin (Italy) and the relationships with proinflammatory chemicals (PM2.5, O3, and NO2) and biological (aeroallergens) pollutants on PTB vs. at-term birth, in the narrow window of a week before delivery. A tailored non-stationary Poisson model correcting for seasonality and possible confounding variables was applied. Relative risk associated with each pollutant was assessed at any time lag between 0 and 7 days prior to delivery. PTB risk was significantly associated with increased levels of both chemical (PM2.5, RR = 1.023 (1.003−1.043), O3, 1.025 (1.001−1.048)) and biological (aeroallergens, RR ~ 1.01 (1.0002−1.016)) pollutants in the week prior to delivery. None of these, except for NO2 (RR = 1.01 (1.002−1.021)), appeared to play any role on at-term delivery. Pollutant-induced acute inflammation eliciting delivery in at-risk pregnancies may represent the pathophysiological link between air pollution and PTB, as testified by the different effects played on PTB revealed. Further studies are needed to better elucidate a possible exposure threshold to prevent PTB.

Ambient air pollution during pregnancy and DNA methylation in umbilical cord blood, with potential mediation of associations with infant adiposity: The Healthy Start study

BACKGROUND

Prenatal exposure to ambient air pollution has been associated with adverse offspring health outcomes. Childhood health effects of prenatal exposures may be mediated through changes to DNA methylation detectable at birth.

METHODS

Among 429 non-smoking women in a cohort study of mother-infant pairs in Colorado, USA, we estimated associations between prenatal exposure to ambient fine particulate matter (PM2.5) and ozone (O3), and epigenome-wide DNA methylation of umbilical cord blood cells at delivery (2010-2014). We calculated average PM2.5 and O3 in each trimester of pregnancy and the full pregnancy using inverse-distance-weighted interpolation. We fit linear regression models adjusted for potential confounders and cell proportions to estimate associations between air pollutants and methylation at each of 432,943 CpGs. Differentially methylated regions (DMRs) were identified using comb-p. Previously in this cohort, we reported positive associations between 3rd trimester O3 exposure and infant adiposity at 5 months of age. Here, we quantified the potential for mediation of that association by changes in DNA methylation in cord blood.

RESULTS

We identified several DMRs for each pollutant and period of pregnancy. The greatest number of significant DMRs were associated with third trimester PM2.5 (21 DMRs). No single CpGs were associated with air pollutants at a false discovery rate <0.05. We found that up to 8% of the effect of 3rd trimester O3 on 5-month adiposity may be mediated by locus-specific methylation changes, but mediation estimates were not statistically significant.

CONCLUSIONS

Differentially methylated regions in cord blood were identified in association with maternal exposure to PM2.5 and O3. Genes annotated to the significant sites played roles in cardiometabolic disease, immune function and inflammation, and neurologic disorders. We found limited evidence of mediation by DNA methylation of associations between third trimester O3 exposure and 5-month infant adiposity.

The effects of economic growth on carbon dioxide emissions in selected Sub-Saharan African (SSA) countries

This research article concerns a study of economic growth influences on carbon dioxide emissions in 20 selected Sub Saharan African (SSA) countries. The study also intends to reexamine energy consumption, tourism sector and population effect on carbon dioxide emissions. The empirical research applies panel linear regression model for the data obtained in these 20 SSA countries throughout 2000 to 2020. The empirical estimation techniques employed in the analysis consist of pooled ordinary least square (OLS), fixed effects model (FEM), random effects model (REM) and robust fixed model, including diagnostic tests such as endogeneity, heteroscedasticity and other measurements. The empirical analysis using the robust fixed effects model has established significant associations between economic growth, energy consumption, tourism sector and population on carbon dioxide emissions in SSA countries between 2000 and 2020. This study has established that a 1% increase in economy growth increases the carbon dioxide emission level by approximately 0.02%. A study has identified that SSA countries' energy consumption, especially from oil, will only contaminate air quality. A study confirmed that international tourist arrivals are one of the factors that significantly caused air quality reduction among SSA countries. However, increasing population and future international agreements and protocols could also mean that carbon emissions can potentially cause less environmental degradation in the region.

Relationship between ambient air pollution and preterm birth: a retrospective birth cohort study in Yan'an, China

Preterm birth (PTB) has been associated with exposure to air pollution, but it is unclear whether effects might vary among air pollution sources in a valley city, and yet few studies have investigated refined susceptible windows for PTB. We performed a retrospective birth cohort study in Yan'an city, a typical valley city in the west of China, and analyze the effects of air pollutants on premature delivery, identify critical windows for maternal air pollutants exposure and PTB. The pregnant women who gave birth in the Affiliated Hospital of Yan'an University and Yan'an people's Hospital from January 1, 2018 to December 31, 2019 were selected as the research objects. A questionnaire survey and medical records were conducted. The daily average concentrations of particulate matter with aerodynamic diameters of ≤ 2.5 μm (PM_2.5) and ≤ 10 μm (PM₁₀), nitrogen dioxide (NO₂), sulfur dioxide (SO₂) and ozone (O₃) in Yan'an City from January 1, 2017 to December 31, 2019 were collected. After controlling the confounding factors of PTB by logistic regression model, the effect of air pollutants on preterm birth was analyzed. After controlling the confounding factors such as maternal age, gestational times and gestational hypertension syndrome, PTB was associated with exposure to third trimester PM₁₀ (adjusted odds ratio [aOR] = 1.019, 95% confidence interval [95%CI] = 1.004-1.035). PTB risk increased with second trimester exposure to SO₂ (aOR = 1.039, CI = 1.011-1.068), also with third trimester (aOR = 1.031, CI = 1.010-1.053). PTB was also associated with third trimester O₃ (aOR = 1.023, CI = 1.005-1.041). This study indicates that maternal exposure to PM₁₀, SO₂ and O₃ might lead to increased risk of PTB, and critical exposure windows were inconsistent.

Air pollution: A culprit of lung cancer

Air pollution is a global health problem, especially in the context of rapid economic development and the expansion of urbanization. Herein, we discuss the harmful effects of outdoor and indoor pollution on the lungs. Ambient particulate matters (PMs) from industrial and vehicle exhausts is associated with lung cancer. Workers exposed to asbestos, polycyclic aromatic hydrocarbons (PAHs), and toxic metals are also likely to develop lung cancer. Indoors, cooking fumes, second-hand smoke, and radioactive products from house decoration materials play roles in the development of lung cancer. Bacteria and viruses can also be detrimental to health and are important risk factors in lung inflammation and cancer. Specific effects of lung cancer caused by air pollution are discussed in detail, including inflammation, DNA damage, and epigenetic regulation. In addition, advanced materials for personal protection, as well as the current government policies to prevent air pollution, are summarized. This review provides a basis for future research on the relationship between lung cancer and air pollution.

Critical Time Windows for Air Pollution Exposure and Birth Weight in a Multicity Canadian Pregnancy Cohort

BACKGROUND

Maternal prenatal exposure to air pollution has been associated with adverse birth outcomes. However, previous studies focused on a priori time intervals such as trimesters reported inconsistent associations.

OBJECTIVES

We investigated time-varying vulnerability of birth weight to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) using flexible time intervals.

METHODS

We analyzed 1,300 live, full-term births from Maternal-Infant Research on Environmental Chemicals, a Canadian prospective pregnancy cohort spanning 10 cities (2008-2011). Daily PM2.5 and NO2 concentrations were estimated from ground-level monitoring, satellite models, and land-use regression, and assigned to participants from pre-pregnancy through delivery. We developed a flexible two-stage modeling method-using a Bayesian Metropolis-Hastings algorithm and empirical density threshold-to identify time-dependent vulnerability to air pollution without specifying exposure periods a priori. This approach identified critical windows with varying lengths (2-363 days) and critical windows that fell within, or straddled, predetermined time periods (i.e., trimesters). We adjusted the models for detailed infant and maternal covariates.

RESULTS

Critical windows associated with reduced birth weight were identified during mid- to late-pregnancy for both PM2.5 and NO2: -6 g (95% credible interval: -11, -1 g) and -5 g (-10, -0.1 g) per µg/m3 PM2.5 during gestational days 91-139 and 249-272, respectively; and -3 g (-5, -1 g) per ppb NO2 during days 55-145.

DISCUSSION

We used a novel, flexible selection method to identify critical windows when maternal exposures to air pollution were associated with decrements in birth weight. Our results suggest that air pollution impacts on fetal development may not be adequately captured by trimester-based analyses.

Extreme heat, preterm birth, and stillbirth: A global analysis across 14 lower-middle income countries

Stillbirths and complications from preterm birth are two of the leading causes of neonatal deaths across the globe. Lower- to middle-income countries (LMICs) are experiencing some of the highest rates of these adverse birth outcomes. Research has suggested that environmental determinants, such as extreme heat, can increase the risk of preterm birth and stillbirth. Under climate change, extreme heat events have become more severe and frequent and are occurring in differential seasonal patterns. Little is known about how extreme heat affects the risk of preterm birth and stillbirth in LMICs. Thus, it is imperative to examine how exposure to extreme heat affects adverse birth outcomes in regions with some of the highest rates of preterm and stillbirths. Most of the evidence linking extreme heat and adverse birth outcomes has been generated from high-income countries (HICs) notably because measuring temperature in LMICs has proven challenging due to the scarcity of ground monitors. The paucity of health data has been an additional obstacle to study this relationship in LMICs. In this study, globally gridded meteorological data was linked with spatially and temporally resolved Demographic and Health Surveys (DHS) data on adverse birth outcomes. A global analysis of 14 LMICs was conducted per a pooled time-stratified case-crossover design with distributed-lag nonlinear models to ascertain the relationship between acute exposure to extreme heat and PTB and stillbirths. We notably found that experiencing higher maximum temperatures and smaller diurnal temperature range during the last week before birth increased the risk of preterm birth and stillbirth. This study is the first global assessment of extreme heat events and adverse birth outcomes and builds the evidence base for LMICs.

