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Wang L, Wu M, Han B, Wang M, Li R, Shen Y, Zhuang Z, Wang Z, Jing T. Seasonal variations and the prevalence of phenolic profiles in ambient fine particulate matter and their impact on oxidative potential. JOURNAL OF HAZARDOUS MATERIALS 2024; 479:135579. [PMID: 39216247 DOI: 10.1016/j.jhazmat.2024.135579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 08/16/2024] [Accepted: 08/17/2024] [Indexed: 09/04/2024]
Abstract
Exposure to fine particulate matter (PM2.5) poses numerous health risks, with oxidative potential (OP) serving as a critical marker of its toxicity. Synthetic phenolic antioxidants (SPAs) and bisphenols (BPs) influence reactive oxygen species (ROS) levels in PM2.5, and exposure to these compounds induces oxidative stress in organisms, thereby potentially affecting the OP of PM2.5. We detected 26 phenols (including 12 SPAs, 5 transformation products (TPs), and 9 BPs) in PM2.5 sample collected from October 2018 to September 2021 in Wuhan, China. Among them, 19 substances were detected at a detection frequency greater than 50 % in PM2.5 sample. AO 2246 and BHT were the main components of SPAs, and BHT-Q and BPA had the highest concentrations in TPs and BPs, respectively. PM2.5 mass concentrations and phenolic levels were higher in winter and autumn. Substances within groups were strongly correlated, suggesting the same or similar source of exposure. This finding aid in more precise pollution source identification and is crucial for comprehensively evaluating their combined health effects. Furthermore, we determined the OP of PM2.5 and found that BPs were related to increased OP and ROS. This suggests that the toxicity of PM2.5 is influenced not only by its concentration but also by its chemical composition, with BPs potentially enhancing its toxic effects. These factors should be fully considered when assessing the health impacts of PM2.5.
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Affiliation(s)
- Lulu Wang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Minmin Wu
- Department of Cardiology, Sheng li Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, PR China
| | - Bin Han
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Mengyi Wang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Ruifang Li
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yang Shen
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Zhijia Zhuang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Zhu Wang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Tao Jing
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
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Holme JA, Myhre O, Øvrevik J. Adverse neurodevelopment in children associated with prenatal exposure to fine particulate matter (PM 2.5) - Possible roles of polycyclic aromatic hydrocarbons (PAHs) and mechanisms involved. Reprod Toxicol 2024:108718. [PMID: 39276806 DOI: 10.1016/j.reprotox.2024.108718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 09/11/2024] [Accepted: 09/11/2024] [Indexed: 09/17/2024]
Abstract
Prenatal exposure to ambient fine particles (PM2.5) and polycyclic aromatic hydrocarbons (PAHs) has been associated with adverse birth outcomes including neurodevelopmental effects with cognitive and/or behavioral implications in early childhood. As a background we first briefly summarize human studies on PM2.5 and PAHs associated with adverse birth outcomes and modified neurodevelopment. Next, we add more specific information from animal studies and in vitro studies and elucidate possible biological mechanisms. More specifically we focus on the potential role of PAHs attached to PM2.5 and explore whether effects of these compounds may arise from disturbance of placental function or more directly by interfering with neurodevelopmental processes in the fetal brain. Possible molecular initiating events (MIEs) include interactions with cellular receptors such as the aryl hydrocarbon receptor (AhR), beta-adrenergic receptors (βAR) and transient receptor potential (TRP)-channels resulting in altered gene expression. MIE linked to the binding of PAHs to cytochrome P450 (CYP) enzymes and formation of reactive electrophilic metabolites are likely less important. The experimental animal and in vitro studies support the epidemiological findings and suggest steps involved in mechanistic pathways explaining the associations. An overall evaluation of the doses/concentrations used in experimental studies combined with the mechanistic understanding further supports the hypothesis that prenatal PAHs exposure may cause adverse outcomes (AOs) linked to human neurodevelopment. Several MIEs will likely occur simultaneously in various cells/tissues involving several key events (KEs) which relative importance will depend on dose, time, tissue, genetics, other environmental factors, and neurodevelopmental endpoint in study.
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Affiliation(s)
- Jørn A Holme
- Department of Air quality and Noise, Division of Climate and Environmental Health, Norwegian Institute of Public Health, PO Box PO Box 222 Skøyen, 0213 Oslo, Norway.
| | - Oddvar Myhre
- Department of Chemical Toxicology, Division of Climate and Environmental Health, Norwegian Institute of Public Health, PO Box PO Box 222 Skøyen, 0213 Oslo, Norway
| | - Johan Øvrevik
- Department of Biosciences, Faculty of Mathematics and Natural Sciences, University of Oslo, PO Box 1066 Blindern, 0316 Oslo, Norway; Division of Climate and Environmental Health, Norwegian Institute of Public Health, PO Box 222 Skøyen 0213 Oslo, Norway
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3
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Kuzukiran O, Yurdakok-Dikmen B, Uyar R, Turgut-Birer Y, Çelik HT, Simsek I, Karakas-Alkan K, Boztepe UG, Ozyuncu O, Kanca H, Ozdag H, Filazi A. Transcriptomic evaluation of metals detected in placenta. CHEMOSPHERE 2024; 363:142929. [PMID: 39048050 DOI: 10.1016/j.chemosphere.2024.142929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/05/2024] [Accepted: 07/22/2024] [Indexed: 07/27/2024]
Abstract
This research aims to assess the concentration of metals in human and canine placentas from the same geographic area and to investigate how these metal levels influence gene expression within the placenta. Placentas of 25 dogs and 60 women who had recently given birth residing in Ankara, Turkey were collected and subjected to metal analysis using ICP-OES. Placentas with detectable metal levels underwent further examination including Next Generation Sequencing, transcriptional analysis, single nucleotide polymorphism investigation, and extensive scrutiny across various groups. For women, placentas with concurrent detection of aluminum (Al), lead (Pb), and cadmium (Cd) underwent transcriptomic analysis based on metal analysis results. However, the metal load in dog placentas was insufficient for comparison. Paired-end sequencing with 100-base pair read lengths was conducted using the DNBseq platform. Sequencing quality control was evaluated using FastQC, fastq screen, and MultiQC. RNA-sequencing data is publicly available via PRJNA936158. Comparative analyses were performed between samples with detected metals and "golden" samples devoid of these metals, revealing significant gene lists and read counts. Normalization of read counts was based on estimated size factors. Principal Component Analysis (PCA) was applied to all genes using rlog-transformed count data. Results indicate that metal exposure significantly influences placental gene expression, impacting various biological processes and pathways, notably those related to protein synthesis, immune responses, and cellular structure. Upregulation of immune-related pathways and alterations in protein synthesis machinery suggest potential defense mechanisms against metal toxicity. Nonetheless, these changes may adversely affect placental function and fetal health, emphasizing the importance of monitoring and mitigating environmental exposure to metals during pregnancy.
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Affiliation(s)
- Ozgur Kuzukiran
- Cankiri Karatekin University, Eldivan Vocational School of Health Sciences, Veterinary Department, Cankiri, Turkey.
| | - Begum Yurdakok-Dikmen
- Ankara University Faculty of Veterinary Medicine, Department of Pharmacology and Toxicology, 06070, Ankara, Turkey.
| | - Recep Uyar
- Ankara University, The Stem Cell Institute, Ankara, Turkey; Ankara University, Graduate School of Health Sciences, 06070, Ankara, Turkey.
| | - Yagmur Turgut-Birer
- Ankara University, Graduate School of Health Sciences, 06070, Ankara, Turkey.
| | - Hasan Tolga Çelik
- Hacettepe University, Faculty of Medicine, Department of Child Health and Diseases, Section of Neonatology, 06230, Altindag, Ankara, Turkey.
| | - Ilker Simsek
- Cankiri Karatekin University, Eldivan Vocational School of Health Sciences, Cankiri, Turkey.
| | - Kubra Karakas-Alkan
- Selcuk University, Faculty of Veterinary Medicine, Department of Obstetrics and Gynaecology, Konya, Turkey.
| | - Ummu Gulsum Boztepe
- Ankara University, Graduate School of Health Sciences, 06070, Ankara, Turkey.
| | - Ozgur Ozyuncu
- Hacettepe University, Faculty of Medicine, Department of Obstetrics and Gynaecology, 06230, Altindag, Ankara, Turkey.
| | - Halit Kanca
- Ankara University, Faculty of Veterinary Medicine, Department of Obstetrics and Gynaecology, Ankara, Turkey.
| | - Hilal Ozdag
- Ankara University Biotechnology Institute, 06135, Ankara, Turkey.
| | - Ayhan Filazi
- Ankara University Faculty of Veterinary Medicine, Department of Pharmacology and Toxicology, 06070, Ankara, Turkey.
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Abu Ahmad W, Nirel R, Barges S, Jolles M, Levine H. Meta-analysis of fine particulate matter exposure during pregnancy and birth weight: Exploring sources of heterogeneity. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 934:173205. [PMID: 38754513 DOI: 10.1016/j.scitotenv.2024.173205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/31/2024] [Accepted: 05/11/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Several meta-analyses assessed the relationship between exposure to PM with aerodynamic diameter ≤ 2.5 μm (PM2.5) during pregnancy and birth weight (BW), but results were inconsistent and substantial unexplained heterogeneity was reported. We aimed to investigate the above association and to explore sources of heterogeneity across studies. METHODS We systematically reviewed the current worldwide evidence examining the association between PM2.5 and BW. The review protocol was registered on the PROSPERO website (CRD42020188996) and followed PRISMA guidelines. We extracted association measures for BW and low birth weight (LBW, BW < 2500 g) from each study to evaluate pooled summary measures and to explore sources of between-study heterogeneity. FINDINGS Of the 2677 articles identified, 84 met the inclusion criteria (~42 M births). Our random effects meta-analyses revealed substantial heterogeneity among included studies (I2 = 98.4 % and I2 = 77.7 %, for BW and LBW respectively). For LBW, the heterogeneity decreased (I2 = 59.7 %) after excluding four outlying studies, with a pooled odds ratio 1.07 (95 % confidence interval, CI: 1.05, 1.09) per a 10-μg/m3 increase in mean PM2.5 exposure over the entire pregnancy. Further subgroup analysis revealed geographic heterogeneity with higher association in Europe (1.34, (1.16, 1.55)) compared to Asia (1.06, (1.03, 1.10)) and US (1.07, (1.04, 1.10)). CONCLUSION The association between PM2.5 and birth weight varied depending on several factors. The sources of heterogeneity between studies included modifiers such as study region and period. Hence, it is advisable not to pool summary measures of PM2.5-BW associations and that policy would be informed by local evidence.
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Affiliation(s)
- Wiessam Abu Ahmad
- School of Public Health, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Ronit Nirel
- Department of Statistics and Data Science, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Saleh Barges
- Community Medical Services Division, Clalit Health Services, Tel-Aviv, Israel
| | - Maya Jolles
- School of Public Health, University of Haifa, Haifa, Israel
| | - Hagai Levine
- School of Public Health, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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5
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Lazar VMA, Rahman S, Chowdhury NH, Hasan T, Akter S, Islam MS, Ahmed S, Baqui AH, Khanam R. Folate deficiency in pregnancy and the risk of preterm birth: A nested case-control study. J Glob Health 2024; 14:04120. [PMID: 38991209 PMCID: PMC11239188 DOI: 10.7189/jogh.14.04120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
Background Preterm birth (PTB) and its complications are important public health problems. Its aetiology is multifactorial and involves both modifiable and non-modifiable factors. Among the modifiable risk factors, micronutrient deficiencies, including maternal folate deficiency, are increasingly being studied in PTB. In this study, we estimated the prevalence of folate deficiency during pregnancy and examined its association with PTB among rural Bangladeshi women. Methods We conducted a nested case-control study using data from a population-based cohort of 3000 pregnant women who were enrolled between 8 and 19 weeks of gestation following ultrasound confirmation of gestational age. Sociodemographic, epidemiologic, clinical, and pregnancy outcomes data were collected through home visits, while blood samples were collected at enrolment and 24-28 weeks of gestation during pregnancy. We included all women who delivered preterm (defined as live births <37 weeks of gestation) as cases (n = 235) and a random sample of women having a term birth as controls (n = 658). The main exposure was folate concentrations in maternal serum during 24-28 weeks of pregnancy. We categorised women into folate deficient (<3 ng/mL) and not deficient (≥3 ng/mL). We then performed multivariable logistic regression analysis to examine the association between maternal folate levels and PTB, adjusting for relevant covariates. Results Thirty-eight per cent of the enrolled pregnant women were folate deficient. Maternal serum folate deficiency was significantly associated with PTB (adjusted OR (aOR) = 1.73; 95% confidence interval (CI) = 1.27-2.36). The risk of PTB was also higher among women who were of short stature (aOR = 1.83; 95% CI = 1.27-2.63), primiparous (aOR = 1.60; 95% CI = 1.15-2.22), and had exposure to passive smoking (aOR = 1.54; 95% CI = 1.02-2.31). Conclusions The prevalence of folate deficiency was high among pregnant women in rural Bangladesh, and folate deficiency was significantly associated with an increased risk of preterm birth.
