Air Pollution Exposure Monitoring among Pregnant Women with and without Asthma

Characterisation of personalised air pollution exposure in pregnant women participating in a birth cohort study

BACKGROUND

Air pollution is a health risk in pregnant women and children. Despite the importance of refined exposure assessment, the characterisation of personalised air pollution exposure remains a challenge in paediatric and perinatal epidemiology.

OBJECTIVE

We used portable personal air monitors to characterise personalised exposure to air pollutants in pregnant women.

METHODS

Between November 2019 and May 2022, we offered personal air monitors to pregnant women participating in a birth cohort in New York City. During pregnancy, women used air monitors, which measured particulate matter (PM), nitrogen dioxide (NO2 ), and volatile organic compounds (average use = 14 days). Data were stored in real-time on a secure database via synchronisation with a smartphone application. Of 497 women who agreed to use air monitors, 273 women (55%) were successful in using air monitors for longer than a day. For these participants, we identified daily patterns of exposure to air pollutants using functional principal component analysis (3827 days of air monitoring).

RESULTS

Compared to women with no pollution data (n = 224), women who successfully used monitors were more likely to be non-Hispanic White and Asian (vs. Hispanic), nulliparous, unemployed, married/partnered, and received the device in-person (vs. mailed). We identified different daily patterns of exposure to air pollutants. The most dominant pattern for all pollutants was low exposure levels with little variations within 24 h, followed by a pattern that showed differences between day and night levels. NO2 had higher daily variations compared to PM.

CONCLUSIONS

Small wearables are useful for the measurement of personalised air pollution exposure in birth cohorts and identify daily patterns that cannot be captured otherwise. Successful participation, however, depends on certain individual characteristics. Future studies should consider strategies in design and analysis to account for selective participation.

Using time-resolved monitor wearing data to study the effect of clean cooking interventions on personal air pollution exposures

BACKGROUND

Personal monitoring can estimate individuals' exposures to environmental pollutants; however, accuracy depends on consistent monitor wearing, which is under evaluated.

OBJECTIVE

To study the association between device wearing and personal air pollution exposure.

METHODS

Using personal device accelerometry data collected in the context of a randomized cooking intervention in Ghana with three study arms (control, improved biomass, and liquified petroleum gas (LPG) arms; N = 1414), we account for device wearing to infer parameters of PM2.5 and CO exposure.

RESULTS

Device wearing was positively associated with exposure in the control and improved biomass arms, but weakly in the LPG arm. Inferred community-level air pollution was similar across study arms (~45 μg/m3). The estimated direct contribution of individuals' cooking to PM2.5 exposure was 64 μg/m3 for the control arm, 74 μg/m3 for improved biomass, and 6 μg/m3 for LPG. Arm-specific average PM2.5 exposure at near-maximum wearing was significantly lower in the LPG arm as compared to the improved biomass and control arms. Analysis of personal CO exposure mirrored PM2.5 results.

CONCLUSIONS

Personal monitor wearing was positively associated with average air pollution exposure, emphasizing the importance of high device wearing during monitoring periods and directly assessing device wearing for each deployment.

SIGNIFICANCE

We demonstrate that personal monitor wearing data can be used to refine exposure estimates and infer unobserved parameters related to the timing and source of environmental exposures.

IMPACT STATEMENTS

In a cookstove trial among pregnant women, time-resolved personal air pollution device wearing data were used to refine exposure estimates and infer unobserved exposure parameters, including community-level air pollution, the direct contribution of cooking to personal exposure, and the effect of clean cooking interventions on personal exposure. For example, in the control arm, while average 48 h personal PM2.5 exposure was 77 μg/m3, average predicted exposure at near-maximum daytime device wearing was 108 μg/m3 and 48 μg/m3 at zero daytime device wearing. Wearing-corrected average 48 h personal PM2.5 exposures were 50% lower in the LPG arm than the control and improved biomass and inferred direct cooking contributions to personal PM2.5 from LPG were 90% lower than the other arms. Our recommendation is that studies assessing personal exposures should examine the direct association between device wearing and estimated mean personal exposure.