Maternal exposure to indoor PM2.5 and associated adverse birth outcomes in low socio-economic households, Durban, South Africa

The association between in utero exposure to indoor PM_2.5 and birth outcomes is not conclusive. We assessed the association between in utero exposure to indoor PM_2.5 , birth weight, gestational age, low birth weight, and/or preterm delivery. Homes of 800 pregnant women were assessed using a structured walkthrough questionnaire. PM_2.5 measurements were undertaken in 300 of the 800 homes for a period of 24 h. Repeated sampling was conducted in 30 of these homes to determine PM_2.5 predictors that can reduce within-and/or between-home variability. A predictive model was used to estimate PM_2.5 levels in unmeasured homes (n = 500). The mean (SD) for PM_2.5 was 37 µg/m³ (29) with a median of 28µg/m³ . The relationship between PM_2.5 exposure, birth weight, gestational age, low birth weight, and preterm delivery was assessed using multivariate linear and logistic regression models. We explored infant sex as a potential effect modifier, by creating an interaction term between PM_2.5 and infant sex. The odds ratio of low birth weight and preterm delivery was 1.75 (95%CI: 1.47, 2.09) and 1.21 (95%CI: 1.06, 1.39), respectively, per interquartile increase (18 µg/m³ ) in PM_2.5 exposure. The reduction in birth weight and gestational age was 75 g (95%CI: 107.89, 53.15) and 0.29 weeks (95%CI: 0.40, 0.19) per interquartile increase in PM_2.5 exposure. Infant sex was an effect modifier for PM_2.5 on birth weight and gestational age, and the reduction in birth weight and gestational age was 103 g (95%CI: 142.98, 64.40) and 0.38 weeks (95% CI: 0.53, 0.23), respectively, for boys, and 54 g (95%CI: 91.78,15.62) and 0.23 weeks (95%CI:0.37, 0.08), respectively, for girls. Exposure to PM_2.5 is associated with adverse pregnancy outcomes. To protect the population during their reproductive period, public health policy should focus on indoor PM_2.5 levels.

Spatially and Temporally Resolved Ambient PM2.5 in Relation to Preterm Birth

Growing evidence suggests that maternal exposure to ambient fine particulate matter (PM_2.5) during pregnancy is associated with preterm birth; however, few studies have examined critical windows of exposure, which can help elucidate underlying biologic mechanisms and inform public health messaging for limiting exposure. Participants included 891 mother-newborn pairs enrolled in a U.S.-based pregnancy cohort study. Daily residential PM_2.5 concentrations at a 1 × 1 km² resolution were estimated using a satellite-based hybrid model. Gestational age at birth was abstracted from electronic medical records and preterm birth (PTB) was defined as <37 completed weeks of gestation. We used Critical Window Variable Selection to examine weekly PM_2.5 exposure in relation to the odds of PTB and examined sex-specific associations using stratified models. The mean ± standard deviation PM_2.5 level averaged across pregnancy was 8.13 ± 1.10 µg/m³. PM_2.5 exposure was not associated with an increased odds of PTB during any gestational week. In sex-stratified models, we observed a marginal increase in the odds of PTB with exposure occurring during gestational week 16 among female infants only. This study does not provide strong evidence supporting an association between weekly exposure to PM_2.5 and preterm birth.

Ambient fine particulate matter air pollution and the risk of preterm birth: A multicenter birth cohort study in China

Preterm birth (PTB), defined as live birth before the 37th week of gestation, is believed to have profound impacts on the infant's health in later life. Air pollution has been suggested to be a potential risk factor of PTB, but the evidence was inconsistent. In this multicenter birth cohort study, we aimed to examine the association between fine particulate matter (PM_2.5) exposure during pregnancy and PTB in China. A total of 5976 live births were identified between Jan. 2009 and Feb. 2011 from 8 provinces in China. Residential exposures to PM_2.5 were assigned based on satellite remote sensing estimates. Cox proportional hazards regressions were employed to explore the correlation for each trimester as well as the entire pregnancy. A total of 443 (7.4%) preterm births were observed. The average PM_2.5 during pregnancy was 57.2 ± 8.8 μg/m³. We found exposure to PM_2.5 during the whole pregnancy (hazard ratio, HR = 1.262; 95% CI: 1.087-1.465) and in the first trimester (HR = 1.114; 95% CI: 1.007-1.232) was associated with higher risk of PTB. The associations of PM_2.5 were stronger for subjects with older maternal or paternal age, lower maternal pre-pregnancy BMI, and lower family income. This study adds supports to the cumulating evidence linking PM_2.5 exposure and elevated PTB risk. Measures of air pollution reduction are needed during pregnancy, especially at early stage of pregnancy to prevent adverse birth outcomes.

Prenatal airshed pollutants and preterm birth in an observational birth cohort study in Detroit, Michigan, USA

Detroit, Michigan, currently has the highest preterm birth (PTB) rate of large cities in the United States. Disproportionate exposure to ambient air pollutants, including particulate matter ≤2.5 μm (PM_2.5), PM ≤ 10 μm (PM₁₀), nitrogen dioxide (NO₂) and benzene, toluene, ethylbenzene, and xylenes (BTEX) may contribute to PTB. Our objective was to examine the association of airshed pollutants with PTB in Detroit, MI. The Geospatial Determinants of Health Outcomes Consortium (GeoDHOC) study collected air pollution measurements at 68 sites in Detroit in September 2008 and June 2009. GeoDHOC data were coupled with 2008-2010 Michigan Air Sampling Network measurements in Detroit to develop monthly ambient air pollution estimates at a spatial density of 300 m². Using delivery records from two urban hospitals, we established a retrospective birth cohort of births by Detroit women occurring from June 2008 to May 2010. Estimates of air pollutant exposure throughout pregnancy were assigned to maternal address at delivery. Our analytic sample size included 7961 births; 891 (11.2%) were PTB. After covariate adjustment, PM₁₀ (P = 0.003) and BTEX (P < 0.001), but not PM_2.5 (P = 0.376) or NO₂ (P = 0.582), were statistically significantly associated with PTB. In adjusted models, for every 5-unit increase in PM₁₀ there was a 1.21 times higher odds of PTB (95% CI 1.07, 1.38) and for every 5-unit increase in BTEX there was a 1.54 times higher odds of PTB (95% CI 1.25, 1.89). Consistent with previous studies, higher PM₁₀ was associated with PTB. We also found novel evidence that higher airshed BTEX is associated with PTB. Future studies confirming these associations and examining direct measures of exposure are needed.

Impact of Maternal Demographic and Socioeconomic Factors on the Association Between Particulate Matter and Adverse Birth Outcomes: a Systematic Review and Meta-analysis

BACKGROUND

Numerous studies conducted in the United States found associations between prenatal exposure to particulate matter (PM) and adverse birth outcomes, and some studies identified vulnerable populations, including certain racial/ethnic groups and people with low-socioeconomic status. However, their findings are not always consistent. In this review, we compared the risk of adverse birth outcomes due to PM exposures among subpopulations and investigated whether any particular population is more vulnerable.

METHODS

We selected U.S. studies examining associations between PM exposure during pregnancy and birth outcomes that included results for effect modification by race/ethnicity and/or maternal education. We summarized the findings for various sizes of PM and birth outcomes. Meta-analysis was conducted to quantify vulnerable race/ethnicity for the association between fine PM (PM_2.5) and birthweight.

RESULTS

In total, 19 studies were assessed, and PM-related risks of adverse birth outcomes, particularly those related to fetal growth, likely differ across subpopulations. A meta-analysis from five studies showed that a 10 μg/m³ increase of PM_2.5 during the full-gestation reduced birthweight by 21.9 g (95% confidence interval 11.7, 32.0), 15.7 g (10.1, 21.4), 9.3 g (2.7, 15.8), and 5.8 g (- 9.0, 20.7) for Black, White, Hispanic, and Asian mothers, respectively.

CONCLUSION

Our review indicated that Black mothers and mothers with low educational attainment are more vulnerable subpopulations. More investigation is needed for effect modification by other maternal factors, such as household income. Characterizing and quantifying vulnerable subpopulations are essential for addressing environmental justice since it can help regulatory agencies allocate resources and design policy interventions.

The Association Between Air Pollution and Low Birth Weight and Preterm Labor in Ahvaz, Iran

PURPOSE

Pregnant women and fetuses are sensitive to air pollution due to physiological changes in pregnancy. The aim of this study was to determine the relationship between exposure to air pollution, low birth weight and preterm labor in Ahvaz.

METHODS

This research was a time-series study. The research sample consisted of all data about low birth weight and preterm labor pregnant women from Imam Khomeini Hospital and Razi Hospital in Ahvaz city. Air pollutant data including O3, NO, NO2, SO2, CO, PM10 and PM2.5 and climate data were collected from the Environmental Protection Agency and the Khuzestan Province during a 10-year period from 2008 to 2018. The generalized additive models (GAMs) with different air pollutant lags up to 6 days were used.

RESULTS

The results of multiple GAM model have shown that there is a direct and significant relationship between exposure to PM10 at 0-6-day lag, SO2 at 2- and 3-day lag and low birth weight. In addition, there was a direct and significant correlation between exposure to NO2, NO, CO and PM2.5 at 0-6-day lag and preterm labor.

CONCLUSION

The results indicate the effect of air pollutants on low birth weight and preterm labor. Therefore, pregnant women should be informed about the negative consequences of air pollution and avoid exposure to polluted air during pregnancy.

Maternal PM2.5 exposure triggers preterm birth: a cross-sectional study in Wuhan, China

Background

Most of the studies regarding air pollution and preterm birth (PTB) in highly polluted areas have estimated the exposure level based on fixed-site monitoring. However, exposure assessment methods relying on monitors have the potential to cause exposure misclassification due to a lack of spatial variation. In this study, we utilized a land use regression (LUR) model to assess individual exposure, and explored the association between PM_2.5 exposure during each time window and the risk of preterm birth in Wuhan city, China.