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Affiliation(s)
- Verna Mauren Amy Lazar
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sayedur Rahman
- Department of Women's and Children's Health, Uppsala University, Sweden
| | | | - Tarik Hasan
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - Sharmin Akter
- International Center for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | | | | | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rasheda Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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6
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O'Sharkey K, Xu Y, Cabison J, Rosales M, Yang T, Chavez T, Johnson M, Lerner D, Lurvey N, Corral CMT, Farzan SF, Bastain TM, Breton CV, Habre R. Effects of in-utero personal exposure to PM 2.5 sources and components on birthweight. Sci Rep 2023; 13:21987. [PMID: 38081912 PMCID: PMC10713978 DOI: 10.1038/s41598-023-48920-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
In-utero exposure to fine particulate matter (PM2.5) and specific sources and components of PM2.5 have been linked with lower birthweight. However, previous results have been mixed, likely due to heterogeneity in sources impacting PM2.5 and due to measurement error from using ambient data. Therefore, we investigated the effect of PM2.5 sources and their high-loading components on birthweight using data from 198 women in the 3rd trimester from the MADRES cohort 48-h personal PM2.5 exposure monitoring sub-study. The mass contributions of six major sources of personal PM2.5 exposure were estimated for 198 pregnant women in the 3rd trimester using the EPA Positive Matrix Factorization v5.0 model, along with their 17 high-loading chemical components using optical carbon and X-ray fluorescence approaches. Single- and multi-pollutant linear regressions evaluated the association between personal PM2.5 sources/components and birthweight, adjusting for gestational age, maternal age, race, infant sex, parity, diabetes status, temperature, maternal education, and smoking history. Participants were predominately Hispanic (81%), with a mean (SD) gestational age of 39.1 (1.5) weeks and age of 28.2 (6.0) years. Mean birthweight was 3295.8 g (484.1) and mean PM2.5 exposure was 21.3 (14.4) µg/m3. A 1 SD increase in the mass contribution of the fresh sea salt source was associated with a 99.2 g decrease in birthweight (95% CI - 197.7, - 0.6), and aged sea salt was associated with a 70.1 g decrease in birthweight (95% CI - 141.7, 1.4). Magnesium, sodium, and chlorine were associated with lower birthweight, which remained after adjusting for PM2.5 mass. This study found evidence that major sources of personal PM2.5 including fresh and aged sea salt were negatively associated with birthweight, with the strongest effect on birthweight from Na and Mg. The effect of crustal and fuel oil sources differed by infant sex with negative associations seen in boys compared to positive associations in girls.
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Affiliation(s)
- Karl O'Sharkey
- Department of Population and Public Health Sciences, University of Southern California, 1845 N Soto St., Los Angeles, CA, 90089, USA.
| | - Yan Xu
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
| | - Jane Cabison
- Department of Population and Public Health Sciences, University of Southern California, 1845 N Soto St., Los Angeles, CA, 90089, USA
| | - Marisela Rosales
- Department of Population and Public Health Sciences, University of Southern California, 1845 N Soto St., Los Angeles, CA, 90089, USA
| | - Tingyu Yang
- Department of Population and Public Health Sciences, University of Southern California, 1845 N Soto St., Los Angeles, CA, 90089, USA
| | - Thomas Chavez
- Department of Population and Public Health Sciences, University of Southern California, 1845 N Soto St., Los Angeles, CA, 90089, USA
| | - Mark Johnson
- Department of Population and Public Health Sciences, University of Southern California, 1845 N Soto St., Los Angeles, CA, 90089, USA
| | | | | | - Claudia M Toledo Corral
- Department of Population and Public Health Sciences, University of Southern California, 1845 N Soto St., Los Angeles, CA, 90089, USA
- Department of Health Sciences, California State University Northridge, Northridge, CA, USA
| | - Shohreh F Farzan
- Department of Population and Public Health Sciences, University of Southern California, 1845 N Soto St., Los Angeles, CA, 90089, USA
| | - Theresa M Bastain
- Department of Population and Public Health Sciences, University of Southern California, 1845 N Soto St., Los Angeles, CA, 90089, USA
| | - Carrie V Breton
- Department of Population and Public Health Sciences, University of Southern California, 1845 N Soto St., Los Angeles, CA, 90089, USA
| | - Rima Habre
- Department of Population and Public Health Sciences, University of Southern California, 1845 N Soto St., Los Angeles, CA, 90089, USA
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
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7
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Hao H, Yoo SR, Strickland MJ, Darrow LA, D'Souza RR, Warren JL, Moss S, Wang H, Zhang H, Chang HH. Effects of air pollution on adverse birth outcomes and pregnancy complications in the U.S. state of Kansas (2000-2015). Sci Rep 2023; 13:21476. [PMID: 38052850 PMCID: PMC10697947 DOI: 10.1038/s41598-023-48329-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/24/2023] [Indexed: 12/07/2023] Open
Abstract
Neonatal mortality and morbidity are often caused by preterm birth and lower birth weight. Gestational diabetes mellitus (GDM) and gestational hypertension (GH) are the most prevalent maternal medical complications during pregnancy. However, evidence on effects of air pollution on adverse birth outcomes and pregnancy complications is mixed. Singleton live births conceived between January 1st, 2000, and December 31st, 2015, and reached at least 27 weeks of pregnancy in Kansas were included in the study. Trimester-specific and total pregnancy exposures to nitrogen dioxide (NO2), particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5), and ozone (O3) were estimated using spatiotemporal ensemble models and assigned to maternal residential census tracts. Logistic regression, discrete-time survival, and linear models were applied to assess the associations. After adjustment for demographics and socio-economic status (SES) factors, we found increases in the second and third trimesters and total pregnancy O3 exposures were significantly linked to preterm birth. Exposure to the second and third trimesters O3 was significantly associated with lower birth weight, and exposure to NO2 during the first trimester was linked to an increased risk of GDM. O3 exposures in the first trimester were connected to an elevated risk of GH. We didn't observe consistent associations between adverse pregnancy and birth outcomes with PM2.5 exposure. Our findings indicate there is a positive link between increased O3 exposure during pregnancy and a higher risk of preterm birth, GH, and decreased birth weight. Our work supports limiting population exposure to air pollution, which may lower the likelihood of adverse birth and pregnancy outcomes.
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Affiliation(s)
- Hua Hao
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd., NE, Atlanta, GA, 30322, USA.
| | - Sodahm R Yoo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Matthew J Strickland
- Depatment of Health Analytics and Biostatistics, Epidemiology and Environmental Health, School of Public Health, University of Nevada, Reno, NV, 89557, USA
| | - Lyndsey A Darrow
- Depatment of Health Analytics and Biostatistics, Epidemiology and Environmental Health, School of Public Health, University of Nevada, Reno, NV, 89557, USA
| | - Rohan R D'Souza
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Joshua L Warren
- Department of Biostatistics, School of Medicine, Yale University, New Haven, CT, 06510, USA
| | - Shannon Moss
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Huaqing Wang
- Department of Landscape Architecture and Environment Planning, College of Agriculture and Applied Sciences, Utah State University, Logan, UT, 84322, USA
| | - Haisu Zhang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd., NE, Atlanta, GA, 30322, USA
| | - Howard H Chang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd., NE, Atlanta, GA, 30322, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
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Noghanibehambari H, Bagheri H, Salari M, Tavassoli N, Javid R, Toranji M. Breathing in the future: prenatal exposure to air pollution and infants' health outcomes in the USA. Public Health 2023; 225:198-205. [PMID: 37939461 PMCID: PMC10842113 DOI: 10.1016/j.puhe.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/04/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES This study aimed to investigate the impact of air pollution on birth outcomes in the USA over several decades. STUDY DESIGN Approximately 70 million birth records were assessed for the years 1980-2020. This study focussed on seven measures of birth outcomes, including birth weight, low birth weight, very low birth weight, full-term birth weight, foetal growth, gestational age and very premature birth. METHODS An instrumental variable identification strategy was used that exploited within county-month and within month-year of birth variations in exposure to precipitation-induced changes in air pollution. RESULTS Air pollution was found to have negative and large effects on a wide range of birth outcomes. The study findings suggest that a one-standard-deviation increase in ozone was associated with a 6.4% and 12.8% increase (from the mean) in the proportion of low birth weight and very preterm birth infants, respectively. Further analyses suggest that these effects were heterogeneous across trimesters of pregnancy and reveal larger impacts during the second and third trimesters. CONCLUSIONS The results suggest that the ordinary least square estimates of previous studies considerably underestimate the true effects of pollution on birth outcomes. Policies that aim to improve the health capital of future generations should allocate more resources and initiatives to improving environmental air quality.
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Affiliation(s)
- H Noghanibehambari
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, WI 53706, USA.
| | - H Bagheri
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran.
| | - M Salari
- Department of Accounting, Finance, and Economics, California State University Dominguez Hills, Carson, CA 90747, USA.
| | - N Tavassoli
- Department of Economics, University of Wisconsin Milwaukee, Milwaukee, WI 53211, USA.
| | - R Javid
- School of Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - M Toranji
- Department of Economics, University of Tehran, Tehran, Iran.
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9
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Mork D, Kioumourtzoglou MA, Weisskopf M, Coull BA, Wilson A. Heterogeneous Distributed Lag Models to Estimate Personalized Effects of Maternal Exposures to Air Pollution. J Am Stat Assoc 2023; 119:14-26. [PMID: 38835505 PMCID: PMC11147136 DOI: 10.1080/01621459.2023.2258595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/07/2023] [Indexed: 06/06/2024]
Abstract
Children's health studies support an association between maternal environmental exposures and children's birth outcomes. A common goal is to identify critical windows of susceptibility-periods during gestation with increased association between maternal exposures and a future outcome. The timing of the critical windows and magnitude of the associations are likely heterogeneous across different levels of individual, family, and neighborhood characteristics. Using an administrative Colorado birth cohort we estimate the individualized relationship between weekly exposures to fine particulate matter (PM 2.5) during gestation and birth weight. To achieve this goal, we propose a statistical learning method combining distributed lag models and Bayesian additive regression trees to estimate critical windows at the individual level and identify characteristics that induce heterogeneity from a high-dimensional set of potential modifying factors. We find evidence of heterogeneity in the PM 2.5 -birth weight relationship, with some mother-child dyads showing a 3 times larger decrease in birth weight for an IQR increase in exposure (5.9 to 8.5 PM 2.5 μg/m3) compared to the population average. Specifically, we find increased vulnerabilitity for non-Hispanic mothers who are either younger, have higher body mass index or lower educational attainment. Our case study is the first precision health study of critical windows.
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Affiliation(s)
- Daniel Mork
- Department of Biostatistics, Harvard T.H. Chan School of Public Health
| | | | - Marc Weisskopf
- Department of Environmental Health, Harvard T.H. Chan School of Public Health
| | - Brent A Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health
| | - Ander Wilson
- Department of Statistics, Colorado State University
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10
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Song S, Gao Z, Zhang X, Zhao X, Chang H, Zhang J, Yu Z, Huang C, Zhang H. Ambient fine particulate matter and pregnancy outcomes: An umbrella review. ENVIRONMENTAL RESEARCH 2023; 235:116652. [PMID: 37451569 DOI: 10.1016/j.envres.2023.116652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
The available evidence on the effects of ambient fine particulate matter (PM2.5) and pregnancy outcomes (birth outcomes and pregnancy complications) has increased substantially. The purpose of this umbrella review is to refine the evidence of the association between birth outcome (birth defects) and PM2.5; and summarize the credibility of existing research on the association between pregnancy complications and PM2.5. We searched PubMed, Web of Science, Embase, and Cochrane databases for relevant systematic reviews and meta-analyses up to March 16, 2022 in accordance with PRISMA guidelines. Two independent investigators conducted data extraction. AMSTAR 2 and GRADE assessment criteria were used to evaluate the methodological and evidence quality. We performed subgroup analyses by trimesters of pregnancy. The review protocol for this study has been registered in PROSPERO (CRD42022325550). This umbrella review identified a total of 41 systematic reviews, including 28 articles evaluating the influence of PM2.5 on birth outcomes and 13 on pregnancy complications. Positive associations between perinatal PM2.5 exposure and adverse birth outcomes were found, including low birth weight, preterm birth, stillbirth, small for gestational age, and birth defects. Pregnant women exposed to PM2.5 had a significantly higher risk of developing hypertensive disorder of pregnancy, gestational diabetes mellitus, gestational hypertension, and preeclampsia. The findings of subgroup analysis demonstrated that the effects of ambient PM2.5 exposure on pregnancy outcomes varied by trimesters. The findings of this extensive umbrella review provide convincing proof that exposure to ambient PM2.5 raises the risks of unfavorable birth outcomes and pregnancy complications. Some associations show considerable disparity between trimesters. These findings have implications for strengthen perinatal health care on air pollution and improving intergenerational equity.
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Affiliation(s)
- Shuaixing Song
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China; College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zhan Gao
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoan Zhang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Zhao
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Chang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junxi Zhang
- NHC Key Laboratory of Birth Defects Prevention & Henan Key Laboratory of Population Defects Prevention, Zhengzhou, China
| | - Zengli Yu
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Huanhuan Zhang
- College of Public Health, Zhengzhou University, Zhengzhou, China; NHC Key Laboratory of Birth Defects Prevention & Henan Key Laboratory of Population Defects Prevention, Zhengzhou, China.