Advancing women's participation in climate action through digital health literacy: gaps and opportunities

Exploring the contribution of health informatics is an emerging topic in relation to addressing climate change, but less examined is a body of literature reporting on the potential and effectiveness of women participating in climate action supported by digital health. This perspective explores how empowering women through digital health literacy (DHL) can support them to be active agents in addressing climate change risk and its impacts on health and well-being. We also consider the current definitional boundary of DHL, and how this may be shaped by other competencies (eg, environmental health literacy), to strengthen this critical agenda for developed nations and lower-resource settings.

Wildfire Smoke Exposure during Pregnancy: A Review of Potential Mechanisms of Placental Toxicity, Impact on Obstetric Outcomes, and Strategies to Reduce Exposure

Climate change is accelerating the intensity and frequency of wildfires globally. Understanding how wildfire smoke (WS) may lead to adverse pregnancy outcomes and alterations in placental function via biological mechanisms is critical to mitigate the harms of exposure. We aim to review the literature surrounding WS, placental biology, biological mechanisms underlying adverse pregnancy outcomes as well as interventions and strategies to avoid WS exposure in pregnancy. This review includes epidemiologic and experimental laboratory-based studies of WS, air pollution, particulate matter (PM), and other chemicals related to combustion in relation to obstetric outcomes and placental biology. We summarized the available clinical, animal, and placental studies with WS and other combustion products such as tobacco, diesel, and wood smoke. Additionally, we reviewed current recommendations for prevention of WS exposure. We found that there is limited data specific to WS; however, studies on air pollution and other combustion sources suggest a link to inflammation, oxidative stress, endocrine disruption, DNA damage, telomere shortening, epigenetic changes, as well as metabolic, vascular, and endothelial dysregulation in the maternal-fetal unit. These alterations in placental biology contribute to adverse obstetric outcomes that disproportionally affect the most vulnerable. Limiting time outdoors, wearing N95 respirator face masks and using high quality indoor air filters during wildfire events reduces exposure to related environmental exposures and may mitigate morbidities attributable to WS.

Outdoor Air Pollution and Pregnancy Loss: a Review of Recent Literature

Purpose of Review

This review summarizes recent literature about the impacts of outdoor air pollution on pregnancy loss (spontaneous abortion/miscarriage and stillbirth), identifies challenges and opportunities, and provides recommendations for actions.

Recent Findings

Both short- and long-term exposures to ubiquitous air pollutants, including fine particulate matter < 2.5 and < 10 μm, may increase pregnancy loss risk. Windows of susceptibility include the entire gestational period, especially early pregnancy, and the week before event. Vulnerable subpopulations were not consistently explored, but some evidence suggests that pregnant parents from more disadvantaged populations may be more impacted even at the same exposure level.

Summary

Given environmental conditions conductive to high air pollution exposures become more prevalent as the climate shifts, air pollution’s impacts on pregnancy is expected to become a growing public health concern. While awaiting larger preconception studies to further understand causal impacts, multi-disciplinary efforts to minimize exposures among pregnant women are warranted.

Time-activity and daily mobility patterns during pregnancy and early postpartum - evidence from the MADRES cohort

INTRODUCTION

Pregnant women's daily time-activity and mobility patterns determine their environmental exposures and subsequently related health effects. Most studies ignore these and assess pregnancy exposures using static residential measures.

METHODS

We conducted 4-day continuous geo-location monitoring in 62 pregnant Hispanic women, during pregnancy and early post-partum then derived trips by mode and stays, classified by context (indoor/outdoor, type). Generalized mixed-effect models were used to examine whether these patterns changed over time.