Methods

Information on 2101 singleton births, which were ≥ 20 weeks of gestation and born between November 1, 2013 and May 31, 2014; between January 1, 2015 and August 31, 2015, was obtained from the Obstetrics Department in one 3A hospital in Wuhan. Air quality index (AQI) data were accessed from the Wuhan Environmental Protection Bureau website. Individual exposure during pregnancy was assessed by LUR models and Kriging interpolation. Logistic regression analyses were conducted to determine the association between women exposure to PM_2.5 and the risk of different subtypes of PTB.

Results

During the study period, the average individual exposure concentration of PM_2.5 during the entire pregnancy was 84.54 μg/m³. A 10 μg/m³ increase of PM_2.5 exposure in the first trimester (OR: 1.169; 95% CI: 1.077, 1.262), the second trimester (OR: 1.056; 95% CI: 1.015, 1.097), the third trimester (OR: 1.052; 95% CI: 1.002, 1.101), and the entire pregnancy (OR: 1.263; 95% CI: 1.158, 1.368) was significantly associated with an increased risk of PTB. For the PTB subgroup, the hazard of PM_2.5 exposure during pregnancy was stronger for very preterm births (VPTB) than moderate preterm births (MPTB). The first trimester was the most susceptible exposure window. Moreover, women who had less than 9 years of education or who conceived during the cold season tended to be more susceptible to the PM_2.5 exposure during pregnancy.

Conclusions

Maternal exposure to PM_2.5 increased the risk of PTB, and this risk was stronger for VPTB than for MPTB, especially during the first trimester.

Personal exposure to fine particulate matter (PM2.5) of pregnant women during three trimesters in rural Yunnan of China

Little is known about fine particulate matter (PM_2.5) exposure among pregnant women in rural China. This study aims to characterize exposure to PM_2.5 among pregnant women in rural China, and investigate potential risk factors of personal exposure to PM_2.5. The data were obtained from a birth cohort study that enrolled 606 pregnant women in Xuanwei, a county known for its high rates of lung cancer. The personal exposure to PM_2.5 was measured using small portable particulate monitors during each trimester of pregnancy. Participants were interviewed using structured questionnaires that sought information on risk factors of PM_2.5 exposure. The daily exposure to PM_2.5 among the pregnant women ranged from 19.68 to 97.08 μg/m³ (median = 26.08). Exposure to PM_2.5 was higher in winter and autumn than other seasons (p < 0.05); higher during the day than during the night (p < 0.001); and greater during cooking hours than during the rest of the day (p < 0.001). Using a mixed effects model, domestic solid fuel for cooking (β = 1.75, p < 0.001), winter and autumn (β = 2.96, p < 0.001), cooking ≥ once per day (β = 1.58, p < 0.05), heating with coal (β = 1.69, p < 0.001), secondhand smoke exposure (β = 1.59, p < 0.001) and township 1(β = 2.39, p < 0.001) were identified as risk factors for personal exposure to PM_2.5 of pregnant women throughout pregnancy. Indirect effects of season and township factors on personal PM_2.5 exposure were mediated by heating, cooking and domestic fuel using. In conclusion, PM_2.5 levels in Xuanwei exceeded WHO guidelines. Seasonal and township factors and individual behaviors like domestic solid fuel using for cooking, heating with coal and secondhand smoke exposure are associated with higher personal PM_2.5 exposure among pregnant women in rural China.

Risk of particulate matter on birth outcomes in relation to maternal socio-economic factors: a systematic review

A growing number of studies provide evidence of an association between exposure to maternal air pollution during pregnancy and adverse birth outcomes including low birth weight and preterm birth. Prevention of these health effects of air pollution is critical to reducing the adverse infant outcomes, which can have impacts throughout the life course. However, there is no consensus on whether the association between air pollution exposure and birth outcomes varies by maternal risk factors including demographic characteristics and socio-economic status. Such information is vital to understand potential environmental health disparities. Our search found 859 unique studies, of which 45 studies met our inclusion criteria (Jan. 2000- July. 2019). We systematically reviewed the 45 identified epidemiologic studies and summarized the results on effect modifications by maternal race/ethnicity, educational attainment, income, and area-level socio-economic status. We considered adverse birth outcomes of preterm birth, low birth weight, small for gestational age (SGA), and stillbirth. Suggestive evidence of higher risk of particulate matter in infants of African-American/black mothers than infants of other women was found for preterm birth and low birth weight. We found weak evidence that particulate matter risk was higher for infants of mothers with lower educational attainment for preterm birth and low birth weight. Due to the small study numbers, we were unable to conclude whether effect modification is present for income, occupation, and area-level socio-economic status, and additional research is needed. Furthermore, adverse birth outcomes such as SGA and stillbirth need more study to understand potential environmental justice issues regarding the impact of particulate matter exposure during pregnancy on birth outcomes.

Preconception Exposure to Fine Particulate Matter Leads to Cardiac Dysfunction in Adult Male Offspring

Background Particulate matter (particles < 2.5 μm [ PM _2.5]) exposure during the in utero and postnatal developmental periods causes cardiac dysfunction during adulthood. Here, we investigated the potential priming effects of preconception exposure of PM _2.5 on cardiac function in adult offspring. Methods and Results Male and female friend leukemia virus b (FVB) mice were exposed to either filtered air ( FA ) or PM _2.5 at an average concentration of 38.58 μg/m³ for 6 hours/day, 5 days/week for 3 months. Mice were then crossbred into 2 groups: (1)  FA _male× FA _female (both parents were exposed to FA preconception) and, (2) PM _2.5male× PM _2.5female (both parents were exposed to PM _2.5 preconception). Male offspring were divided: (1) preconception FA (offspring born to FA exposed parents) and, (2) preconception PM _2.5 (offspring born to PM _2.5 exposed parents) and analyzed at 3 months of age. Echocardiography identified increased left ventricular end systolic volume and reduced posterior wall thickness, reduced %fractional shortening and %ejection fraction in preconception PM _2.5 offspring. Cardiomyocytes isolated from preconception PM _2.5 offspring showed reduced %peak shortening, -dL/dT, TPS 90 and slower calcium reuptake (tau). Gene and protein expression revealed modifications in markers of inflammation ( IL -6, IL -15, TNF α, NF қB, CRP , CD 26E, CD 26P, intercellular adhesion molecule 1, and monocyte chemoattractant protein-1) profibrosis (collagen type III alpha 1 chain), oxidative stress ( NOS 2), antioxidants (Nrf2, SOD , catalase), Ca²⁺ regulatory proteins ( SERCA 2a, p- PLN , NCX ), and epigenetic regulators (Dnmt1, Dnmt3a, Dnmt3b, Sirt1, and Sirt2) in preconception PM _2.5 offspring. Conclusions Preconception exposure to PM _2.5 results in global cardiac dysfunction in adult offspring, suggesting that abnormalities during development are not limited to the prenatal or postnatal periods but can also be determined before conception.

Maternal exposure to benzene and toluene and preterm birth. A longitudinal study

BACKGROUND

Exposure to air pollutants has several effects on human health, including during pregnancy.

OBJECTIVE

To identify whether exposure to benzene and toluene among pregnant women contributes to preterm delivery.

DESIGN AND SETTING

Longitudinal study using data on newborns from mothers living in São José dos Campos (SP) in 2016, who had been exposed to benzene and toluene.

METHODS

A logistic regression model with three hierarchical levels was constructed using maternal variables relating to newborns, and using benzene and toluene concentrations in quartiles. Occurrences of cesarean births, twins or malformations were excluded. Maternal exposure windows of 5, 10, 15, 30, 60 and 90 days prior to delivery were considered.

RESULTS

Out of the 9,562 live births, 3,671 newborns were included and 343 newborns were born at less than 37 weeks of gestation (9.3%). The average birth weight was 3,167.2 g. Exposure to benzene and toluene was significantly associated (P = 0.04) with preterm delivery in the five-day window. There was no association in any of the other exposure windows.

CONCLUSIONS

It was possible to identify that maternal exposure to benzene and toluene has an acute effect on preterm delivery.

Associations between PM2.5 and risk of preterm birth among liveborn infants

PURPOSE

Studies suggest exposure to ambient particulate matter less than 2.5 μg/m3 in aerodynamic diameter (PM2.5) may be associated with preterm birth (PTB), but few have evaluated how this is modified by ambient temperature. We investigated the relationship between PM2.5 exposure during pregnancy and PTB in infants without birth defects (1999-2006) and enrolled in the National Birth Defects Prevention Study and how it is modified by concurrent temperature.

METHODS

PTB was defined as spontaneous or iatrogenic delivery before 37 weeks. Exposure was assigned using inverse distance weighting with up to four monitors within 50 kilometers of maternal residence. To account for state-level variations, a Bayesian two-level hierarchal model was developed.

RESULTS

PTB was associated with PM2.5 during the third and fourth months of pregnancy (range: (odds ratio (95% confidence interval) = 1.00 (0.35, 2.15) to 1.49 (0.82, 2.68) and 1.31 (0.56, 2.91) to 1.62 (0.7, 3.32), respectively); no week of exposure conveyed greater risk. Temperature may modify this relationship; higher local average temperatures during pregnancy yielded stronger positive relationships between PM2.5 and PTB compared to nonstratified results.

CONCLUSIONS

Results add to literature on associations between PM2.5 and PTB, underscoring the importance of considering co-exposures when estimating effects of PM2.5 exposure during pregnancy.

Ambient PM2.5 and birth outcomes: Estimating the association and attributable risk using a birth cohort study in nine Chinese cities

BACKGROUND

Previous studies have reported that maternal exposure to particles with aerodynamic diameter <2.5 μm (PM_2.5) is associated with birth outcomes. However, a multicity birth cohort study has not been conducted in China, and the attributable fraction of adverse birth outcomes due to PM_2.5 exposure remains unknown.