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11
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Ahmad WA, Nirel R, Golan R, Kloog I, Rotem R, Negev M, Koren G, Levine H. Association between ambient particulate matter and preterm birth stratified by temperature: A population-based pregnancy cohort study. Int J Hyg Environ Health 2023; 254:114269. [PMID: 37832218 DOI: 10.1016/j.ijheh.2023.114269] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/16/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023]
Abstract
A growing body of literature reports associations between exposure to particulate matter with aerodynamic diameters ≤2.5 μm (PM2.5) and 2.5-10 μm (PM10-2.5) during pregnancy and preterm birth (PTB). However, the role of ambient temperature in PM-PTB associations was rarely investigated. In Israel, we used Maccabi Healthcare Services data to establish a population-based cohort of 381,265 singleton births reaching 24-42 weeks' gestation and birth weight of 500-5000 g (2004-2015). Daily PM and ambient temperature predictions from a satellite-based spatiotemporal model, at a 1 × 1 km spatial resolution, were linked to the date of birth and maternal residence. Mixed effects Cox regression models, adjusted for covariates, with a random intercept at the mother level were used to assess associations between mean exposure during pregnancy and PTB. We found that exposure to PM2.5 was positively associated with PTB when the average exposure during pregnancy was either low (first quintile) or high (fifth quintile), compared to exposure in the 2nd-4th quintiles, with hazard ratios (HRs) 1.18 (95% confidence interval [CI], 1.13-1.24) and 1.07 (95% CI, 1.02-1.12), respectively. The results revealed effect modification of temperature. For mothers exposed to low (below median) average temperature during pregnancy, HRs of PTB were 0.93 (95% CI, 0.87-1.00) and 1.21 (95% CI, 1.14-1.29) for the first and fifth PM2.5 quintiles, respectively, when compared to the 2nd-4th quintiles. However, a reverse trend was indicated for high-temperature pregnancies, where the corresponding HRs were 1.48 (95% CI, 1.39-1.58) and 0.92, (95% CI, 0.96-0.98). In conclusion, consideration of climatic factors can provide new insights into the risk of PTB as a result of exposure to PM2.5 during pregnancy.
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Affiliation(s)
- Wiessam Abu Ahmad
- Hebrew University-Hadassah School of Public Health, Hebrew University of Jerusalem, Israel.
| | - Ronit Nirel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rachel Golan
- Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Itai Kloog
- Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ran Rotem
- Harvard T.H. Chan School of Public Health, Boston, MA, USA; Institute of Research and Innovation, Maccabitech, Tel-Aviv, Israel
| | - Maya Negev
- University of Haifa, School of Public Health, Haifa, Israel
| | - Gideon Koren
- Institute of Research and Innovation, Maccabitech, Tel-Aviv, Israel; Tel Aviv University, Tel-Aviv, Israel
| | - Hagai Levine
- Hebrew University-Hadassah School of Public Health, Hebrew University of Jerusalem, Israel
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Molitor J, Sun Y, Rubio VG, Benmarhnia T, Chen JC, Avila C, Sacks DA, Chiu V, Slezak J, Getahun D, Wu J. Modeling spatially varying compliance effects of PM 2.5 exposure reductions on gestational diabetes mellitus in southern California: Results from electronic health record data of a large pregnancy cohort. ENVIRONMENTAL RESEARCH 2023; 231:116091. [PMID: 37182828 PMCID: PMC10405446 DOI: 10.1016/j.envres.2023.116091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/06/2023] [Accepted: 05/09/2023] [Indexed: 05/16/2023]
Abstract
Gestational diabetes mellitus (GDM) is a major pregnancy complication affecting approximately 14.0% of pregnancies around the world. Air pollution exposure, particularly exposure to PM2.5, has become a major environmental issue affecting health, especially for vulnerable pregnant women. Associations between PM2.5 exposure and adverse birth outcomes are generally assumed to be the same throughout a large geographical area. However, the effects of air pollution on health can very spatially in subpopulations. Such spatially varying effects are likely due to a wide range of contextual neighborhood and individual factors that are spatially correlated, including SES, demographics, exposure to housing characteristics and due to different composition of particulate matter from different emission sources. This combination of elevated environmental hazards in conjunction with socioeconomic-based disparities forms what has been described as a "double jeopardy" for marginalized sub-populations. In this manuscript our analysis combines both an examination of spatially varying effects of a) unit-changes in exposure and examines effects of b) changes from current exposure levels down to a fixed compliance level, where compliance levels correspond to the Air Quality Standards (AQS) set by the U.S. Environmental Protection Agency (EPA) and World Health Organization (WHO) air quality guideline values. Results suggest that exposure reduction policies should target certain "hotspot" areas where size and effects of potential reductions will reap the greatest rewards in terms of health benefits, such as areas of southeast Los Angeles County which experiences high levels of PM2.5 exposures and consist of individuals who may be particularly vulnerable to the effects of air pollution on the risk of GDM.
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Affiliation(s)
- John Molitor
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, 97331, USA.
| | - Yi Sun
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA
| | | | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, CA, USA
| | - Jiu-Chiuan Chen
- Departments of Population & Public Health Sciences and Neurology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Chantal Avila
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - David A Sacks
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Vicki Chiu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jeff Slezak
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Jun Wu
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA.
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Choi ES, Lee JS, Hwang Y, Lee KS, Ahn KH. Association between early preterm birth and maternal exposure to fine particular matter (PM10): A nation-wide population-based cohort study using machine learning. PLoS One 2023; 18:e0289486. [PMID: 37549180 PMCID: PMC10406328 DOI: 10.1371/journal.pone.0289486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/19/2023] [Indexed: 08/09/2023] Open
Abstract
Although preterm birth (PTB), a birth before 34 weeks of gestation accounts for only less than 3% of total births, it is a critical cause of various perinatal morbidity and mortality. Several studies have been conducted on the association between maternal exposure to PM and PTB, but the results were inconsistent. Moreover, no study has analyzed the risk of PM on PTB among women with cardiovascular diseases, even though those were thought to be highly susceptible to PM considering the cardiovascular effect of PM. Therefore, we aimed to evaluate the effect of PM10 on early PTB according to the period of exposure, using machine learning with data from Korea National Health Insurance Service (KNHI) claims. Furthermore, we conducted subgroup analysis to compare the risk of PM on early PTB among pregnant women with cardiovascular diseases and those without. A total of 149,643 primiparous singleton women aged 25 to 40 years who delivered babies in 2017 were included. Random forest feature importance and SHAP (Shapley additive explanations) value were used to identify the effect of PM10 on early PTB in comparison with other well-known contributing factors of PTB. AUC and accuracy of PTB prediction model using random forest were 0.9988 and 0.9984, respectively. Maternal exposure to PM10 was one of the major predictors of early PTB. PM10 concentration of 5 to 7 months before delivery, the first and early second trimester of pregnancy, ranked high in feature importance. SHAP value showed that higher PM10 concentrations before 5 to 7 months before delivery were associated with an increased risk of early PTB. The probability of early PTB was increased by 7.73%, 10.58%, or 11.11% if a variable PM10 concentration of 5, 6, or 7 months before delivery was included to the prediction model. Furthermore, women with cardiovascular diseases were more susceptible to PM10 concentration in terms of risk for early PTB than those without cardiovascular diseases. Maternal exposure to PM10 has a strong association with early PTB. In addition, in the context of PTB, pregnant women with cardiovascular diseases are a high-risk group of PM10 and the first and early second trimester is a high-risk period of PM10.
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Affiliation(s)
- Eun-Saem Choi
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jue Seong Lee
- Department of Pediatrics, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Yujin Hwang
- Department of Pediatrics, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
- AI Center, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Kwang-Sig Lee
- AI Center, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
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14
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O'Sharkey K, Xu Y, Cabison J, Rosales M, Yang T, Chavez T, Johnson M, Lerner D, Lurvey N, Toledo Corral CM, Farzan SF, Bastain TM, Breton CV, Habre R. Effects of In-Utero Personal Exposure to PM2.5 Sources and Components on Birthweight. RESEARCH SQUARE 2023:rs.3.rs-3026552. [PMID: 37333108 PMCID: PMC10274950 DOI: 10.21203/rs.3.rs-3026552/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background In-utero exposure to fine particulate matter (PM2.5) and specific sources and components of PM2.5 have been linked with lower birthweight. However, previous results have been mixed, likely due to heterogeneity in sources impacting PM2.5 and due to measurement error from using ambient data. Therefore, we investigated the effect of PM2.5 sources and their high-loading components on birthweight using data from 198 women in the 3rd trimester from the MADRES cohort 48-hour personal PM2.5 exposure monitoring sub-study. Methods The mass contributions of six major sources of personal PM2.5 exposure were estimated for 198 pregnant women in the 3rd trimester using the EPA Positive Matrix Factorization v5.0 model, along with their 17 high-loading chemical components using optical carbon and X-ray fluorescence approaches. Single- and multi-pollutant linear regressions were used to evaluate the association between personal PM2.5 sources and birthweight. Additionally, high-loading components were evaluated with birthweight individually and in models further adjusted for PM2.5 mass. Results Participants were predominately Hispanic (81%), with a mean (SD) gestational age of 39.1 (1.5) weeks and age of 28.2 (6.0) years. Mean birthweight was 3,295.8g (484.1) and mean PM2.5 exposure was 21.3 (14.4) μg/m3. A 1 SD increase in the mass contribution of the fresh sea salt source was associated with a 99.2g decrease in birthweight (95% CI: -197.7, -0.6), while aged sea salt was associated with lower birthweight (β =-70.1; 95% CI: -141.7, 1.4). Magnesium sodium, and chlorine were associated with lower birthweight, which remained after adjusting for PM2.5 mass. Conclusions This study found evidence that major sources of personal PM2.5 including fresh and aged sea salt were negatively associated with birthweight, with the strongest effect on birthweight from Na and Mg. The effect of crustal and fuel oil sources differed by infant sex with negative associations seen in boys compared to positive associations in girls.
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Affiliation(s)
| | - Yan Xu
- University of Southern California
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15
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Ashorn P, Ashorn U, Muthiani Y, Aboubaker S, Askari S, Bahl R, Black RE, Dalmiya N, Duggan CP, Hofmeyr GJ, Kennedy SH, Klein N, Lawn JE, Shiffman J, Simon J, Temmerman M. Small vulnerable newborns-big potential for impact. Lancet 2023; 401:1692-1706. [PMID: 37167991 DOI: 10.1016/s0140-6736(23)00354-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/27/2023] [Accepted: 02/14/2023] [Indexed: 05/13/2023]
Abstract
Despite major achievements in child survival, the burden of neonatal mortality has remained high and even increased in some countries since 1990. Currently, most neonatal deaths are attributable to being born preterm, small for gestational age (SGA), or with low birthweight (LBW). Besides neonatal mortality, these conditions are associated with stillbirth and multiple morbidities, with short-term and long-term adverse consequences for the newborn, their families, and society, resulting in a major loss of human capital. Prevention of preterm birth, SGA, and LBW is thus critical for global child health and broader societal development. Progress has, however, been slow, largely because of the global community's failure to agree on the definition and magnitude of newborn vulnerability and best ways to address it, to frame the problem attractively, and to build a broad coalition of actors and a suitable governance structure to implement a change. We propose a new definition and a conceptual framework, bringing preterm birth, SGA, and LBW together under a broader umbrella term of the small vulnerable newborn (SVN). Adoption of the framework and the unified definition can facilitate improved problem definition and improved programming for SVN prevention. Interventions aiming at SVN prevention would result in a healthier start for live-born infants, while also reducing the number of stillbirths, improving maternal health, and contributing to a positive economic and social development in the society.
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Affiliation(s)
- Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland.
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Yvonne Muthiani
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | | | - Rajiv Bahl
- Indian Council for Medical Research, New Delhi, India
| | - Robert E Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Nita Dalmiya
- United Nations Children's Fund, New York, NY, USA
| | - Christopher P Duggan
- Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana; Effective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Obstetrics and Gynaecology, Walter Sisulu University, East London, South Africa
| | - Stephen H Kennedy
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Jeremy Shiffman
- Paul H Nitze School of Advanced International Studies, Johns Hopkins University, Baltimore, MD, USA
| | | | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
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Caron-Beaudoin É, Subramanian A, Daley C, Lakshmanan S, Whitworth KW. Estimation of exposure to particulate matter in pregnant individuals living in an area of unconventional oil and gas operations: Findings from the EXPERIVA study. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2023; 86:383-396. [PMID: 37154018 DOI: 10.1080/15287394.2023.2208594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Northeastern British Columbia (Canada) is an area of oil and gas exploitation, which may result in release of fine (PM2.5) and inhalable (PM10) particulate matter. The aims of this study were to: 1) apply extrapolation methods to estimate exposure to PM2.5 and PM10 concentrations among EXPERIVA (Exposures in the Peace River Valley study) participants using air quality data archives; and 2) conduct exploratory analyses to investigate correlation between PM exposure and metrics of oil and gas wells density, proximity, and activity. Gestational exposure to PM2.5 and PM10 of the EXPERIVA participants (n = 85) was estimated by averaging the concentrations measured at the closest or three closest air monitoring stations during the pregnancy period. Drilling metrics were calculated based upon the density and proximity of conventional and unconventional oil and gas wells to each participant's residence. Phase-specific metrics were determined for unconventional wells. The correlations (ρ) between exposure to PM2.5 and PM10 and metrics of well density/proximity were determined using Spearman's rank correlation test. Estimated PM ambient air concentrations ranged between 4.73 to 12.13 µg/m3 for PM2.5 and 7.14 to 26.61 µg/m3 for PM10. Conventional wells metrics were more strongly correlated with PM10 estimations (ρ between 0.28 and 0.79). Unconventional wells metrics for all phases were positively correlated with PM2.5 estimations (ρ between 0.23 and 0.55). These results provide evidence of a correlation between density and proximity of oil and gas wells and estimated PM exposure in the EXPERIVA participants.