RESULTS

Women spent on average 17.3 h/day at home. Commercial and service locations were the most popular non-home destinations, while parks and open spaces were seldom visited. Women made 3.5 daily trips (63.7 min/day and approximately 25% were pedestrian-based). Women were less likely to visit commercial and services locations and make vehicle-based trips postpartum compared to the 3^rd trimester.

CONCLUSION

Our findings suggest time-activity patterns vary across pregnancy and postpartum, thus assessing exposures at stationary locations might introduce measurement error.

Pregnant Women's Exposure to Household Air Pollution in Rural Bangladesh: A Feasibility Study for Poriborton: The CHANge Trial

The use of liquefied petroleum gas (LPG) for cooking is a strategy to reduce household air pollution (HAP) exposure and improve health. We conducted this feasibility study to evaluate personal exposure measurement methods to representatively assess reductions in HAP exposure. We enrolled 30 pregnant women to wear a MicroPEM for 24 h to assess their HAP exposure when cooking with a traditional stove (baseline) and with an LPG stove (intervention). The women wore the MicroPEM an average of 77% and 69% of the time during the baseline and intervention phases, respectively. Mean gravimetric PM_2.5 mass and black carbon concentrations were comparable during baseline and intervention. Temporal analysis of the MicroPEM nephelometer data identified high PM_2.5 concentrations in the afternoon, late evening, and overnight during the intervention phase. Likely seasonal sources present during the intervention phase were emissions from brick kiln and rice parboiling facilities, and evening kerosene lamp and mosquito coil use. Mean background adjusted PM_2.5 concentrations during cooking were lower during intervention at 71 μg/m³, versus 105 μg/m³ during baseline. Representative real-time personal PM_2.5 concentration measurements supplemented with ambient PM_2.5 measures and surveys will be a valuable tool to disentangle external sources of PM_2.5, other indoor HAP sources, and fuel-sparing behaviors when assessing the HAP reduction due to intervention with LPG stoves.

Review and analysis of personal-ambient ozone measurements

Ambient ozone measurements are often used as surrogates for personal exposures. Due to the limited number of central ozone monitors and varying personal behavioral patterns, some level of variability between ambient and personal exposures is expected. Low-cost sensors and different ways to capture personal activity patterns are being developed as an effort to improve the accuracy of exposure assessment. However, it is still most common to use the traditional approach of using unadjusted ambient concentrations as surrogates for personal exposures. To our knowledge, there has not been a meta-analysis that summarizes the findings from studies that investigated the differences between personal and ambient ozone. We conducted a literature search in PubMed and Science Direct for peer-reviewed studies reporting at least one of the following in a numeric format: 1) personal-ambient measurements, 2) personal-ambient slopes, or 3) personal-ambient correlations to identify and summarize existing studies that investigated personal and ambient ozone concentrations. Twenty-two articles met inclusion criteria and were included in our review. Ambient concentrations almost always overestimated personal exposures. A meta-analysis of slopes showed an overall personal-ambient slope of 0.21 (95% CI: 0.15, 0.27) with high heterogeneity (97%) across studies. The correlations between personal and ambient ozone varied dramatically across subjects from a strong positive (0.77) to a moderate negative correlation (-0.43). Our study found that ambient measurements are not accurate representations of personal exposure, while the magnitude of exposure measurement error varied across studies. Different sources of ozone and how they contribute to true exposure levels for individuals in complementary ways need to be better addressed. The effort to better understand the impact of traditional exposure assessment on the risk estimates must be emphasized along with efforts to improve the current exposure assessment approaches to provide context for interpreting the results from ozone epidemiological studies. Implications: The traditional approach of using ambient ozone measurements as surrogates for personal exposures is likely to result in exposure misclassification, which is a well-recognized source of bias in epidemiological studies. There are efforts to characterize the differences between ambient and personal ozone measurements, though, to our knowledge, there has not been a meta-analysis that summarizes the findings of different studies. Better understanding of the pattern and magnitude of exposure error for ambient and personal ozone can provide directions for future studies and context for interpreting the results from ozone epidemiological studies.