METHODS

We examined associations in a birth cohort of 1,455,026 mother-and-live-birth pairs who were followed up from the first hospital visit for pregnancy until the birth of the baby during 2014-2017 in nine cites of the Pearl River Delta (PRD) region, China. The PM_2.5 exposures were estimated based on the air pollution concentrations of the nearby monitors. Cox proportional hazards regressions were employed to examine the associations.

RESULTS

We found 1% (HR = 1.01; 95% CI: 1.00, 1.02), 6% (HR = 1.06; 95% CI: 1.05, 1.07), and 7% (HR = 1.07; 95% CI: 1.06, 1.08) increases in risk of PTB and 20% (HR = 1.20; 95% CI: 1.18, 1.22), 18% (HR = 1.18; 95% CI: 1.15, 1.20), and 20% (HR = 1.20; 95% CI: 1.17, 1.23) increases in risk of LBW, with each 10 μg/m³ increase in PM_2.5 from trimester 1 to trimester 3, respectively. For PTB, highest HRs were observed during trimester 3, as for LBW, stronger effect were observed during trimester 1 and trimester 3. We further estimated that 7.84% (95% CI: 6.21%, 9.50%) of PTB and 14.85% (95% CI: 13.00%, 16.61%) of the LBW cases could be attributable to PM_2.5 exposure during the third trimester.

CONCLUSION

The results indicate that maternal PM_2.5 exposure is a risk factor for both LBW and PTB, and responsible for considerable burdens of PTB and LBW in the Pearl River Delta region.

Premature births in Spain: Measuring the impact of air pollution using time series analyses

BACKGROUND

Premature birth (<37 weeks of gestation) is the principal indicator of neonatal death during the first month of life and the second cause of death of children under age five. There are 15 million premature births (PTB) worldwide. Air pollution in cities, primarily the result of urban traffic, greatly impacts PTBs, though there are few studies carried out on this topic at the country level. The objective of this study is to quantify the relative risks (RR) and the population attributable risk (PAR) of concentrations of contaminants on PTBs in Spain, and to analyze the most susceptible trimesters.

METHODS

For each province average weekly PTBs were calculated (ICD-10: P07.2-P07.3) during the period 2001-2009 as well as weekly average concentrations of PM₁₀, NO₂ and O₃. Estimations were made of RR and PAR using generalized linear models with link Poisson, controlling for the trend, seasonality, the autoregressive nature of the series and the influence of temperature in periods of heat and/or cold waves. A meta-analysis was carried out to estimate RR and PAR at the global level based on the RR obtained for each of the provinces.

RESULTS

For all of Spain, the global RR of PTB due to the impact of PM₁₀ was 1.071 (1.049, 1.093) and 1.150 (1.084, 1.220) for NO₂, with no detected association for O₃. Therefore, with decreases of 10 μg/m³ in the concentrations of PM₁₀ and NO₂, around 12.5% and 4.5% of PTBs could have been avoided respectively.

CONCLUSIONS

Around 1.35% of PTBs that occurred in Spain during the study period can be attributed to air pollution. The adoption of structural measures to reduce these air pollutants should result in a decrease in the number of PTBs in Spain.

Air pollution in the week prior to delivery and preterm birth in 24 Canadian cities: a time to event analysis

BACKGROUND

Numerous studies have examined the association between air pollution and preterm birth (< 37 weeks gestation) but findings have been inconsistent. These associations may be more difficult to detect than associations with other adverse birth outcomes because of the different duration of exposure in preterm vs. term births, and the existence of seasonal cycles in incidence of preterm birth.

METHODS

We analyzed data pertaining to 1,001,700 singleton births occurring between 1999 and 2008 in 24 Canadian cities where daily air pollution data were available from government monitoring sites. In the first stage, data were analyzed in each city employing Cox proportional hazards models using gestational age in days as the time scale, obtaining city-specific hazard ratios (HRs) with their 95% confidence intervals (CIs) expressed per interquartile range (IQR) of each air pollutant. Effects were examined using distributed lag functions for lags of 0-6 days prior to delivery, as well as cumulative lags from two to six days. We accounted for the potential nonlinear effect of daily mean ambient temperature using a cubic B-spline with three internal knots. In the second stage, we pooled the estimated city-specific hazard ratios using a random effects model.

RESULTS

Pooled estimates across 24 cities indicated that an IQR increase in ozone (O3, 13.3 ppb) 0-3 days prior to delivery was associated with a hazard ratio of 1.036 (95% CI 1.005, 1.067) for preterm birth, adjusting for infant sex, maternal age, marital status and country of birth, neighbourhood socioeconomic status (SES) and visible minority, temperature, year and season of birth, and a natural spline function of day of year. There was some evidence of effect modification by gestational age and season. Associations with carbon monoxide, nitrogen dioxide, particulate matter, and sulphur dioxide were inconsistent.

CONCLUSIONS

We observed associations between daily O3 in the week before delivery and preterm birth in an analysis of approximately 1 million births in 24 Canadian cities between 1999 and 2008. Our analysis is one of a limited number which have examined these short term associations employing Cox proportional hazards models to account for the different exposure durations of preterm vs. term births.

Exposure to ambient PM2.5 during pregnancy and preterm birth in metropolitan areas of the state of Georgia

A number of studies has pointed to air pollution as an additional factor that could be associated with preterm birth. We assessed in this study the association between exposure to PM_2.5 in ambient air during pregnancy and preterm birth in metropolitan areas of the state of Georgia, where the rate of preterm birth has been among the highest in the nation over the years. Birth data were obtained from the National Center for Health Statistics natality dataset. The study population consisted of 53,094 singleton live births between January 1 and December 31, 2004 in nine metropolitan counties of Georgia. Preterm birth was defined as birth, which occurs before 37 weeks of gestation. County-level daily air quality index (AQI) data obtained from the US Environmental Protection Agency (EPA) was used to estimate individual exposure levels of PM_2.5 for each study participant based on the county of residence for the duration of the pregnancy. A multivariate logistic regression analysis was conducted to assess the association, adjusting for potential confounders. Of the infants whose mothers resided in the nine metropolitan counties of Georgia, 4543 (8.6%) were born preterm. A higher rate of preterm birth (9.8%) was observed in infants whose mothers were exposed to ambient PM_2.5 with AQI values > 50 than the ones with AQI ≤ 50 (EPA standard for good air quality conditions). Mothers with exposure to PM_2.5 at average AQI values greater than 50 during the entire pregnancy were at increased risk of preterm birth (odds ratio 1.15; 95% CI 1.07, 1.25), after adjusting for sex of infant, mother's age, race/ethnicity, education, marital status, prenatal care, cigarette smoking, alcohol consumption, and season of conception. The study provides more evidence on the role of PM_2.5 in preterm birth. Reducing exposure to ambient particulate matter, especially in urban areas, for pregnant women would be necessary to improve the health of infants.

Impacts of gestational age uncertainty in estimating associations between preterm birth and ambient air pollution

Supplemental Digital Content is available in the text.

Background:

Previous epidemiologic studies utilizing birth records have shown heterogeneous associations between air pollution exposure during pregnancy and the risk of preterm birth (PTB, gestational age <37 weeks). Uncertainty in gestational age at birth may contribute to this heterogeneity.

Methods:

We first examined disagreement between clinical and last menstrual period-based (LMP) determination of PTB from individual-level birth certificate data for the 20-county Atlanta metropolitan area during 2002 to 2006. We then estimated associations between five trimester-averaged pollutant exposures and PTB, defined using various methods based on the clinical or LMP gestational age. Finally, using a multiple imputation approach, we incorporated uncertainty in gestational age to quantify the impact of this variability on associations between pollutant exposures and PTB.

Results:

Odds ratios (OR) were most elevated when a more stringent definition of PTB was used. For example, defining PTB only when LMP and clinical diagnoses agree yielded an OR of 1.09 (95% confidence interval [CI] = 1.04, 1.14) per interquartile range increase in first trimester carbon monoxide exposure versus an OR of 1.04 (95% CI = 1.01, 1.08) when PTB was defined as either an LMP or clinical diagnosis. Accounting for outcome uncertainty resulted in wider CIs—between 7.4% and 43.8% wider than those assuming the PTB outcome is without error.

Conclusions:

Despite discrepancies in PTB derived using either the clinical or LMP gestational age estimates, our analyses demonstrated robust positive associations between PTB and ambient air pollution exposures even when gestational age uncertainty is present.

Effect of airborne particulate matter of 2.5 μm or less on preterm birth: A national birth cohort study in China

BACKGROUND

Most evidences regarding ambient PM_2.5 or PM₁₀ (particulate matter of median aerodynamic diameter ≤2.5 μm or ≤10 μm) and preterm birth (PTB) come from western countries which has relatively low PM pollution exposure, and the results are still inconsistent. This study aims to examine whether exposure to high concentrations of PM_2.5 or PM₁₀ was associated with PTB (<37 weeks) and near term birth (37-38 weeks).

METHOD

We established a birth cohort with 1,280,524 singleton pregnancies who delivered from Dec 1st, 2013 to Nov 30th, 2014 and matched their home address to PM_2.5 and PM₁₀ concentrations which were predicted with machine learning methods based satellite remote sensing, meteorological and land use information. Cox proportional hazard regression models were used to analyze the associations between PTB and exposure of PM_2.5 or PM₁₀, after controlling for individual level covariates.

RESULTS

Exposure to PM_2.5 or PM₁₀ during pregnancy increases the risk of PTB and near term birth [e.g., Hazard ratios: 1.09 (95% CI: 1.09, 1.10), 1.08 (95% CI: 1.07, 1.08), 1.01 (95% CI: 1.01, 1.02), and 1.09 (95% CI: 1.08, 1.10) for each 10 μg/m³ increase in PM_2.5 for the 1st, 2nd, 3rd trimester and over the entire pregnancy, respectively]. The effects appeared to be stronger among women who come from rural areas, worked as farmers, were overweight before conception, whose mate was smoking during pregnancy, and conceived in autumn.