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Affiliation(s)
- Élyse Caron-Beaudoin
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Department of Physical and Environmental Sciences, University of Toronto Scarborough, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amrita Subramanian
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Coreen Daley
- Department of Physical and Environmental Sciences, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Siddharthan Lakshmanan
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Kristina W Whitworth
- Department of Medicine, Section of Epidemiology and Population Sciences, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
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Downward GS, Vermeulen R. Ambient Air Pollution and All-Cause and Cause-Specific Mortality in an Analysis of Asian Cohorts. Res Rep Health Eff Inst 2023; 2016:1-53. [PMID: 37424069 PMCID: PMC7266370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
INTRODUCTION Much of what is currently known about the adverse effects of ambient air pollution comes from studies conducted in high-income regions, with relatively low air pollution levels. The aim of the current project is to examine the relationship between exposure to ambient air pollution (as predicted from satellite-based models) and all-cause and cause-specific mortality in several Asian cohorts. METHODS Cohorts were recruited from the Asia Cohort Consortium (ACC). The geocoded residences of participants were assigned levels of ambient particulate material with aerodynamic diameter of 2.5 μm or less (PM2.5) and nitrogen dioxide (NO2) utilizing global satellite-derived models and assigned for the year of enrollment (or closest available year). The association between ambient exposure and mortality was established with Cox proportional hazard models, after adjustment for common confounders. Both single- and two-pollutant models were generated. Model robustness was evaluated, and hazard ratios were calculated for each cohort separately and combined via random effect meta-analysis for pooled risk estimates. RESULTS Six cohort studies from the ACC participated: the Community-based Cancer Screening Program (CBCSCP, Taiwan), the Golestan Cohort Study (Iran), the Health Effects for Arsenic Longitudinal Study (HEALS, Bangladesh), the Japan Public Health Center-based Prospective Study (JPHC), the Korean Multi-center Cancer Cohort Study (KMCC), and the Mumbai Cohort Study (MCS, India). The cohorts represented over 340,000 participants. Mean exposures to PM2.5 ranged from 8 to 58 μg/m3. Mean exposures to NO2 ranged from 7 to 23 ppb. For PM2.5, a positive, borderline nonsignificant relationship was observed between PM2.5 and cardiovascular mortality. Other relationships with PM2.5 tended toward the null in meta-analysis. For NO2, an overall positive relationship was observed between exposure to NO2 and all cancers and lung cancer. A borderline association between NO2 and nonmalignant lung disease was also observed. The findings within individual cohorts remained consistent across a variety of subgroups and alternative analyses, including two-pollutant models. CONCLUSIONS In a pooled examination of cohort studies across Asia, ambient PM2.5 exposure appears to be associated with an increased risk of cardiovascular mortality and ambient NO2 exposure is associated with an increased cancer (and lung cancer) mortality. This project has shown that satellite-derived models of pollution can be used in examinations of mortality risk in areas with either incomplete or missing air pollution monitoring.
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Affiliation(s)
- G S Downward
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
| | - R Vermeulen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
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Fan W, Zlatnik MG. Climate Change and Pregnancy: Risks, Mitigation, Adaptation, and Resilience. Obstet Gynecol Surv 2023; 78:223-236. [PMID: 37043299 PMCID: PMC10508966 DOI: 10.1097/ogx.0000000000001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Importance Climate change is affecting the earth, resulting in more extreme temperatures and weather, rising sea levels, more frequent natural disasters, and displacement of populations of plants and animals, including people and insects. These changes affect food and housing security, vector-borne illnesses, and access to clean air and water, all of which influence human health. Evidence and Results There are a number of adverse health outcomes linked to heat, air pollution from wildfires, stress from natural disasters, and other elements of climate change. Pregnant people are especially vulnerable to the health harms resulting from climate change, namely, preterm birth, small for gestational age, hypertensive disorders of pregnancy, and other adverse reproductive health and birth outcomes. Strategies to minimize these harms include mitigation and adaptation. Conclusions and Relevance Physicians are in a unique position to protect the health of pregnant persons and children by advocating for policy changes that address climate change and providing clinical recommendations for patients to protect themselves from the health impacts of climate hazards.
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Affiliation(s)
| | - Marya G Zlatnik
- Professor, Maternal Fetal Medicine, Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, Western States Pediatric Environmental Health Specialty Unit, University of California San Francisco, San Francisco, CA
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19
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Huang M, Zeng Y, Luo K, Lan B, Luo J, Zeng L, Kang Y. Inhalation bioacessibility and lung cell penetration of indoor PM 2.5-bound PAEs and its implication in risk assessment. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 322:121216. [PMID: 36746290 DOI: 10.1016/j.envpol.2023.121216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/11/2022] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
Several studies have evaluated the human exposure of phthalate esters (PAEs) in PM2.5 via inhalation route, however, inhalation bioaccessibility and the lung cell penetration of PAEs were barely considered in risk assessment. In the present study, PM2.5 samples collected from indoor environments were investigated for inhalation bioaccessibility of PAEs using two simulated lung fluids (gamble's solution (GMB) and artificial lysosomal fluid (ALF)). The results showed that the inhalation bioaccessibility of PAEs (except for diethyl phthalate) under healthy state (GMB: 8.9%-62.8%) was lower than that under the inflammatory condition (ALF: 14.5%-67.6%). Lung cell permeation and metabolism of three selected PAEs (diethyl phthalate, di(n-butyl)phthalate and di-2-ethylhexyl phthalate) was tested using equivalent lung cell (A549) model. The inhalation bioavailability obtained by combination of the bioaccessibility of PAEs in indoor PM2.5 and permeability data of A549 cell ranged from 11.7% to 51.1% in health condition, and 13.5%-55.0% in inflammatory state. The calibration parameter (Fc) based on the inhalation bioavailability was established in present study and could provide a reference for a more accurate risk assessment of PM2.5-bound PAEs.
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Affiliation(s)
- Mantuo Huang
- School of Environment, South China Normal University, Higher Education Mega Center, Guangzhou, 510006, China; Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou, 510006, China
| | - Yuqi Zeng
- School of Environment, South China Normal University, Higher Education Mega Center, Guangzhou, 510006, China; Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou, 510006, China
| | - Kesong Luo
- School of Environment, South China Normal University, Higher Education Mega Center, Guangzhou, 510006, China; Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou, 510006, China
| | - Bingyan Lan
- School of Environment, South China Normal University, Higher Education Mega Center, Guangzhou, 510006, China; Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou, 510006, China
| | - Jiwen Luo
- School of Environment, South China Normal University, Higher Education Mega Center, Guangzhou, 510006, China; Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou, 510006, China
| | - Lixuan Zeng
- School of Environment, South China Normal University, Higher Education Mega Center, Guangzhou, 510006, China; Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou, 510006, China
| | - Yuan Kang
- School of Environment, South China Normal University, Higher Education Mega Center, Guangzhou, 510006, China; Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou, 510006, China.
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20
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Chen X, Chen S, Zhu Z, Luo J, Wang H, Wulayin M, Huang C, Zhao W, Wang Q. Identifying the critical windows and joint effects of temperature and PM 2.5 exposure on small for gestational age. ENVIRONMENT INTERNATIONAL 2023; 173:107832. [PMID: 36822007 DOI: 10.1016/j.envint.2023.107832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/06/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
The potential critical windows for extreme ambient temperature, air pollution exposure and small for gestational age (SGA) are still unclear, and no study has explored their joint effects on SGA. In a national multi-center prospective cohort, we included 179,761 pairs of mother-infant from 16 counties of 8 provinces in China during 2014-2018. Daily averaged temperature and PM2.5 concentration were matched to the maternal residential address to estimate personal exposure. Extreme temperature exposures were categorized by a series of percentile in each meteorological and geographic division for the entire pregnancy, each trimester and gestational week (GA-week). Generalized linear mixed models (GLMMs) and distributed lag nonlinear models (DLNMs) were used to estimate the whole pregnancy-, trimester-specific, and weekly-specific associations of extreme temperature and PM2.5 exposures with SGA. Combined effects were evaluated with the relative excess risk due to interaction (RERI) and proportion attributable to interaction (AP). We observed that by referring to temperature at the 41st - 50th percentile, heat (>90th percentile) exposure during 13th - 29th GA-weeks was associated with SGA; odds ratio (OR) and 95 % confidence intervals (CI) was 1.16 (1.06, 1.28). For cold (<=10th percentile), inverse associations were observed during the 1st - 8th GA-weeks. PM2.5 exposure during the 2nd - 5th and 19th - 27th GA-weeks was associated with SGA, with the strongest association in the 2nd GA-week (OR = 1.0017, 95 %CI: 1.0001, 1.0034, for a 10 μg/m3 increase). No interactive effects between ambient temperature and PM2.5 on SGA were observed. Our findings suggest the weekly susceptibility windows for heat and PM2.5 exposure were primarily the gestational weeks within the 2nd trimester, therefore, corresponding protective measures should be conveyed to pregnant women during routine prenatal visits to reduce exposures.
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Affiliation(s)
- Xin Chen
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Sidi Chen
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhenghong Zhu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jiajun Luo
- Institute for Population and Precision Health, the University of Chicago, Chicago, USA
| | - Huailin Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | | | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Wei Zhao
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Qiong Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China.
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21
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Chiarello DI, Ustáriz J, Marín R, Carrasco-Wong I, Farías M, Giordano A, Gallardo FS, Illanes SE, Gutiérrez J. Cellular mechanisms linking to outdoor and indoor air pollution damage during pregnancy. Front Endocrinol (Lausanne) 2023; 14:1084986. [PMID: 36875486 PMCID: PMC9974835 DOI: 10.3389/fendo.2023.1084986] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
Pregnancies are a critical window period for environmental influences over the mother and the offspring. There is a growing body of evidence associating indoor and outdoor air pollution exposure to adverse pregnancy outcomes such as preterm birth and hypertensive disorders of pregnancy. Particulate matter (PM) could trigger oxi-inflammation and could also reach the placenta leading to placental damage with fetal consequences. The combination of strategies such as risk assessment, advise about risks of environmental exposures to pregnant women, together with nutritional strategies and digital solutions to monitor air quality can be effective in mitigating the effects of air pollution during pregnancy.
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Affiliation(s)
- Delia I. Chiarello
- Cellular Signaling and Differentiation Laboratory (CSDL), School of Medical Technology, Faculty of Medicine and Science, Universidad San Sebastián, Santiago, Chile
| | - Javier Ustáriz
- Department of Chemical and Bioprocess Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Reinaldo Marín
- Center for Biophysics and Biochemistry (CBB), Venezuelan Institute for Scientific Research (IVIC), Caracas, Venezuela
| | - Ivo Carrasco-Wong
- Cellular Signaling and Differentiation Laboratory (CSDL), School of Medical Technology, Faculty of Medicine and Science, Universidad San Sebastián, Santiago, Chile
| | - Marcelo Farías
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ady Giordano
- Inorganic Chemistry Department, Faculty of Chemistry and of Pharmacy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe S. Gallardo
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián E. Illanes
- Reproductive Biology Program, Center for Biomedical Research and Innovation (CiiB), Universidad de los Andes, Santiago, Chile
- IMPACT, Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Santiago, Chile
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile
| | - Jaime Gutiérrez
- Cellular Signaling and Differentiation Laboratory (CSDL), School of Medical Technology, Faculty of Medicine and Science, Universidad San Sebastián, Santiago, Chile
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22
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Robbins T, Kuhrt K, Vousden N, Seed P, Shennan A. Household air pollution and incidence of eclampsia in eight low- and middle-income countries. Int J Gynaecol Obstet 2023; 160:449-450. [PMID: 36181287 PMCID: PMC10092445 DOI: 10.1002/ijgo.14484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 01/20/2023]
Affiliation(s)
- Tanya Robbins
- Department of Women and Children's Health, School of Life Course Science, King's College London, London, UK
| | - Katy Kuhrt
- Department of Women and Children's Health, School of Life Course Science, King's College London, London, UK
| | - Nicola Vousden
- Department of Women and Children's Health, School of Life Course Science, King's College London, London, UK
| | - Paul Seed
- Department of Women and Children's Health, School of Life Course Science, King's College London, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, School of Life Course Science, King's College London, London, UK
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23
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Canto MV, Guxens M, García-Altés A, López MJ, Marí-Dell’Olmo M, García-Pérez J, Ramis R. Air Pollution and Birth Outcomes: Health Impact and Economic Value Assessment in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2290. [PMID: 36767658 PMCID: PMC9916075 DOI: 10.3390/ijerph20032290] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
Air pollution is considered an ongoing major public health and environmental issue around the globe, affecting the most vulnerable, such as pregnant women and fetuses. The aim of this study is to estimate the health impact and economic value on birth outcomes, such as low birthweight (LBW), preterm birth (PTB), small for gestational age (SGA), attributable to a reduction of PM10 levels in Spain. Reduction based on four scenarios was implemented: fulfillment of WHO guidelines and EU limits, and an attributable reduction of 15% and 50% in annual PM10 levels. Retrospective study on 288,229 live-born singleton children born between 2009-2010, using data from Spain Birth Registry Statistics database, as well as mean PM10 mass concentrations. Our finding showed that a decrease in annual exposure to PM10 appears to be associated with a decrease in the annual cases of LBW, SGA and PTB, as well as a reduction in hospital cost attributed to been born with LBW. Improving pregnancy outcomes by reducing the number of LBW up to 5% per year, will result in an estimate associated monetary saving of 50,000 to 7,000,000 euros annually. This study agrees with previous literature and highlights the need to implement, and ensure compliance with, stricter policies that regulate the maximum exposure to outdoor PM permitted in Spain, contributing to decreased environmental health risk, especially negative birth outcomes.
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Affiliation(s)
- Marcelle Virginia Canto
- Department of Preventive Medicine, Hospital Central de la Cruz Roja, 28003 Madrid, Spain
- Doctoral Program in Biomedical Sciences and Public Health, International Doctorate Program, National University of Distance Education (UNED), 28015 Madrid, Spain
| | - Mònica Guxens
- Barcelona Institute of Global Health (ISGlobal), 08003 Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Department of Medicine and Live Sciences, Universitat Pompeu Fabra, 08002 Barcelona, Spain
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Centre, 3015 GE Rotterdam, The Netherlands
| | - Anna García-Altés
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Departament de Salut, Direcció General de Planificació i Recerca en Salut, 08028 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08003 Barcelona, Spain
| | - Maria José López
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08003 Barcelona, Spain
- Public Health Agency of Barcelona, 08023 Barcelona, Spain
| | - Marc Marí-Dell’Olmo
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08003 Barcelona, Spain
- Public Health Agency of Barcelona, 08023 Barcelona, Spain
| | - Javier García-Pérez
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Cancer and Environmental Epidemiology Unit, Chronic Diseases Department, National Centre for Epidemiology, Carlos III Institute of Health, 28029 Madrid, Spain
| | - Rebeca Ramis
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Cancer and Environmental Epidemiology Unit, Chronic Diseases Department, National Centre for Epidemiology, Carlos III Institute of Health, 28029 Madrid, Spain
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24
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Fu Z, Liu Q, Liang J, Huang T, Liang G, Zhou Y, Gu A. Association of ambient air pollution exposure with low birth weight. ENVIRONMENTAL RESEARCH 2022; 215:114164. [PMID: 36027958 DOI: 10.1016/j.envres.2022.114164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/28/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
Increasing evidence has shown that exposure to air pollution is linked to adverse birth outcomes, but the results are not consistent. This study was performed on a subset of participants from the UK Biobank between 2006 and 2010. The land use regression (LUR) model was constructed to calculate the concentrations of particulate matter (PM2.5, PM2.5-10 and PM10), nitrogen oxides (NOx), and nitrogen dioxide (NO2). Binary logistic/multivariate linear regression models were applied to explore the potential linear relationships between air pollution exposure and newborn low birth weight (LBW) or BW. The Cochran-Armitage trend test was used to explore the possible association between the air pollution level and LBW. A restricted cubic spline (RCS) transformation of exposure variables was applied to visualize the relation of air pollutants to BW. Exposure to air pollutants, especially PM2.5 and PM10, was positively associated with LBW, and the odds ratios (ORs) and 95% confidence intervals (CIs) for each 10-μg/m3 increase in PM2.5 and PM10 were 1.25 ([1.03, 1.51], P = 0.025) and 1.12 ([1.02, 1.24], P = 0.021), respectively. A negative correlation was observed between the BW and PM2.5 (-0.05 [-0.08, -0.02], P = 0.001), PM10 (-0.03 [-0.05, -0.02], P < 0.001), PM2.5-10 (-0.04 [-0.07, -0.01], P < 0.001) and NOx (0.00 [0.00, 0.00], P = 0.021). Additionally, the BW changed dramatically up to a specific point (PM2.5 for 10.74 μg/m3, Pnonlinearity = 0.004; PM10 for 16.06 μg/m3, Pnonlinearity = 0.004; NO2 for 25.58 μg/m3, Pnonlinearity <0.001; and NOx for 39.88 μg/m3, Pnonlinearity <0.001), subsequently becoming relatively stable. PM2.5 and PM10 exposure were positively associated with LBW, and a negative correlation was observed between PM2.5, PM2.5-10, PM10 and NOx and BW.
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Affiliation(s)
- Zuqiang Fu
- School of Public Health, Southeast University, Nanjing, China; State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, Center for Global Health, Nanjing Medical University, Nanjing, China
| | - Qian Liu
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, Center for Global Health, Nanjing Medical University, Nanjing, China
| | - Jingjia Liang
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, Center for Global Health, Nanjing Medical University, Nanjing, China
| | - Tao Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Geyu Liang
- School of Public Health, Southeast University, Nanjing, China.
| | - Yong Zhou
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China.
| | - Aihua Gu
- School of Public Health, Southeast University, Nanjing, China; State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, Center for Global Health, Nanjing Medical University, Nanjing, China.
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25
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Gutvirtz G, Sheiner E. Airway pollution and smoking in reproductive health. Best Pract Res Clin Obstet Gynaecol 2022; 85:81-93. [PMID: 36333255 DOI: 10.1016/j.bpobgyn.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/04/2022] [Indexed: 12/14/2022]
Abstract
Environmental exposure refers to contact with chemical, biological, or physical substances found in air, water, food, or soil that may have a harmful effect on a person's health. Almost all of the global population (99%) breathe air that contains high levels of pollutants. Smoking is one of the most common forms of recreational drug use and is the leading preventable cause of morbidity and mortality worldwide. The small particles from either ambient (outdoor) pollution or cigarette smoke are inhaled to the lungs and quickly absorbed into the bloodstream. These substances can affect virtually every organ in our body and have been associated with various respiratory, cardiovascular, endocrine, and also reproductive morbidities, including decreased fertility, adverse pregnancy outcomes, and offspring long-term morbidity. This review summarizes the latest literature reporting the reproductive consequences of women exposed to ambient (outdoor) air pollution and cigarette smoking.
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Affiliation(s)
- Gil Gutvirtz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Soroka University Medical Center (SUMC), Department of Obstetrics and Gynecology B, Beer-Sheva, Israel.
| | - Eyal Sheiner
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Soroka University Medical Center (SUMC), Department of Obstetrics and Gynecology B, Beer-Sheva, Israel
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26
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Starling AP, Wood C, Liu C, Kechris K, Yang IV, Friedman C, Thomas DSK, Peel JL, Adgate JL, Magzamen S, Martenies SE, Allshouse WB, Dabelea D. Ambient air pollution during pregnancy and DNA methylation in umbilical cord blood, with potential mediation of associations with infant adiposity: The Healthy Start study. ENVIRONMENTAL RESEARCH 2022; 214:113881. [PMID: 35835166 PMCID: PMC10402394 DOI: 10.1016/j.envres.2022.113881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 06/11/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Anne P Starling
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Cheyret Wood
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Cuining Liu
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Katerina Kechris
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ivana V Yang
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA; Center for Genes, Environment and Health, National Jewish Health, Denver, CO, USA
| | - Chloe Friedman
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Deborah S K Thomas
- Department of Geography and Earth Sciences, University of North Carolina Charlotte, NC, USA
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - John L Adgate
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA; Department of Epidemiology, Colorado School of Public Health, Colorado State University, Fort Collins, CO, USA
| | - Sheena E Martenies
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA; Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - William B Allshouse
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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27
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Basilio E, Chen R, Fernandez AC, Padula AM, Robinson JF, Gaw SL. Wildfire Smoke Exposure during Pregnancy: A Review of Potential Mechanisms of Placental Toxicity, Impact on Obstetric Outcomes, and Strategies to Reduce Exposure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13727. [PMID: 36360613 PMCID: PMC9657128 DOI: 10.3390/ijerph192113727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/07/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
- Emilia Basilio
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA 94143, USA
| | - Rebecca Chen
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA 94143, USA
| | | | - Amy M. Padula
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA 94143, USA
| | - Joshua F. Robinson
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA 94143, USA
| | - Stephanie L. Gaw
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA 94143, USA
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA 94143, USA
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28
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Longo V, Drago G, Longo A, Ruggieri S, Sprovieri M, Cibella F, Colombo P. A multipollutant low-grade exposure regulates the expression of miR-30b, Let-7a and miR-223 in maternal sera: Evidence from the NEHO cohort. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 844:157051. [PMID: 35780881 DOI: 10.1016/j.scitotenv.2022.157051] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/14/2022] [Accepted: 06/25/2022] [Indexed: 06/15/2023]
Abstract
There is growing evidence that environmental pollutants can induce epigenetic modifications altering the balance of miRNAs and inducing the onset of pathological conditions in animals. In this study, we measured the serum concentration of a suite of inorganic and organic pollutants (Cu, Zn, Se, Hg, HCB, p,p'-DDE, PCBs) and their association to serum miR-30b, miR-223 and Let-7a microRNA expression in 68 healthy pregnant women from the NEHO birth cohort sited in a highly industrialized area. The effects of the pollutants on the modulation of circulating miRNAs' expression were first investigated using linear continuous regression models with a single-compound approach showing that miR-223 expression was significantly associated with serum concentration of Se and Zn (pSe = 0.0336; pZn = 0.0225) and miR-30b was associated with Hg levels (pHg = 0.019). Furthermore, when contaminants were categorized into tertiles, miR-223 and miR-30b showed a positive association with higher tertiles of Zn, p,p'-DDE (pZn = 0.023; pDDE = 0.041) and Hg (pHg = 0.008), respectively. Moreover, Let-7a expression was exclusively influenced by medium tertiles levels of Se (low vs medium tertiles, p = 0.001). Simultaneous exposure to multi-pollutant mixture was approached by WQS regression model. Statistical analysis shows a driving effect of Zn, Se, Cu, Hg and HCB on significant increased expression of Let-7a (p = 0.045). Mercury and Se significantly amplified the expression for miR-30b (p = 0.038). Differently, the combined effect of p,p'-DDE, Zn and Se decreased miR-223 expression (p = 0.0001). The documented modified expression of circulating miRNAs in the serum of pregnant women, exposed to low-medium dose contaminants mixtures offers innovative early-warning approaches to human health risk assessment.
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Affiliation(s)
- Valeria Longo
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB-CNR), Via Ugo La Malfa 153, 90146 Palermo, Italy
| | - Gaspare Drago
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB-CNR), Via Ugo La Malfa 153, 90146 Palermo, Italy
| | - Alessandra Longo
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB-CNR), Via Ugo La Malfa 153, 90146 Palermo, Italy
| | - Silvia Ruggieri
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB-CNR), Via Ugo La Malfa 153, 90146 Palermo, Italy
| | - Mario Sprovieri
- Institute of Anthropic Impacts and Sustainability in Marine Environment, National Research Council of Italy (CNR-IAS), via del Mare 3, 91021 Torretta Granitola, Trapani, Italy
| | - Fabio Cibella
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB-CNR), Via Ugo La Malfa 153, 90146 Palermo, Italy
| | - Paolo Colombo
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB-CNR), Via Ugo La Malfa 153, 90146 Palermo, Italy.
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Genin M, Lecoeuvre A, Cuny D, Subtil D, Chevalier G, Ficheur G, Occelli F, Garabedian C. The association between the incidence of preterm birth and overall air pollution: A nationwide, fine-scale, spatial study in France from 2012 to 2018. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 311:120013. [PMID: 36007792 DOI: 10.1016/j.envpol.2022.120013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/05/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Michael Genin
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France.
| | - Adrien Lecoeuvre
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
| | - Damien Cuny
- Univ. Lille, Institut Mines-Télécom, Univ. Artois, Junia, ULR 4515 - LGCgE, Laboratoire de Génie Civil et Géo-Environnement, F-59000 Lille, France
| | - Damien Subtil
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000, Lille, France
| | - Geoffroy Chevalier
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000, Lille, France
| | - Grégoire Ficheur
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
| | - Florent Occelli
- Univ. Lille, Institut Mines-Télécom, Univ. Artois, Junia, ULR 4515 - LGCgE, Laboratoire de Génie Civil et Géo-Environnement, F-59000 Lille, France
| | - Charles Garabedian
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000, Lille, France
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O’Sharkey K, Xu Y, Chavez T, Johnson M, Cabison J, Rosales M, Grubbs B, Toledo-Corral CM, Farzan SF, Bastain T, Breton CV, Habre R. In-utero personal exposure to PM 2.5 impacted by indoor and outdoor sources and birthweight in the MADRES cohort. ENVIRONMENTAL ADVANCES 2022; 9:100257. [PMID: 36778968 PMCID: PMC9912940 DOI: 10.1016/j.envadv.2022.100257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND In-utero exposure to outdoor particulate matter with aerodynamic diameter less than 2.5 μm (PM2.5) is linked with low birthweight. However, previous results are mixed, likely due to measurement error introduced by estimating personal exposure from ambient data. This study investigated the effect of total personal PM2.5 exposure on birthweight and whether it differed when it was more heavily impacted by sources of indoor vs outdoor origin in the MADRES cohort study. METHODS Personal PM2.5 exposure was measured in 205 pregnant women in the 3rd trimester using 48 h integrated, filter-based sampling. Linear regression was used to test the association between personal PM2.5 exposure and birthweight, adjusting for key covariates. Interactions of PM2.5 with variables representing indoor sources of PM2.5, home ventilation, or time spent indoors tested whether the effect of total PM2.5 on birthweight varied when it was more impacted by sources of indoor vs outdoor origin. RESULTS In a sample of largely Hispanic (81%) pregnant women, total personal PM2.5 was not significantly associated with birthweight (β = 38.6 per 1SD increase in PM2.5; 95% CI:-21.1, 98.2). This association however, differed by home type (single family home: 156.9 (26.9, 287.0), 2-4 attached units:-16.6 (-111.9, 78.7), 5+ units:-62.6 (-184.9, 59.6), missing: 145.4 (-4.1, 294.9), interaction p = 0.028) and by household air conditioner use (none of the time: -27.6 (-101.5, 46.3) vs. some of the time: 139.9 (42.9, 237.0), interaction p = 0.008) Additionally, the effect of personal PM2.5 on birthweight varied by time spent indoors (none or little of the time: - 45.1 (-208.3, 118.1) vs. most or all of the time: 57.1 (-7.3, 121.6), interaction p = 0.255). CONCLUSIONS While no significant association between total personal PM2.5 exposure and birthweight was found, there was evidence that multi-unit housing (vs. single-family homes), candle and/or incense smoke, and greater outdoor source contributions to personal PM2.5 were more strongly associated with lower birthweight.