CONCLUSION

This study provides clear evidence that exposure to PM_2.5 or PM₁₀ during pregnancy increases the risk of PTB and near term birth. Public policies regarding improvement of air quality would produce great health benefit by reducing the burden of preterm birth.

Interactions of Fly Ash Particles with Mucin and Serum Albumin

Fly ash particles can contribute to haze and adverse health outcomes. In this study, two mucins, one from bovine submaxillary glands (bovine submaxillary mucin, BSM) and one from porcine stomach (porcine gastric mucin), as well as bovine serum albumin (BSA), which served as the physical barriers against foreign substances entering the tissues and the blood protein, respectively, were chosen as models for the investigations of the interactions between the proteins and the fly ash particles. Their adsorption behaviors were studied using spectroscopy and a quartz crystal microbalance with a dissipation monitor (QCM-D). The results indicated that the fly ash particles can induce the loosening of mucins and BSA, probably via the formation of complexes. Further, the secondary structure of proteins changed in the presence of fly ash particles. The α-helix content decreased with an increasing fly ash particle concentration. The addition of fly ash particles into protein solutions led to fluorescence quenching, which suggested that there were interactions between these particles and the mucins and BSA. The association constants ( K_a) for BSM and BSA were 5.35 and 4.18 L/g, respectively. Furthermore, the results of QCM-D analyses showed that the amount decreased on the mucin surface but increased slightly on the BSA surface, which indicated that the fly ash particles disrupted the mucin layer upon adsorption. These findings provide clear evidence of the interactions between the fly ash particles and the mucins and BSA, which can lead to structural changes. This study contributes to a better understanding of the interactions and adsorptions of atmospheric particulate pollutants with the proteins in the human body.

Air pollution and the fetal origin of disease: A systematic review of the molecular signatures of air pollution exposure in human placenta

BACKGROUND

Fetal development is a crucial window of susceptibility in which exposure-related alterations can be induced on the molecular level, leading to potential changes in metabolism and development. The placenta serves as a gatekeeper between mother and fetus, and is in contact with environmental stressors throughout pregnancy. This makes the placenta as a temporary organ an informative non-invasive matrix suitable to investigate omics-related aberrations in association with in utero exposures such as ambient air pollution.

OBJECTIVES

To summarize and discuss the current evidence and define the gaps of knowledge concerning human placental -omics markers in association with prenatal exposure to ambient air pollution.

METHODS

Two investigators independently searched the PubMed, ScienceDirect, and Scopus databases to identify all studies published until January 2017 with an emphasis on epidemiological research on prenatal exposure to ambient air pollution and the effect on placental -omics signatures.

RESULTS

From the initial 386 articles, 25 were retained following an a priori set inclusion and exclusion criteria. We identified eleven studies on the genome, two on the transcriptome, five on the epigenome, five on the proteome category, one study with both genomic and proteomic topics, and one study with both genomic and transcriptomic topics. Six studies discussed the triple relationship between exposure to air pollution during pregnancy, the associated placental -omics marker(s), and the potential effect on disease development later in life. So far, no metabolomic or exposomic data discussing associations between the placenta and prenatal exposure to air pollution have been published.

CONCLUSIONS

Integration of placental biomarkers in an environmental epidemiological context enables researchers to address fundamental questions essential in unraveling the fetal origin of disease and helps to better define the pregnancy exposome of air pollution.

Exposure to air pollution during preconceptional and prenatal periods and risk of hypertensive disorders of pregnancy: a retrospective cohort study in Seoul, Korea

Background

Previous studies suggested associations between prenatal exposure to air pollution and hypertensive disorders of pregnancy. We explored the associations between ambient concentrations of five major air pollutants during preconceptional and prenatal periods and three hypertensive disorders of pregnancy in Seoul, Korea, using a population-representative cohort.

Methods

We obtained heath and demographic data of pregnant women residing in Seoul for 2002–2013 from the Korean National Health Insurance Service–National Sample Cohort. For mother’s individual exposures to air pollution, we computed concentrations of particulate matter ≤10 μm in diameter (PM₁₀), nitrogen dioxide (NO₂), carbon monoxide (CO), sulfur dioxide (SO₂), and ozone (O₃) during 1, 3, 6, and 12 months to birth using regulatory monitoring data in Seoul. The associations between air pollution and hypertensive disorders were explored by using logistic regression models after adjusting for individual confounders.

Results

Among 18,835 pregnant women in Seoul, 0.6, 0.5, and 0.4% of women developed gestational hypertension, preeclampsia, and preeclampsia requiring magnesium sulfate (Mg-preeclampsia), respectively. Although most odds ratios (ORs) were not statistically significant, we found increasing risk gradients with disease severity depending on the pollutant. There was the association between PM₁₀ during 6 months to birth and gestational hypertension (OR for an interquartile range increase = 1.68 [95% confidence interval = 1.09–2.58]). NO₂ and ozone during 12 and 1 month, respectively, before birth were associated with Mg-preeclampsia (1.43 [1.01–2.03], 1.53 [1.03–2.27]).

Conclusions

We observed positive associations of exposure to some air pollutants before and during pregnancy with hypertensive disorders of pregnancy among the Korean general population. Future studies with refined exposure metrics should confirm our findings.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-1982-z) contains supplementary material, which is available to authorized users.

The association between ambient PM2.5 exposure and the risk of preterm birth in China: A retrospective cohort study

BACKGROUND

The relationship between PM2.5 exposure and preterm birth remains unclear.

OBJECTIVES

To explore the effect of exposure to PM2.5 on preterm birth in China.

METHODS

The birth outcomes of 426,246 pregnant women enrolled between January 2014 and December 2014 in NFPCP (National Free Pre-pregnancy Checkups Project) were collected, and their individual PM2.5 exposure values were estimated from the China National Environmental Monitoring Centre. The time of gestational exposure to PM2.5 was divided into four periods (the first trimester, the second trimester, the third trimester and the entire pregnancy). The average concentration and the corresponding quartiles of PM2.5 were calculated in these periods by the daily average PM2.5 data. Cox proportional hazards regression was used and he effects of maternal age, education level, occupation, second-hand smoking, alcohol use, pre-pregnancy BMI, baby's sex, number of previous pregnancies, coastal areas and season of conception were adjusted for.

RESULTS

A total of 426,246 singleton births were included, among which 35,261 (8.3%) were preterm birth. Effect of each 10μg/m³ increase of PM2.5 on preterm birth was most significant during the third trimester (HR, 1.06; 95%CI, 1.06-1.07), and also significant during the first trimester (HR, 1.04; 95%CI, 1.03-1.04), the second trimester (HR, 1.02; 95%CI, 1.02-1.02) and the entire pregnancy (HR, 1.06; 95%CI, 1.05-1.06). Compared with the lowest quartile of PM2.5, other quartiles increased the risk of preterm birth, and were most significant during the third trimester (HR, 1.87; 95%CI, 1.69-2.06). Subgroup analysis showed that compared with other subgroups, women who were older than 30years, had low education level, worked as farmers, had male baby, had previous pregnancies, not live in coastal areas and pregnant in winter were more sensitive to PM2.5 exposure.

CONCLUSIONS

Ambient PM2.5 exposure during pregnancy played an important role in the pregnancy process and increased the risk of preterm birth.

Retirements of Coal and Oil Power Plants in California: Association With Reduced Preterm Birth Among Populations Nearby

Coal and oil power plant retirements reduce air pollution nearby, but few studies have leveraged these natural experiments for public health research. We used California Department of Public Health birth records and US Energy Information Administration data from 2001-2011 to evaluate the relationship between the retirements of 8 coal and oil power plants and nearby preterm (gestational age of <37 weeks) birth. We conducted a difference-in-differences analysis using adjusted linear mixed models that included 57,005 births-6.3% of which were preterm-to compare the probability of preterm birth before and after power plant retirement among mothers residing within 0-5 km and 5-10 km of the 8 power plants. We found that power plant retirements were associated with a decrease in the proportion of preterm birth within 5 km (-0.019, 95% CI: -0.031, -0.008) and 5-10 km (-0.015, 95% CI: -0.024, -0.007), controlling for secular trends with mothers living 10-20 km away. For the 0-5-km area, this corresponds to a reduction in preterm birth from 7.0% to 5.1%. Subgroup analyses indicated a potentially larger association among non-Hispanic black and Asian mothers than among non-Hispanic white and Hispanic mothers and no differences in educational attainment. Future coal and oil power plant retirements may reduce preterm birth among nearby populations.

Environmental risk factors associated with low birth weight: The case study of the Haifa Bay Area in Israel

BACKGROUND

Low birth weight (LBW) is known to be associated with infant mortality and postnatal health complications. Previous studies revealed strong relationships between LBW rate and several socio-demographic factors, including ethnicity, maternal age, and family income. However, studies of association between LBW rate and environmental risk factors remain infrequent.

STUDY METHODS

We retrieved a geo-referenced data set, containing 7216 individual records of children born in 2015 in the Haifa Bay Area in Israel. Using this dataset, we analysed factors affecting LBW prevalence by applying two alternative techniques: analysis of LBW rates in small census area (SCAs) and more recently developed double kernel density (DKD) relative risk (RR) estimates.

RESULTS

In the SCA models, LBW rate was found to be associated with proximity to petrochemical industries (B=-0.26, 95%CI=-0.30, -0.22), road density (B=0.05, 95%CI=0.02, 0.08), distance to the seashore (B=0.17, 95%CI=0.14, 0.22), PM_2.5 (B=0.06, 95%CI=0.04, 0.09) and NO_x (B=0.10, 95%CI=0.06, 0.13) exposure estimates. Although similar factors emerged in the DKD models as well, in most cases, the effects of these factors in the latter models were found to be stronger: proximity to petrochemical industries (B=-0.48, 95%CI= -0.51, -0.30), road density (B=0.05, 95%CI=0.02, 0.08), distance to the seashore (B=0.24, 95%CI=0.21, 0.27), PM_2.5 (B=0.08, 95%CI=0.05, 0.10) and NO_x (B=0.20, 95%CI=0.17, 0.23) exposure estimates. In addition, elevation above the sea level was found to be statistically significant in spatial dependence models estimated for both DKD and SCA rates (P < 0.01).