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Affiliation(s)
- Karl O’Sharkey
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
| | - Yan Xu
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, United States
| | - Thomas Chavez
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
| | - Mark Johnson
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
| | - Jane Cabison
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
| | - Marisela Rosales
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
| | - Brendan Grubbs
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
| | - Claudia M. Toledo-Corral
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
- Department of Health Sciences, California State University Northridge, Northridge, CA, United States
| | - Shohreh F. Farzan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
| | - Theresa Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
| | - Rima Habre
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, United States
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Quraishi SM, Hazlehurst MF, Loftus CT, Nguyen RHN, Barrett ES, Kaufman JD, Bush NR, Karr CJ, LeWinn KZ, Sathyanarayana S, Tylavsky FA, Szpiro AA, Enquobahrie DA. Association of prenatal exposure to ambient air pollution with adverse birth outcomes and effect modification by socioeconomic factors. ENVIRONMENTAL RESEARCH 2022; 212:113571. [PMID: 35640705 PMCID: PMC9674115 DOI: 10.1016/j.envres.2022.113571] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/22/2022] [Accepted: 05/24/2022] [Indexed: 06/02/2023]
Abstract
BACKGROUND Maternal exposure to air pollution has been associated with birth outcomes; however, few studies examined biologically critical exposure windows shorter than trimesters or potential effect modifiers. OBJECTIVES To examine associations of prenatal fine particulate matter (PM2.5), by trimester and in biologically critical windows, with birth outcomes and assess potential effect modifiers. METHODS This study used two pregnancy cohorts (CANDLE and TIDES; N = 2099) in the ECHO PATHWAYS Consortium. PM2.5 was estimated at the maternal residence using a fine-scale spatiotemporal model, averaged over pregnancy, trimesters, and critical windows (0-2 weeks, 10-12 weeks, and last month of pregnancy). Outcomes were preterm birth (PTB, <37 completed weeks of gestation), small-for-gestational-age (SGA), and continuous birthweight. We fit multivariable adjusted linear regression models for birthweight and Poisson regression models (relative risk, RR) for PTB and SGA. Effect modification by socioeconomic factors (maternal education, household income, neighborhood deprivation) and infant sex were examined using interaction terms. RESULTS Overall, 9% of births were PTB, 10.4% were SGA, and mean term birthweight was 3268 g (SD = 558.6). There was no association of PM2.5 concentration with PTB or SGA. Lower birthweight was associated with higher PM2.5 averaged over pregnancy (β -114.2, 95%CI -183.2, -45.3), during second (β -52.9, 95%CI -94.7, -11.2) and third (β -45.5, 95%CI -85.9, -5.0) trimesters, and the month prior to delivery (β -30.5, 95%CI -57.6, -3.3). Associations of PM2.5 with likelihood of SGA and lower birthweight were stronger among male infants (p-interaction ≤0.05) and in those with lower household income (p-interaction = 0.09). CONCLUSIONS Findings from this multi city U.S. birth cohort study support previous reports of inverse associations of birthweight with higher PM2.5 exposure during pregnancy. Findings also suggest possible modification of this association by infant sex and household income.
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Affiliation(s)
- Sabah M Quraishi
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Marnie F Hazlehurst
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Christine T Loftus
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Ruby H N Nguyen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Emily S Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Environmental and Occupational Health Sciences Institute, Piscataway, NJ, USA
| | - Joel D Kaufman
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; Division of General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Nicole R Bush
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California San Francisco, San Francisco, CA, USA; Department of Pediatrics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Catherine J Karr
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Kaja Z LeWinn
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sheela Sathyanarayana
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA
| | - Frances A Tylavsky
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adam A Szpiro
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Daniel A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
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Yu Z, Zhang X, Zhang J, Feng Y, Zhang H, Wan Z, Xiao C, Zhang H, Wang Q, Huang C. Gestational exposure to ambient particulate matter and preterm birth: An updated systematic review and meta-analysis. ENVIRONMENTAL RESEARCH 2022; 212:113381. [PMID: 35523275 DOI: 10.1016/j.envres.2022.113381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/17/2022] [Accepted: 04/26/2022] [Indexed: 06/14/2023]
Abstract
Previous studies on gestational particulate matter (PM) exposure and preterm birth (PTB) showed inconsistent results, and no study systematically examined the short-term effect of PM exposure on PTB subtypes. To investigate both long- and short-term effects of the evidence to date in general population, we searched for epidemiological studies on PM exposure and PTB that published in PubMed, Web of Science, Embase and Cochrane Library up to March 31, 2022. The protocol for this review was registered with PROSPERO (CRD42021265202). Heterogeneity was assessed by Cochran's Q test and I2 statistic. Publication bias was evaluated using funnel plots and Egger's tests. Subgroup analysis, meta-regression and sensitivity analysis were performed. Of 16,801 records, 84 eligible studies were finally included. The meta-analysis of long-term effect showed that per 10 μg/m3 increase in PM2.5 and PM10 during entire pregnancy were associated with PTB, the pooled odds ratios (ORs) were 1.084 (95% CI: 1.055-1.113) and 1.034 (95% CI: 1.018-1.049). Positive associations were found between PM2.5 in second trimester and PTB subtypes. For the short-term exposure, we observed that PTB was positively associated with a 10 μg/m3 increment in PM2.5 on lag day 2 and 3, the pooled ORs and 95% CIs were 1.003 (1.001-1.004) and 1.003 (1.001-1.005), with I2 of 65.30% and 76.60%. PM10 exposure on ave day 1 increased the risk of PTB, the pooled OR was 1.001 (95% CI: 1.000, 1.001). We also found that PM10 exposure in 2 weeks prior to birth increased PTB risk. Our results support the hypothesis of both long- and short-term PM2.5 exposure increase the risk of PTB. Further well-designed longitudinal studies and investigations into potential biological mechanisms are warranted.
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Affiliation(s)
- Zengli Yu
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaoan Zhang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junxi Zhang
- National Health Commission Key Laboratory of Birth Defects Prevention; Key Laboratory of Population Defects Prevention, Zhengzhou, China
| | - Yang Feng
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Han Zhang
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zhongxiao Wan
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Chenglong Xiao
- School of Earth Sciences, Chengdu University of Technology, Chengdu, China
| | - Huanhuan Zhang
- School of Public Health, Zhengzhou University, Zhengzhou, China; National Health Commission Key Laboratory of Birth Defects Prevention; Key Laboratory of Population Defects Prevention, Zhengzhou, China.
| | - Qiong Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Evans J, Bansal A, Schoenaker DAJM, Cherbuin N, Peek MJ, Davis DL. Birth Outcomes, Health, and Health Care Needs of Childbearing Women following Wildfire Disasters: An Integrative, State-of-the-Science Review. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:86001. [PMID: 35980335 PMCID: PMC9387511 DOI: 10.1289/ehp10544] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 06/27/2022] [Accepted: 08/01/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND The frequency and severity of extreme weather events such as wildfires are expected to increase due to climate change. Childbearing women, that is, women who are pregnant, soon to be pregnant, or have recently given birth, may be particularly vulnerable to the effect of wildfire exposure. OBJECTIVES This review sought to systematically assess what is known about birth outcomes, health, and health care needs of childbearing women during and after exposure to wildfires. METHODS An integrative review methodology was utilized to enable article selection, data extraction, and synthesis across qualitative and quantitative studies. Comprehensive searches of SCOPUS (including MEDLINE and Embase), CINAHL, PubMed, and Google Scholar identified studies for inclusion with no date restriction. Included studies were independently appraised by two reviewers using the Crowe Critical Appraisal Tool. The findings are summarized and illustrated in tables. RESULTS Database searches identified 480 records. Following title, abstract, and full text screening, sixteen studies published between 2012 and 2022 were identified for this review. Eleven studies considered an association between in utero exposure to wildfire and impacts on birth weight and length of gestation. One study reported increased rates of maternal gestational diabetes mellitus and gestational hypertension following exposure; whereas one study reported differences in the secondary sex ratio. Two studies reported higher incidence of birth defects following in utero exposure to wildfire smoke. Three studies reported increased mental health morbidity, and one study associated a reduction in breastfeeding among women who evacuated from a wildfire disaster. DISCUSSION Evidence indicates that wildfire exposure may be associated with changes to birth outcomes and increased morbidity for childbearing women and their babies. These effects may be profound and have long-term and wide-ranging public health implications. This research can inform the development of effective clinical and public health strategies to address the needs of childbearing women exposed to wildfire disaster. https://doi.org/10.1289/EHP10544.
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Affiliation(s)
- Jo Evans
- School of Midwifery, University of Canberra, Canberra, Australian Capital Territory, Australia
- Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Amita Bansal
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Danielle A J M Schoenaker
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michael J Peek
- Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Deborah L Davis
- School of Midwifery, University of Canberra, Canberra, Australian Capital Territory, Australia
- ACT Government, Health Directorate, Canberra, Australian Capital Territory, Australia
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Nyadanu SD, Dunne J, Tessema GA, Mullins B, Kumi-Boateng B, Lee Bell M, Duko B, Pereira G. Prenatal exposure to ambient air pollution and adverse birth outcomes: An umbrella review of 36 systematic reviews and meta-analyses. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 306:119465. [PMID: 35569625 DOI: 10.1016/j.envpol.2022.119465] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/12/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
Multiple systematic reviews and meta-analyses linked prenatal exposure to ambient air pollutants to adverse birth outcomes with mixed findings, including results indicating positive, negative, and null associations across the pregnancy periods. The objective of this study was to systematically summarise systematic reviews and meta-analyses on air pollutants and birth outcomes to assess the overall epidemiological evidence. Systematic reviews with/without meta-analyses on the association between air pollutants (NO2, CO, O3, SO2, PM2.5, and PM10) and birth outcomes (preterm birth; stillbirth; spontaneous abortion; birth weight; low birth weight, LBW; small-for-gestational-age) up to March 30, 2022 were included. We searched PubMed, CINAHL, Scopus, Medline, Embase, and the Web of Science Core Collection, systematic reviews repositories, grey literature databases, internet search engines, and references of included studies. The consistency in the directions of the effect estimates was classified as more consistent positive or negative, less consistent positive or negative, unclear, and consistently null. Next, the confidence in the direction was rated as either convincing, probable, limited-suggestive, or limited non-conclusive evidence. Final synthesis included 36 systematic reviews (21 with and 15 without meta-analyses) that contained 295 distinct primary studies. PM2.5 showed more consistent positive associations than other pollutants. The positive exposure-outcome associations based on the entire pregnancy period were more consistent than trimester-specific exposure averages. For whole pregnancy exposure, a more consistent positive association was found for PM2.5 and birth weight reductions, particulate matter and spontaneous abortion, and SO2 and LBW. Other exposure-outcome associations mostly showed less consistent positive associations and few unclear directions of associations. Almost all associations showed probable evidence. The available evidence indicates plausible causal effects of criteria air pollutants on birth outcomes. To strengthen the evidence, more high-quality studies are required, particularly from understudied settings, such as low-and-middle-income countries. However, the current evidence may warrant the adoption of the precautionary principle.
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Affiliation(s)
- Sylvester Dodzi Nyadanu
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia; Education, Culture, and Health Opportunities (ECHO) Ghana, ECHO Research Group International, P. O. Box 424, Aflao, Ghana.
| | - Jennifer Dunne
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia
| | - Gizachew Assefa Tessema
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia; School of Public Health, University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - Ben Mullins
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia
| | - Bernard Kumi-Boateng
- Department of Geomatic Engineering, University of Mines and Technology, P. O. Box 237, Tarkwa, Ghana
| | - Michelle Lee Bell
- School of the Environment, Yale University, New Haven, CT, 06511, USA
| | - Bereket Duko
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia; Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, 0473, Oslo, Norway; enAble Institute, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia
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Markozannes G, Pantavou K, Rizos EC, Sindosi OΑ, Tagkas C, Seyfried M, Saldanha IJ, Hatzianastassiou N, Nikolopoulos GK, Ntzani E. Outdoor air quality and human health: An overview of reviews of observational studies. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 306:119309. [PMID: 35469927 DOI: 10.1016/j.envpol.2022.119309] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/15/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
The epidemiological evidence supporting putative associations between air pollution and health-related outcomes continues to grow at an accelerated pace with a considerable heterogeneity and with varying consistency based on the outcomes assessed, the examined surveillance system, and the geographic region. We aimed to evaluate the strength of this evidence base, to identify robust associations as well as to evaluate effect variation. An overview of reviews (umbrella review) methodology was implemented. PubMed and Scopus were systematically screened (inception-3/2020) for systematic reviews and meta-analyses examining the association between air pollutants, including CO, NOX, NO2, O3, PM10, PM2.5, and SO2 and human health outcomes. The quality of systematic reviews was evaluated using AMSTAR. The strength of evidence was categorized as: strong, highly suggestive, suggestive, or weak. The criteria included statistical significance of the random-effects meta-analytical estimate and of the effect estimate of the largest study in a meta-analysis, heterogeneity between studies, 95% prediction intervals, and bias related to small study effects. Seventy-five systematic reviews of low to moderate methodological quality reported 548 meta-analyses on the associations between outdoor air quality and human health. Of these, 57% (N = 313) were not statistically significant. Strong evidence supported 13 associations (2%) between elevated PM2.5, PM10, NO2, and SO2 concentrations and increased risk of cardiorespiratory or pregnancy/birth-related outcomes. Twenty-three (4%) highly suggestive associations were identified on elevated PM2.5, PM10, O3, NO2, and SO2 concentrations and increased risk of cardiorespiratory, kidney, autoimmune, neurodegenerative, cancer or pregnancy/birth-related outcomes. Sixty-seven (12%), and 132 (24%) meta-analyses were graded as suggestive, and weak, respectively. Despite the abundance of research on the association between outdoor air quality and human health, the meta-analyses of epidemiological studies in the field provide evidence to support robust associations only for cardiorespiratory or pregnancy/birth-related outcomes.
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Affiliation(s)
- Georgios Markozannes
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | | | - Evangelos C Rizos
- Department of Internal Medicine, University Hospital of Ioannina, Ioannina, Greece; School of Medicine, European University Cyprus, Nicosia, Cyprus; Hellenic Open University, Patra, Greece
| | - Ourania Α Sindosi
- Laboratory of Meteorology, Department of Physics, University of Ioannina, Ioannina, Greece
| | - Christos Tagkas
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Maike Seyfried
- Faculty of Medicine, University of Tuebingen, Tuebingen, Germany
| | - Ian J Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, and Department of Epidemiology, School of Public Health, Brown University, RI, USA
| | - Nikos Hatzianastassiou
- Laboratory of Meteorology, Department of Physics, University of Ioannina, Ioannina, Greece
| | | | - Evangelia Ntzani
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece; Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, and Department of Epidemiology, School of Public Health, Brown University, RI, USA.