CONCLUSION

The analysis revealed an excess LBW rate in residential areas located close to petrochemical industries and a protective effect of seashore proximity and elevation above the sea level on the LBW rate. We attribute the latter finding to the moderating effect of elevated seashore locations on outdoor temperatures during the hot summer season.

Retirements of Coal and Oil Power Plants in California: Association With Reduced Preterm Birth Among Populations Nearby

Coal and oil power plant retirements reduce air pollution nearby, but few studies have leveraged these natural experiments for public health research. We used California Department of Public Health birth records and US Energy Information Administration data from 2001-2011 to evaluate the relationship between the retirements of 8 coal and oil power plants and nearby preterm (gestational age of <37 weeks) birth. We conducted a difference-in-differences analysis using adjusted linear mixed models that included 57,005 births-6.3% of which were preterm-to compare the probability of preterm birth before and after power plant retirement among mothers residing within 0-5 km and 5-10 km of the 8 power plants. We found that power plant retirements were associated with a decrease in the proportion of preterm birth within 5 km (-0.019, 95% CI: -0.031, -0.008) and 5-10 km (-0.015, 95% CI: -0.024, -0.007), controlling for secular trends with mothers living 10-20 km away. For the 0-5-km area, this corresponds to a reduction in preterm birth from 7.0% to 5.1%. Subgroup analyses indicated a potentially larger association among non-Hispanic black and Asian mothers than among non-Hispanic white and Hispanic mothers and no differences in educational attainment. Future coal and oil power plant retirements may reduce preterm birth among nearby populations.

Maternal exposure to ambient PM10 during pregnancy increases the risk of congenital heart defects: Evidence from machine learning models

Previous research suggested an association between maternal exposure to ambient air pollutants and risk of congenital heart defects (CHDs), though the effects of particulate matter ≤10μm in aerodynamic diameter (PM₁₀) on CHDs are inconsistent. We used two machine learning models (i.e., random forest (RF) and gradient boosting (GB)) to investigate the non-linear effects of PM₁₀ exposure during the critical time window, weeks 3-8 in pregnancy, on risk of CHDs. From 2009 through 2012, we carried out a population-based birth cohort study on 39,053 live-born infants in Beijing. RF and GB models were used to calculate odds ratios for CHDs associated with increase in PM₁₀ exposure, adjusting for maternal and perinatal characteristics. Maternal exposure to PM₁₀ was identified as the primary risk factor for CHDs in all machine learning models. We observed a clear non-linear effect of maternal exposure to PM₁₀ on CHDs risk. Compared to 40μgm^-3, the following odds ratios resulted: 1) 92μgm^-3 [RF: 1.16 (95% CI: 1.06, 1.28); GB: 1.26 (95% CI: 1.17, 1.35)]; 2) 111μgm^-3 [RF: 1.04 (95% CI: 0.96, 1.14); GB: 1.04 (95% CI: 0.99, 1.08)]; 3) 124μgm^-3 [RF: 1.01 (95% CI: 0.94, 1.10); GB: 0.98 (95% CI: 0.93, 1.02)]; 4) 190μgm^-3 [RF: 1.29 (95% CI: 1.14, 1.44); GB: 1.71 (95% CI: 1.04, 2.17)]. Overall, both machine models showed an association between maternal exposure to ambient PM₁₀ and CHDs in Beijing, highlighting the need for non-linear methods to investigate dose-response relationships.

Development of a high-throughput in vivo screening platform for particulate matter exposures

Particulate matter (PM) exposure is a public health burden with poorly understood health effect mechanisms and lacking an efficient model to compare the vast diversity of PM exposures. Zebrafish (Danio rerio) are amenable to high-throughput screening (HTS), but few studies have investigated PM toxicity in zebrafish, despite the multitude of advantages. To develop standardized exposure procedures, the urban PM standard reference material (SRM) 1649b was used to systematically determine sample preparation methods, design experimental controls, determine concentration ranges and evaluation procedures. Embryos (n = 32/treatment) were dechorionated and placed into 96-well plates containing SRM1649b (0-200 μg/mL) at 6 h post fertilization (hpf). Developmental toxicity was assessed at 24 and 120 hpf by evaluating morphological changes, embryonic/larval photomotor behavior, and mortality. Differences from blank medium and particle controls were observed for all biological responses measured. Differences due to SRM1649b concentration and preparation method were also observed. Exposure to SRM1649b from DMSO extraction was associated with changes in morphology and mortality and hypoactivity in photomotor responses compared to the DMSO control for the whole particle suspension (76, 68%) and soluble fraction (59, 54%) during the embryonic and larval stages, respectively. Changes in behavioral responses were not observed following exposure to the insoluble fraction of SRM1649b from DMSO extraction. The toxicity bias from PM preparation provided further impetus to select a single HTS exposure method. Based on the biological activity results, the soluble fraction of SRM1649b from DMSO extraction was selected and shown to have concentration dependent cyp1a/GFP expression. This rapid, sensitive and consistently scalable model is a potentially cost-effective vertebrate approach to study the toxicology of PM from diverse locations, and provides a path to identifying the toxic material(s) in these samples, and discover the mechanisms of toxicity.

Air pollution-induced placental epigenetic alterations in early life: a candidate miRNA approach

Particulate matter (PM) exposure during in utero life may entail adverse health outcomes in later-life. Air pollution's adverse effects are known to alter gene expression profiles, which can be regulated by microRNAs (miRNAs). We investigate the potential influence of air pollution exposure in prenatal life on placental miRNA expression. Within the framework of the ENVIRONAGE birth cohort, we measured the expression of six candidate miRNAs in placental tissue from 210 mother-newborn pairs by qRT-PCR. Trimester-specific PM_2.5 exposure levels were estimated for each mother's home address using a spatiotemporal model. Multiple regression models were used to study miRNA expression and in utero exposure to PM_2.5 over various time windows during pregnancy. The placental expression of miR-21 (−33.7%, 95% CI: −53.2 to −6.2, P = 0.022), miR-146a (−30.9%, 95% CI: −48.0 to −8.1, P = 0.012) and miR-222 (−25.4%, 95% CI: −43.0 to −2.4, P = 0.034) was inversely associated with PM_2.5 exposure during the 2nd trimester of pregnancy, while placental expression of miR-20a and miR-21 was positively associated with 1st trimester exposure. Tumor suppressor phosphatase and tensin homolog (PTEN) was identified as a common target of the miRNAs significantly associated with PM exposure. Placental PTEN expression was strongly and positively associated (+59.6% per 5 µg/m³ increment, 95% CI: 26.9 to 100.7, P < 0.0001) with 3rd trimester PM_2.5 exposure. Further research is required to establish the role these early miRNA and mRNA expression changes might play in PM-induced health effects. We provide molecular evidence showing that in utero PM_2.5 exposure affects miRNAs expression as well as its downstream target PTEN.

Air Pollution and Other Environmental Modulators of Cardiac Function

Cardiovascular disease (CVD) is the leading cause of death in developed regions and a worldwide health concern. Multiple external causes of CVD are well known, including obesity, diabetes, hyperlipidemia, age, and sedentary behavior. Air pollution has been linked with the development of CVD for decades, though the mechanistic characterization remains unknown. In this comprehensive review, we detail the background and epidemiology of the effects of air pollution and other environmental modulators on the heart, including both short- and long-term consequences. Then, we provide the experimental data and current hypotheses of how pollution is able to cause the CVD, and how exposure to pollutants is exacerbated in sensitive states. Published 2017. Compr Physiol 7:1479-1495, 2017.

Association between PM2.5 and PM2.5 Constituents and Preterm Delivery in California, 2000-2006

BACKGROUND

Particulate matter (PM) has been documented to contribute to preterm delivery. However, few studies have investigated the relationships between individual constituents of fine PM (PM_2.5 ) and preterm delivery, and factors that may modify their associations.

METHODS

In this study, we examined the associations between several prenatal exposure metrics to PM_2.5 and 23 constituents of PM_2.5 and preterm delivery in California from 2000 to 2006. In a retrospective cohort study including 231 637 births, we conducted logistic regression analyses adjusting for maternal, infant, temporal, geographic, and neighbourhood characteristics.

RESULTS

We observed increased risk for preterm delivery with full-gestational exposure for several PM_2.5 constituents. Per interquartile range increase, ammonium (21.2%, 95% confidence interval (CI) 17.1, 25.4), nitrate (18.1%, 95% CI 14.9, 21.4) and bromine (16.7%, 95% CI 13.2, 20.3) had some of the largest increased risks. Alternatively, some PM_2.5 constituents were inversely associated with preterm delivery, including chlorine (-8.2%, 95% CI -10.3, -6.0), sodium (-13.2%, 95% CI -15.2, -11.3), sodium ion (-11.9%, 95% CI -14.1, -9.6) and vanadium (-19.2%, 95% CI -25.3, -12.6). Greater associations between PM_2.5 constituents and preterm delivery were observed for Blacks and Asians, older mothers, and those with some college education compared to their reference groups, as well as for births with gestational ages from 32 to 34 weeks.

CONCLUSIONS

PM_2.5 constituents ammonium, nitrate and bromine, often linked to traffic and biomass combustion, were most associated with increased risk of preterm delivery in California. Certain demographic subgroups may be particularly impacted.

Association between ambient fine particulate matter and preterm birth or term low birth weight: An updated systematic review and meta-analysis

An increasing number of studies have been conducted to determine a possible linkage between maternal exposure to ambient fine particulate matter and effects on the developing human fetus that can lead to adverse birth outcomes, but, the present results are not consistent. A total of 23 studies published before July 2016 were collected and analyzed and the mean value of reported exposure to fine particulate matter (PM_2.5) ranged from 1.82 to 22.11 We found a significantly increased risk of preterm birth with interquartile range increase in PM_2.5 exposure throughout pregnancy (odds ratio (OR) = 1.03; 95% conditional independence (CI): 1.01-1.05). The pooled OR for the association between PM_2.5 exposure, per interquartile range increment, and term low birth weight throughout pregnancy was 1.03 (95% CI: 1.02-1.03). The pooled ORs for the association between PM_2.5 exposure per 10 increment, and term low birth weight and preterm birth were 1.05 (95% CI: 0.98-1.12) and 1.02 (95% CI: 0.93-1.12), respectively throughout pregnancy. There is a significant heterogeneity in most meta-analyses, except for pooled OR per interquartile range increase for term low birth weight throughout pregnancy. We here show that maternal exposure to fine particulate air pollution increases the risk of preterm birth and term low birth weight. However, the effect of exposure time needs to be further explored. In the future, prospective cohort studies and personal exposure measurements needs to be more widely utilized to better characterize the relationship between ambient fine particulate exposure and adverse birth outcomes.

Exposure to Ambient Particulate Matter during Specific Gestational Periods Produces Adverse Obstetric Consequences in Mice

BACKGROUND

Epidemiological studies associate inhalation of fine-sized particulate matter (PM_2.5) during pregnancy with preterm birth (PTB) and low birth weight (LBW) but disagree over which time frames are most sensitive, or if effects are cumulative.

OBJECTIVES

Our objective was to provide experimental plausibility for epidemiological observations by testing the hypothesis that exposure to PM_2.5 during discrete periods of pregnancy results in PTB and LBW.

METHODS

For the first study, timed-pregnant B6C3F1 mice were exposed to concentrated ambient PM_2.5 (CAPs) or filtered air (FA) throughout pregnancy [6 h/d from gestational day (GD) 0.5 through GD16.5]. A follow-up study examined the effects of CAPs exposure during discrete gestational periods (1: GD0.5–5.5; 2: GD6.5–14.5; 3: GD14.5–16.5; 4: GD0.5–16.5) aligning to milestones during human development.

RESULTS

In the first experiment, exposure to 160 μg CAPs/m³ throughout pregnancy decreased gestational term by 0.5 d (∼1.1  wk decrease for humans) and birth weight by 11.4% compared with FA. The follow-up experiment investigated timing of CAPs exposure (mean concentrations at 178, 193, 171, and 173 μg/m³ for periods 1–4, respectively). Pregnancy was significantly shortened (vs. FA) by ∼0.4d when exposure occurred during gestational periods 2 and 4, and by ∼0.5d if exposure occurred during period 3. Exposure during periods 1, 2, and 4 reduced birth weight by ∼10% compared with FA, and placental weight was reduced (∼8%) on GD17.5 if exposure occurred only during period 3.

CONCLUSIONS

Adverse PM_2.5-induced outcomes such as PTB and LBW are dependent upon the periods of maternal exposure. The results of these experimental studies could contribute significantly to air pollution policy decisions in the future. https://doi.org/10.1289/EHP1029.

Newborn sex-specific transcriptome signatures and gestational exposure to fine particles: findings from the ENVIRONAGE birth cohort

BACKGROUND

Air pollution exposure during pregnancy has been associated with adverse birth outcomes and health problems later in life. We investigated sex-specific transcriptomic responses to gestational long- and short-term exposure to particulate matter with a diameter < 2.5 μm (PM_2.5) in order to elucidate potential underlying mechanisms of action.

METHODS

Whole genome gene expression was investigated in cord blood of 142 mother-newborn pairs that were enrolled in the ENVIRONAGE birth cohort. Daily PM_2.5 exposure levels were calculated for each mother's home address using a spatial-temporal interpolation model in combination with a dispersion model to estimate both long- (annual average before delivery) and short- (last month of pregnancy) term exposure. We explored the association between gene expression levels and PM_2.5 exposure, and identified modulated pathways by overrepresentation analysis and gene set enrichment analysis.

RESULTS

Some processes were altered in both sexes for long- (e.g. DNA damage) or short-term exposure (e.g. olfactory signaling). For long-term exposure in boys neurodevelopment and RhoA pathways were modulated, while in girls defensin expression was down-regulated. For short-term exposure we identified pathways related to synaptic transmission and mitochondrial function (boys) and immune response (girls).

CONCLUSIONS

This is the first whole genome gene expression study in cord blood to identify sex-specific pathways altered by PM_2.5. The identified transcriptome pathways could provide new molecular insights as to the interaction pattern of early life PM_2.5 exposure with the biological development of the fetus.

Fetal Thyroid Function, Birth Weight, and in Utero Exposure to Fine Particle Air Pollution: A Birth Cohort Study

BACKGROUND

Thyroid hormones are critical for fetal development and growth. Whether prenatal exposure to fine particle air pollution (≤ 2.5 μm; PM_2.5) affects fetal thyroid function and what the impact is on birth weight in normal healthy pregnancies have not been studied yet.

OBJECTIVES

We studied the impact of third-trimester PM_2.5 exposure on fetal and maternal thyroid hormones and their mediating role on birth weight.

METHODS

We measured the levels of free thyroid hormones (FT₃, FT₄) and thyroid-stimulating hormone (TSH) in cord blood (n = 499) and maternal blood (n = 431) collected after delivery from mother-child pairs enrolled between February 2010 and June 2014 in the ENVIRONAGE birth cohort with catchment area in the province of Limburg, Belgium.

RESULTS

An interquartile range (IQR) increment (8.2 μg/m³) in third-trimester PM_2.5 exposure was inversely associated with cord blood TSH levels (-11.6%; 95% CI: -21.8, -0.1) and the FT₄/FT₃ ratio (-62.7%; 95% CI: -91.6, -33.8). A 10th-90th percentile decrease in cord blood FT₄ levels was associated with a 56 g decrease in mean birth weight (95% CI: -90, -23). Assuming causality, we estimated that cord blood FT₄ mediated 21% (-19 g; 95% CI: -37, -1) of the estimated effect of an IQR increment in third-trimester PM_2.5 exposure on birth weight. Third-trimester PM_2.5 exposure was inversely but not significantly associated with maternal blood FT₄ levels collected 1 day after delivery (-4.0%, 95% CI: -8.0, 0.2 for an IQR increment in third-trimester PM_2.5).

CONCLUSIONS

In our study population of normal healthy pregnancies, third-trimester exposure to PM_2.5 air pollution was associated with differences in fetal thyroid hormone levels that may contribute to reduced birth weight. Additional research is needed to confirm our findings in other populations and to evaluate potential consequences later in life.

Environmental chemicals and preterm birth: Biological mechanisms and the state of the science

PURPOSE OF REVIEW

Preterm birth is a significant worldwide health problem of uncertain origins. The extant body of literature examining environmental contaminant exposures in relation to preterm birth is extensive but results remain ambiguous for most organic pollutants, metals and metalloids, and air pollutants. In the present review we examine recent epidemiologic studies investigating these associations, and identify recent advances and the state of the science. Additionally, we highlight biological mechanisms of action in the pathway between chemical exposures and preterm birth, including inflammation, oxidative stress, and endocrine disruption, that deserve more attention in this context.

RECENT FINDINGS

Important advances have been made in the study of the environment and preterm birth, particularly in regard to exposure assessment methods, exploration of effect modification by co-morbidities and exposures, and in identification of windows of vulnerability during gestation. There is strong evidence for an association between maternal exposure to some persistent pesticides, lead, and fine particulate matter, but data on other contaminants is sparse and only suggestive trends can be noted with the current data.

SUMMARY

Beyond replicating current findings, further work must be done to improve understanding of mechanisms underlying the associations observed between environmental chemical exposures and preterm birth. By examining windows of vulnerability, disaggregating preterm birth by phenotypes, and measuring biomarkers of mechanistic pathways in these epidemiologic studies we can improve our ability to detect associations with exposure, provide additional evidence for causality in an observational setting, and identify opportunities for intervention.

Lower Placental Leptin Promoter Methylation in Association with Fine Particulate Matter Air Pollution during Pregnancy and Placental Nitrosative Stress at Birth in the ENVIRONAGE Cohort

BACKGROUND

Particulate matter with a diameter ≤ 2.5 μm (PM2.5) affects human fetal development during pregnancy. Oxidative stress is a putative mechanism by which PM2.5 may exert its effects. Leptin (LEP) is an energy-regulating hormone involved in fetal growth and development.

OBJECTIVES

We investigated in placental tissue whether DNA methylation of the LEP promoter is associated with PM2.5 and whether the oxidative/nitrosative stress biomarker 3-nitrotyrosine (3-NTp) is involved.

METHODS

LEP DNA methylation status of 361 placentas from the ENVIRONAGE birth cohort was assessed using bisulfite-PCR-pyrosequencing. Placental 3-NTp (n = 313) was determined with an ELISA assay. Daily PM2.5 exposure levels were estimated for each mother's residence, accounting for residential mobility during pregnancy, using a spatiotemporal interpolation model.

RESULTS

After adjustment for a priori chosen covariates, placental LEP methylation was 1.4% lower (95% CI: -2.7, -0.19%) in association with an interquartile range increment (7.5 μg/m3) in second-trimester PM2.5 exposure and 0.43% lower (95% CI: -0.85, -0.02%) in association with a doubling of placental 3-NTp content.

CONCLUSIONS

LEP methylation status in the placenta was negatively associated with PM2.5 exposure during the second trimester, and with placental 3-NTp, a marker of oxidative/nitrosative stress. Additional research is needed to confirm our findings and to assess whether oxidative/nitrosative stress might contribute to associations between PM2.5 and placental epigenetic events. Potential consequences for health during the neonatal period and later in life warrant further exploration. Citation: Saenen ND, Vrijens K, Janssen BG, Roels HA, Neven KY, Vanden Berghe W, Gyselaers W, Vanpoucke C, Lefebvre W, De Boever P, Nawrot TS. 2017. Lower placental leptin promoter methylation in association with fine particulate matter air pollution during pregnancy and placental nitrosative stress at birth in the ENVIRONAGE cohort. Environ Health Perspect 125:262-268; http://dx.doi.org/10.1289/EHP38.