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Ahmad WA, Nirel R, Golan R, Jolles M, Kloog I, Rotem R, Negev M, Koren G, Levine H. Mother-level random effect in the association between PM 2.5 and fetal growth: A population-based pregnancy cohort. ENVIRONMENTAL RESEARCH 2022; 210:112974. [PMID: 35192805 DOI: 10.1016/j.envres.2022.112974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/02/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND A growing body of literature reports associations between exposure to particulate matter with diameter ≤2.5 μm (PM2.5) during pregnancy and birth outcomes. However, findings are inconsistent across studies. OBJECTIVES To assess the association between PM2.5 and birth outcomes of fetal growth in a cohort with high prevalence of siblings by multilevel models accounting for geographical- and mother-level correlations. METHODS In Israel, we used Maccabi Healthcare Services data to establish a population-based cohort of 381,265 singleton births reaching 24-42 weeks' gestation and birth weight of 500-5000 g (2004-2015). Daily PM2.5 predictions from a satellite-based spatiotemporal model were linked to the date of birth and maternal residence. We generated mean PM2.5 values for the entire pregnancy and for exposure periods during pregnancy. Associations between exposure and birth outcomes were modeled by using multilevel logistic regression with random effects for maternal locality of residence, administrative census area (ACA) and mother. RESULTS In fully adjusted models with a mother-level random intercept only, a 10-μg/m3 increase in PM2.5 over the entire pregnancy was positively associated with term low birth weight (TLBW) (Odds ratio, OR = 1.25, 95% confidence interval, CI: 1.09,1.43) and small for gestational age (SGA) (OR = 1.15, 95% CI: 1.06,1.26). Locality- and ACA-level effects accounted for <0.4% of the variance while mother-level effects explained ∼50% of the variability. Associations varied by exposure period, infants' sex, birth order, and maternal pre-pregnancy BMI. CONCLUSIONS Consideration of mother-level variability in a region with high fertility rates provides new insights on the strength of associations between PM2.5 and birth outcomes.
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Affiliation(s)
| | - Ronit Nirel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rachel Golan
- Ben-Gurion University of the Negev, Beer Sheva, Israel
| | | | - Itai Kloog
- Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ran Rotem
- Harvard T.H. Chan School of Public Health, Boston, MA, USA; Institute of Research and Innovation, Maccabitech, Tel-Aviv, Israel
| | | | - Gideon Koren
- Institute of Research and Innovation, Maccabitech, Tel-Aviv, Israel; Tel Aviv University, Tel-Aviv, Israel
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Xu J, Yang Z, Han B, Yang W, Duan Y, Fu Q, Bai Z. A unified empirical modeling approach for particulate matter and NO 2 in a coastal city in China. CHEMOSPHERE 2022; 299:134384. [PMID: 35337823 DOI: 10.1016/j.chemosphere.2022.134384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/27/2022] [Accepted: 03/18/2022] [Indexed: 06/14/2023]
Abstract
Modeling air pollutants on a fine spatiotemporal scale is necessary for health studies that focus on critical short-term exposure windows. A unified empirical modeling approach is useful for health studies; however, it is unclear whether this approach can be used in a coastal city for air pollutants driven by local emissions and regional meteorological factors. An advanced empirical modeling approach was used to develop exposure models from October 2012 to December 2019, for particulate matter with aerodynamic diameters less than or equal to 2.5 and 10 μm (PM2.5 and PM10) and nitrogen dioxide (NO2) in the coastal city of Shanghai, China. Air pollutant concentrations were obtained from daily measurements at 55 administrative monitoring sites that were integrated into three-day average concentrations. Data on a large array of geographic variables were collected, and their dimensions were reduced using the partial least squares regression method. A geostatistical model using the land-use regression approach in a universal kriging framework was developed to estimate short-term exposure concentrations. The prediction ability of the models were determined by leave-one (site)-out cross-validation (LOOCV) and external validation (EV). Compared to the LOOCV results, the EV results for PM2.5 and PM10 were consistently reliable, but the EV for NO2 had a larger root mean squared error. The temporal random effects involved in the model structure were interpreted using sensitivity analyses. This affected the short-term PM2.5 and PM10 model predictions. This unified empirical modeling approach was successfully used for particulate matter in Shanghai, where air pollution is affected by complex regional and meteorological conditions. These exposure models are going to be applied for making exposure predictions at residential locations for short-term exposure predictions in the "Growth trajectories and air pollution" (GAAP) study in Shanghai that focuses on maternal and early life exposure to air pollutants.
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Affiliation(s)
- Jia Xu
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing, 100012, China
| | - Zhenchun Yang
- Duke Global Health Institute, Duke University, Durham, NC, 27708, United States
| | - Bin Han
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing, 100012, China
| | - Wen Yang
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing, 100012, China.
| | - Yusen Duan
- Shanghai Environmental Monitoring Center, Shanghai, China.
| | - Qingyan Fu
- Shanghai Environmental Monitoring Center, Shanghai, China
| | - Zhipeng Bai
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing, 100012, China
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Song AY, Feinberg JI, Bakulski KM, Croen LA, Fallin MD, Newschaffer CJ, Hertz-Picciotto I, Schmidt RJ, Ladd-Acosta C, Volk HE. Prenatal Exposure to Ambient Air Pollution and Epigenetic Aging at Birth in Newborns. Front Genet 2022; 13:929416. [PMID: 35836579 PMCID: PMC9274082 DOI: 10.3389/fgene.2022.929416] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
In utero air pollution exposure has been associated with adverse birth outcomes, yet effects of air pollutants on regulatory mechanisms in fetal growth and critical windows of vulnerability during pregnancy are not well understood. There is evidence that epigenetic alterations may contribute to these effects. DNA methylation (DNAm) based age estimators have been developed and studied extensively with health outcomes in recent years. Growing literature suggests environmental factors, such as air pollution and smoking, can influence epigenetic aging. However, little is known about the effect of prenatal air pollution exposure on epigenetic aging. In this study, we leveraged existing data on prenatal air pollution exposure and cord blood DNAm from 332 mother-child pairs in the Early Autism Risk Longitudinal Investigation (EARLI) and Markers of Autism Risk in Babies-Learning Early Signs (MARBLES), two pregnancy cohorts enrolling women who had a previous child diagnosed with autism spectrum disorder, to assess the relationship of prenatal exposure to air pollution and epigenetic aging at birth. DNAm age was computed using existing epigenetic clock algorithms for cord blood tissue-Knight and Bohlin. Epigenetic age acceleration was defined as the residual of regressing chronological gestational age on DNAm age, accounting for cell type proportions. Multivariable linear regression models and distributed lag models (DLMs), adjusting for child sex, maternal race/ethnicity, study sites, year of birth, maternal education, were completed. In the single-pollutant analysis, we observed exposure to PM2.5, PM10, and O3 during preconception period and pregnancy period were associated with decelerated epigenetic aging at birth. For example, pregnancy average PM10 exposure (per 10 unit increase) was associated with epigenetic age deceleration at birth (weeks) for both Knight and Bohlin clocks (β = -0.62, 95% CI: -1.17, -0.06; β = -0.32, 95% CI: -0.63, -0.01, respectively). Weekly DLMs revealed that increasing PM2.5 during the first trimester and second trimester were associated with decelerated epigenetic aging and that increasing PM10 during the preconception period was associated with decelerated epigenetic aging, using the Bohlin clock estimate. Prenatal ambient air pollution exposure, particularly in early and mid-pregnancy, was associated with decelerated epigenetic aging at birth.
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Affiliation(s)
- Ashley Y. Song
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jason I. Feinberg
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kelly M. Bakulski
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente, Oakland, CA, United States
| | - M. Daniele Fallin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Craig J. Newschaffer
- College of Health and Human Development, Pennsylvania State University, State College, PA, United States
| | - Irva Hertz-Picciotto
- Department of Public Health Sciences, UC Davis, Davis CA and the UC Davis MIND Institute, Sacramento, CA, United States
| | - Rebecca J. Schmidt
- Department of Public Health Sciences, UC Davis, Davis CA and the UC Davis MIND Institute, Sacramento, CA, United States
| | - Christine Ladd-Acosta
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Heather E. Volk
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Zhai Y, Wang B, Qin L, Luo B, Xie Y, Hu H, Du H, Li Z. Smog and risk of maternal and fetal birth outcomes: A retrospective study in Baoding, China. Open Med (Wars) 2022; 17:1007-1018. [PMID: 35733622 PMCID: PMC9164291 DOI: 10.1515/med-2022-0489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/30/2022] [Accepted: 04/20/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
Pregnant women are more susceptible to smog pollution than the general population. This study focused on the association between smog and birth outcomes, considering both pregnant mothers and their offspring. In this retrospective study, conducted in Baoding between 2013 and 2016, we enrolled 842 participants. Birth outcomes were low birth weight (LBW), pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), and premature rupture of membranes (PROM). The overall prevalence of LBW, PIH, GDM, and PROM was 8.2%, 14.8%, 16.5%, and 12.1%, respectively. Compared with lower pollution level, higher pollution level of fine particulate matter (particulate matter with aerodynamics diameter <2.5 μm) (PM2.5), inhalable particle (particulate matter with aerodynamics diameter <10 μm) (PM10), and CO increased the risk of term with LBW. PM2.5, PM10, and NO2 increased the risk of PIH during different trimesters, while PM10 increased the risk of PROM during trimester 3. In conclusion, smog significantly affects the risk of adverse birth outcomes by different exposure time windows.
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Affiliation(s)
- Yijing Zhai
- Department of Nutrition, Hebei Key Laboratory of Nutrition and Health, The First Hospital of Hebei Medical University , Shijiazhuang , 050031 , China
| | - Bei Wang
- Department of Nutrition, Hebei Key Laboratory of Nutrition and Health, The First Hospital of Hebei Medical University , Shijiazhuang , 050031 , China
| | - Liqiang Qin
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University , Suzhou , 215000 , China
| | - Bin Luo
- Department of Nutrition, Hebei Key Laboratory of Nutrition and Health, The First Hospital of Hebei Medical University , Shijiazhuang , 050031 , China
| | - Ying Xie
- Department of Nutrition, Hebei Key Laboratory of Nutrition and Health, The First Hospital of Hebei Medical University , Shijiazhuang , 050031 , China
| | - Huanyu Hu
- Department of Nutrition, Hebei Key Laboratory of Nutrition and Health, The First Hospital of Hebei Medical University , Shijiazhuang , 050031 , China
| | - Hongzhen Du
- Department of Nutrition, Hebei Key Laboratory of Nutrition and Health, The First Hospital of Hebei Medical University , Shijiazhuang , 050031 , China
| | - Zengning Li
- Department of Nutrition, Hebei Key Laboratory of Nutrition and Health, The First Hospital of Hebei Medical University , Shijiazhuang , 050031 , China
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40
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Payne-Sturges DC, Puett R, Cory-Slechta DA. Both parents matter: a national-scale analysis of parental race/ethnicity, disparities in prenatal PM 2.5 exposures and related impacts on birth outcomes. Environ Health 2022; 21:47. [PMID: 35513869 PMCID: PMC9074320 DOI: 10.1186/s12940-022-00856-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 04/12/2022] [Indexed: 05/05/2023]
Abstract
BACKGROUND Most U.S. studies that report racial/ethnic disparities in increased risk of low birth weight associated with air pollution exposures have been conducted in California or northeastern states and/or urban areas, limiting generalizability of study results. Few of these studies have examined maternal racial/ethnic groups other than Non-Hispanic Black, non-Hispanic White and Hispanic, nor have they included paternal race. We aimed to examine the independent effects of PM2.5 on birth weight among a nationally representative sample of U.S. singleton infants and how both maternal and paternal race/ethnicity modify relationships between prenatal PM2.5 exposures and birth outcomes. METHODS We used data from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), a longitudinal nationally representative cohort of 10,700 U.S. children born in 2001, which we linked to U.S.EPA's Community Multi-scale Air Quality (CMAQ)-derived predicted daily PM2.5 concentrations at the centroid of each Census Bureau Zip Code Tabulation Area (ZCTA) for maternal residences. We examined relationships between term birthweight (TBW), term low birthweight rate (TLBW) and gestational PM2.5 pollutant using multivariate regression models. Effect modification of air pollution exposures on birth outcomes by maternal and paternal race was evaluated using stratified models. All analyses were conducted with sample weights to provide national-scale estimates. RESULTS The majority of mothers were White (61%). Fourteen percent of mothers identified as Black, 21% as Hispanic, 3% Asian American and Pacific Islander (AAPI) and 1% American Indian and Alaskan Native (AIAN). Fathers were also racially/ethnically diverse with 55% identified as White Non-Hispanic, 10% as Black Non-Hispanic, 19% as Hispanic, 3% as AAPI and 1% as AIAN. Results from the chi-square and ANOVA tests of significance for racial/ethnic differences indicate disparities in prenatal exposures and birth outcomes by both maternal and paternal race/ethnicity. Prenatal PM2.5 was associated with reduced birthweights during second and third trimester and over the entire gestational period in adjusted regression models, although results did not reach statistical significance. In models stratified by maternal race and paternal race, one unit increase in PM2.5 was statistically significantly associated with lower birthweights among AAPI mothers, -5.6 g (95% CI:-10.3, -1.0 g) and AAPI fathers, -7.6 g (95% CI: -13.1, -2.1 g) during 3rd trimester and among births where father's race was not reported, -14.2 g (95% CI: -24.0, -4.4 g). CONCLUSIONS These data suggest that paternal characteristics should be used, in addition to maternal characteristics, to describe the risks of adverse birth outcomes. Additionally, our study suggests that serious consideration should be given to investigating environmental and social mechanisms, such as air pollution exposures, as potential contributors to disparities in birth outcomes among AAPI populations.