Particulate Matter Exposure and Preterm Birth: Estimates of U.S. Attributable Burden and Economic Costs

BACKGROUND

Preterm birth (PTB) rates (11.4% in 2013) in the United States remain high and are a substantial cause of morbidity. Studies of prenatal exposure have associated particulate matter ≤ 2.5 μm in diameter (PM2.5) and other ambient air pollutants with adverse birth outcomes; yet, to our knowledge, burden and costs of PM2.5-attributable PTB have not been estimated in the United States.

OBJECTIVES

We aimed to estimate burden of PTB in the United States and economic costs attributable to PM2.5 exposure in 2010.

METHODS

Annual deciles of PM2.5 were obtained from the U.S. Environmental Protection Agency. We converted PTB odds ratio (OR), identified in a previous meta-analysis (1.15 per 10 μg/m3 for our base case, 1.07-1.16 for low- and high-end scenarios) to relative risk (RRs), to obtain an estimate that better represents the true relative risk. A reference level (RL) of 8.8 μg/m3 was applied. We then used the RR estimates and county-level PTB prevalence to quantify PM2.5-attributable PTB. Direct medical costs were obtained from the 2007 Institute of Medicine report, and lost economic productivity (LEP) was estimated using a meta-analysis of PTB-associated IQ loss, and well-established relationships of IQ loss with LEP. All costs were calculated using 2010 dollars.

RESULTS

An estimated 3.32% of PTBs nationally (corresponding to 15,808 PTBs) in 2010 could be attributed to PM2.5 (PM2.5 > 8.8 μg/m3). Attributable PTBs cost were estimated at $5.09 billion [sensitivity analysis (SA): $2.43-9.66 B], of which $760 million were spent for medical care (SA: $362 M-1.44 B). The estimated PM2.5 attributable fraction (AF) of PTB was highest in urban counties, with highest AFs in the Ohio Valley and the southern United States.

CONCLUSIONS

PM2.5 may contribute substantially to burden and costs of PTB in the United States, and considerable health and economic benefits could be achieved through environmental regulatory interventions that reduce PM2.5 exposure in pregnancy. Citation: Trasande L, Malecha P, Attina TM. 2016. Particulate matter exposure and preterm birth: estimates of U.S. attributable burden and economic costs. Environ Health Perspect 124:1913-1918; http://dx.doi.org/10.1289/ehp.1510810.

Effect of Environmental Factors on Low Weight in Non-Premature Births: A Time Series Analysis

OBJECTIVE

Exposure to pollutants during pregnancy has been related to adverse birth outcomes. LBW can give rise to lifelong impairments. Prematurity is the leading cause of LBW, yet few studies have attempted to analyse how environmental factors can influence LBW in infants who are not premature. This study therefore sought to analyse the influence of air pollution, noise levels and temperature on LBW in non-premature births in Madrid during the period 2001-2009.

METHODS

Ecological time-series study to assess the impact of PM2.5, NO2 and O3 concentrations, noise levels, and temperatures on LBW among non-premature infants across the period 2001-2009. Our analysis extended to infants having birth weights of 1,500 g to 2,500 g (VLBW) and less than 1,500 g (ELBW). Environmental variables were lagged until 37 weeks with respect to the date of birth, and cross-correlation functions were used to identify explaining lags. Results were quantified using Poisson regression models.

RESULTS

Across the study period 298,705 births were registered in Madrid, 3,290 of which had LBW; of this latter total, 1,492 were non-premature. PM2.5 was the only pollutant to show an association with the three variables of LBW in non-premature births. This association occurred at around the third month of gestation for LBW and VLBW (LBW: lag 23 and VLBW: lag 25), and at around the eighth month of gestation for ELBW (lag 6). Leqd was linked to LBW at lag zero. The RR of PM2.5 on LBW was 1.01 (1.00 1.03). The RR of Leqd on LBW was 1.09 (0.99 1.19)(p<0.1).

CONCLUSIONS

The results obtained indicate that PM2.5 had influence on LBW. The adoption of measures aimed at reducing the number of vehicles would serve to lower pregnant women's exposure. In the case of noise should be limited the exposure to high levels during the final weeks of pregnancy.

Comparison of gestational dating methods and implications for exposure-outcome associations: an example with PM2.5 and preterm birth

OBJECTIVES

Estimating gestational age is usually based on date of last menstrual period (LMP) or clinical estimation (CE); both approaches introduce potential bias. Differences in methods of estimation may lead to misclassification and inconsistencies in risk estimates, particularly if exposure assignment is also gestation-dependent. This paper examines a 'what-if' scenario in which alternative methods are used and attempts to elucidate how method choice affects observed results.

METHODS

We constructed two 20-week gestational age cohorts of pregnancies between 2000 and 2005 (New Jersey, Pennsylvania, Ohio, USA) using live birth certificates: one defined preterm birth (PTB) status using CE and one using LMP. Within these, we estimated risk for 4 categories of preterm birth (PTBs per 10⁶ pregnancies) and risk differences (RD (95% CIs)) associated with exposure to particulate matter (PM_2.5).

RESULTS

More births were classified preterm using LMP (16%) compared with CE (8%). RD divergences increased between cohorts as exposure period approached delivery. Among births between 28 and 31 weeks, week 7 PM_2.5 exposure conveyed RDs of 44 (21 to 67) for CE and 50 (18 to 82) for LMP populations, while week 24 exposure conveyed RDs of 33 (11 to 56) and -20 (-50 to 10), respectively.

CONCLUSIONS

Different results from analyses restricted to births with both CE and LMP are most likely due to differences in dating methods rather than selection issues. Results are sensitive to choice of gestational age estimation, though degree of sensitivity can vary by exposure timing. When both outcome and exposure depend on estimate of gestational age, awareness of nuances in the method used for estimation is critical.

Intrauterine Inflammation and Maternal Exposure to Ambient PM2.5 during Preconception and Specific Periods of Pregnancy: The Boston Birth Cohort

BACKGROUND

Prenatal exposure to ambient PM2.5, (i.e., fine particulate matter, aerodynamic diameter ≤ 2.5 μm) has been associated with preterm birth and low birth weight. The association between prenatal PM2.5 exposure and intrauterine inflammation (IUI), an important risk factor for preterm birth and neurodevelopmental outcomes, has not been evaluated.

OBJECTIVES

We aimed to investigate the association between maternal exposure to PM2.5 and IUI in the Boston Birth Cohort, a predominantly urban low-income minority population.

METHODS

This analysis included 5,059 mother-infant pairs in the Boston Birth Cohort. IUI was assessed based on intrapartum fever and placenta pathology. PM2.5 exposure was assigned using data from the U.S. EPA's Air Quality System. Odds ratios (OR) and 95% confidence intervals (CI) quantified the association of maternal PM2.5 exposure during preconception and various periods of pregnancy with IUI.

RESULTS

Comparing the highest with the lowest PM2.5 exposure quartiles, the multi-adjusted association with IUI was significant for all exposure periods considered, including 3 months before conception (OR = 1.52; 95% CI: 1.22, 1.89), first trimester (OR = 1.93; 95% CI: 1.55, 2.40), second trimester (OR = 1.67; 95% CI: 1.35, 2.08), third trimester (OR = 1.53; 95% CI: 1.24, 1.90), and whole pregnancy (OR = 1.92; 95% CI: 1.55, 2.37).

CONCLUSIONS

Despite relatively low exposures, our results suggest a monotonic positive relationship between PM2.5 exposure during preconception and pregnancy and IUI. IUI may be a sensitive biomarker for assessing early biological effect of PM2.5 exposure on the developing fetus.

CITATION

Nachman RM, Mao G, Zhang X, Hong X, Chen Z, Soria CS, He H, Wang G, Caruso D, Pearson C, Biswal S, Zuckerman B, Wills-Karp M, Wang X. 2016. Intrauterine inflammation and maternal exposure to ambient PM2.5 during preconception and specific periods of pregnancy: the Boston Birth Cohort. Environ Health Perspect 124:1608-1615; http://dx.doi.org/10.1289/EHP243.

Placental Nitrosative Stress and Exposure to Ambient Air Pollution During Gestation: A Population Study

The placenta plays a crucial role in fetal growth and development through adaptive responses to perturbations of the maternal environment. We investigated the association between placental 3-nitrotyrosine (3-NTp), a biomarker of oxidative stress, and exposure to air pollutants during various time windows of pregnancy. We measured the placental 3-NTp levels of 330 mother-newborn pairs enrolled in the Environmental Influence on Ageing in Early Life (ENVIRONAGE) Study, a Belgian birth cohort study (2010-2013). Daily concentrations of particulate matter with an aerodynamic diameter ≤2.5 µm (PM2.5), black carbon (BC), and nitrogen dioxide were interpolated for each mother's residence using a spatiotemporal interpolation method. Placental 3-NTp levels, adjusted for covariates, increased by 35.0% (95% confidence interval (CI): 13.9, 60.0) for each interquartile-range increment in entire-pregnancy PM2.5 exposure. The corresponding estimate for BC exposure was 13.9% (95% CI: -0.21, 29.9). These results were driven by the first (PM2.5: 29.0% (95% CI: 4.9, 58.6); BC: 23.6% (95% CI: 4.4, 46.4)) and second (PM2.5: 39.3% (95% CI: 12.3, 72.7)) gestational exposure windows. This link between placental nitrosative stress and exposure to fine particle air pollution during gestation is in line with experimental evidence on cigarette smoke and diesel exhaust exposure. Further research is needed to elucidate potential health consequences experienced later in life through particle-mediated nitrosative stress incurred during fetal life.