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Affiliation(s)
- Devon C Payne-Sturges
- School of Public Health, Maryland Institute for Applied Environmental Health, University of Maryland, 255 Valley Drive, College Park, MD, 20742, USA.
| | - Robin Puett
- School of Public Health, Maryland Institute for Applied Environmental Health, University of Maryland, 255 Valley Drive, College Park, MD, 20742, USA
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Mendoza-Sanchez I, Uwak I, Myatt L, Van Cleve A, Pulczinski JC, Rychlik KA, Sweet S, Ramani T, Zietsman J, Zamora ML, Koehler K, Carrillo G, Johnson NM. Maternal exposure to polycyclic aromatic hydrocarbons in South Texas, evaluation of silicone wristbands as personal passive samplers. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022; 32:280-288. [PMID: 34131287 PMCID: PMC8920889 DOI: 10.1038/s41370-021-00348-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 05/12/2023]
Abstract
BACKGROUND Prenatal exposure to polycyclic aromatic hydrocarbons (PAHs) is associated with adverse health effects in children. Valid exposure assessment methods with accurate spatial and temporal resolution across pregnancy is a critical need for advancing environmental health studies. OBJECTIVE The objective of this study was to quantify maternal PAH exposure in pregnant women residing in McAllen, Texas where the prematurity rate and childhood asthma prevalence rates are high. A secondary objective was to compare PAH levels in silicone wristbands deployed as passive samplers with concentrations measured using standardized active air-sampling techniques. METHODS Participants carried a backpack that contained air-sampling equipment (i.e., filter and XAD sorbent) and a silicone wristband (i.e., passive sampler) for three nonconsecutive 24-h periods. Filters, XAD tubes, and wristbands were analyzed for PAHs. RESULTS The median level of exposure for the sum of 16 PAHs measured via active sampling over 24 h was 5.54 ng/m3 (filters) and 43.82 ng/m3 (XADs). The median level measured in wristbands (WB) was 586.82 ng/band. Concentrations of the PAH compounds varied across sampling matrix type. Phenanthrene and fluorene were consistently measured for all participants and in all matrix types. Eight additional volatile PAHs were measured in XADs and WBs; the median level of exposure for the sum of these eight PAHs was 342.98 ng/m3 (XADs) and 632.27 ng/band. The silicone wristbands (WB) and XAD sorbents bound 1-methynaphthalyne, 2-methylnaphthalene, biphenyl following similar patterns of detection. SIGNIFICANCE Since prior studies indicate linkages between PAH exposure and adverse health outcomes in children at the PAH levels detected in our study, further investigation on the associated health effects is needed. Data reflect the ability of silicone wristbands to bind smaller molecular weight, semivolatile PAHs similar to XAD resin. Application of wristbands as passive samplers may be useful in studies evaluating semivolatile PAHs.
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Affiliation(s)
- Itza Mendoza-Sanchez
- Department of Environmental and Occupational Health, Texas A&M University School of Public Health, College Station, TX, USA
| | - Inyang Uwak
- Department of Environmental and Occupational Health, Texas A&M University School of Public Health, College Station, TX, USA
| | - Louise Myatt
- Department of Environmental and Occupational Health, Texas A&M University School of Public Health, College Station, TX, USA
| | - Allison Van Cleve
- Department of Environmental and Occupational Health, Texas A&M University School of Public Health, College Station, TX, USA
| | - Jairus C Pulczinski
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kristal A Rychlik
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephen Sweet
- Geochemical and Environmental Research Group, Texas A&M University, College Station, TX, USA
| | - Tara Ramani
- Environment and Air Quality Division, Texas A&M Transportation Institute, College Station, TX, USA
| | - Josias Zietsman
- Environment and Air Quality Division, Texas A&M Transportation Institute, College Station, TX, USA
| | - Misti Levy Zamora
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Genny Carrillo
- Department of Environmental and Occupational Health, Texas A&M University School of Public Health, College Station, TX, USA
| | - Natalie M Johnson
- Department of Environmental and Occupational Health, Texas A&M University School of Public Health, College Station, TX, USA.
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Veras M, Waked D, Saldiva P. Safe in the womb? Effects of air pollution to the unborn child and neonates. J Pediatr (Rio J) 2022; 98 Suppl 1:S27-S31. [PMID: 34740534 PMCID: PMC9510928 DOI: 10.1016/j.jped.2021.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE In this brief review, the authors focus on the effects of gestational exposures to urban air pollution on fetal development and neonatal outcomes. SOURCE OF DATA In this review the authors used PubMed, Web of Science and SciELO research platforms, analyzing papers from the last 30 years. SUMMARY OF THE FINDINGS Epidemiological and experimental evidence agree that gestational exposure to air pollution in urban increases the risks for low birth weight, preterm birth, congenital malformation, intrauterine growth restriction, and neonatal mortality. Furthermore, exposures are associated with increased risks for preeclampsia, hypertension, gestational diabetes. CONCLUSIONS Therefore, it is time for greater involvement and engagement of the health sector in the discussion of public policies that may affect the quality of the environment, and that directly or indirectly impact the health of those who were not yet born.
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Affiliation(s)
- Mariana Veras
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Patologia Ambiental e Experimental (LIM05), São Paulo, SP, Brazil.
| | - Dunia Waked
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Patologia Ambiental e Experimental (LIM05), São Paulo, SP, Brazil
| | - Paulo Saldiva
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Patologia Ambiental e Experimental (LIM05), São Paulo, SP, Brazil
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Behlen JC, Lau CH, Pendleton D, Li Y, Hoffmann AR, Golding MC, Zhang R, Johnson NM. NRF2-Dependent Placental Effects Vary by Sex and Dose following Gestational Exposure to Ultrafine Particles. Antioxidants (Basel) 2022; 11:352. [PMID: 35204234 PMCID: PMC8868520 DOI: 10.3390/antiox11020352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 02/04/2023] Open
Abstract
Exposure to ultrafine particles (UFPs, PM0.1) during pregnancy triggers placental oxidative stress and inflammation, similar to fine PM (PM2.5). The Nrf2 gene encodes a redox-sensitive transcription factor that is a major regulator of antioxidant and anti-inflammatory responses. Disruption of NRF2 is known to substantially enhance PM2.5-driven oxidant and inflammatory responses; however, specific responses to UFP exposure, especially during critical windows of susceptibility such as pregnancy, are not fully characterized; To investigate the role of NRF2 in regulating maternal antioxidant defenses and placental responses to UFP exposure, wildtype (WT) and Nrf2-/- pregnant mice were exposed to either low dose (LD, 100 µg/m3) or high dose (HD, 500 µg/m3) UFP mixture or filtered air (FA, control) throughout gestation; Nrf2-/- HD-exposed female offspring exhibited significantly reduced fetal and placental weights. Placental morphology changes appeared most pronounced in Nrf2-/- LD-exposed offspring of both sexes. Glutathione (GSH) redox analysis revealed significant increases in the GSH/GSSG ratio (reduced/oxidized) in WT female placental tissue exposed to HD in comparison with Nrf2-/- HD-exposed mice. The expression of inflammatory cytokine genes (Il1β, Tnfα) was significantly increased in Nrf2-/- placentas from male and female offspring across all exposure groups. Genes related to bile acid metabolism and transport were differentially altered in Nrf2-/- mice across sex and exposure groups. Notably, the group with the most marked phenotypic effects (Nrf2-/- HD-exposed females) corresponded to significantly higher placental Apoa1 and Apob expression suggesting a link between placental lipid transport and NRF2 in response to high dose UFP exposure; Disruption of NRF2 exacerbates adverse developmental outcomes in response to high dose UFP exposure in female offspring. Morphological effects in placenta from male and female offspring exposed to low dose UFPs also signify the importance of NRF2 in maternal-fetal response to UFPs.
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Affiliation(s)
- Jonathan C. Behlen
- Department of Environmental and Occupational Health, Texas A&M University, College Station, TX 77843, USA; (J.C.B.); (D.P.)
| | - Carmen H. Lau
- Department of Veterinary Pathobiology, Texas A&M University, College Station, TX 77843, USA;
| | - Drew Pendleton
- Department of Environmental and Occupational Health, Texas A&M University, College Station, TX 77843, USA; (J.C.B.); (D.P.)
| | - Yixin Li
- Department of Chemistry, Texas A&M University, College Station, TX 77843, USA; (Y.L.); (R.Z.)
| | - Aline Rodrigues Hoffmann
- Department of Comparative, Diagnostic and Preventive Medicine, University of Florida, Gainesville, FL 32653, USA;
| | - Michael C. Golding
- Department of Veterinary Physiology and Pharmacology, Texas A&M University, College Station, TX 77843, USA;
| | - Renyi Zhang
- Department of Chemistry, Texas A&M University, College Station, TX 77843, USA; (Y.L.); (R.Z.)
- Department of Atmospheric Sciences, Texas A&M University, College Station, TX 77843, USA
| | - Natalie M. Johnson
- Department of Environmental and Occupational Health, Texas A&M University, College Station, TX 77843, USA; (J.C.B.); (D.P.)
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Gong C, Wang J, Bai Z, Rich DQ, Zhang Y. Maternal exposure to ambient PM 2.5 and term birth weight: A systematic review and meta-analysis of effect estimates. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 807:150744. [PMID: 34619220 DOI: 10.1016/j.scitotenv.2021.150744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/18/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
Effect estimates of prenatal exposure to ambient PM2.5 on change in grams (β) of birth weight among term births (≥37 weeks of gestation; term birth weight, TBW) vary widely across studies. We present the first systematic review and meta-analysis of evidence regarding these associations. Sixty-two studies met the eligibility criteria for this review, and 31 studies were included in the meta-analysis. Random-effects meta-analysis was used to assess the quantitative relationships. Subgroup analyses were performed to gain insight into heterogeneity derived from exposure assessment methods (grouped by land use regression [LUR]-models, aerosol optical depth [AOD]-based models, interpolation/dispersion/Bayesian models, and data from monitoring stations), study regions, and concentrations of PM2.5 exposure. The overall pooled estimate involving 23,925,941 newborns showed that TBW was negatively associated with PM2.5 exposure (per 10 μg/m3 increment) during the entire pregnancy (β = -16.54 g), but with high heterogeneity (I2 = 95.6%). The effect estimate in the LUR-models subgroup (β = -16.77 g) was the closest to the overall estimate and with less heterogeneity (I2 = 18.3%) than in the other subgroups of AOD-based models (β = -41.58 g; I2 = 95.6%), interpolation/dispersion models (β = -10.78 g; I2 = 86.6%), and data from monitoring stations (β = -11.53 g; I2 = 97.3%). Even PM2.5 exposure levels of lower than 10 μg/m3 (the WHO air quality guideline value) had adverse effects on TBW. The LUR-models subgroup was the only subgroup that obtained similar significant of negative associations during the three trimesters as the overall trimester-specific analyses. In conclusion, TBW was negatively associated with maternal PM2.5 exposures during the entire pregnancy and each trimester. More studies based on relatively standardized exposure assessment methods need to be conducted to further understand the precise susceptible exposure time windows and potential mechanisms.
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Affiliation(s)
- Chen Gong
- Department of Family Planning, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jianmei Wang
- Department of Family Planning, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhipeng Bai
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing, China; Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - David Q Rich
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Yujuan Zhang
- Department of Family Planning, The Second Hospital of Tianjin Medical University, Tianjin, China; State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing, China.
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45
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Heft-Neal S, Driscoll A, Yang W, Shaw G, Burke M. Associations between wildfire smoke exposure during pregnancy and risk of preterm birth in California. ENVIRONMENTAL RESEARCH 2022; 203:111872. [PMID: 34403668 DOI: 10.1016/j.envres.2021.111872] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 05/25/2023]
Abstract
There is limited population-scale evidence on the burden of exposure to wildfire smoke during pregnancy and its impacts on birth outcomes. In order to investigate this relationship, data on every singleton birth in California 2006-2012 were combined with satellite-based estimates of wildfire smoke plume boundaries and high-resolution gridded estimates of surface PM2.5 concentrations and a regression model was used to estimate associations with preterm birth risk. Results suggest that each additional day of exposure to any wildfire smoke during pregnancy was associated with an 0.49 % (95 % CI: 0.41-0.59 %) increase in risk of preterm birth (<37 weeks). At sample median smoke exposure (7 days) this translated to a 3.4 % increase in risk, relative to an unexposed mother. Estimates by trimester suggest stronger associations with exposure later in pregnancy and estimates by smoke intensity indicate that observed associations were driven by higher intensity smoke-days. Exposure to low intensity smoke-days had no association with preterm birth while an additional medium (smoke PM2.5 5-10 μg/m3) or high (smoke PM2.5 > 10 μg/m3) intensity smoke-day was associated with an 0.95 % (95 % CI: 0.47-1.42 %) and 0.82 % (95 % CI: 0.41-1.24 %) increase in preterm risk, respectively. In contrast to previous findings for other pollution types, neither exposure to smoke nor the relative impact of smoke on preterm birth differed by race/ethnicity or income in our sample. However, impacts differed greatly by baseline smoke exposure, with mothers in regions with infrequent smoke exposure experiencing substantially larger impacts from an additional smoke-day than mothers in regions where smoke is more common. We estimate 6,974 (95 % CI: 5,513-8,437) excess preterm births attributable to wildfire smoke exposure 2007-2012, accounting for 3.7 % of observed preterm births during this period. Our findings have important implications for understanding the costs of growing wildfire smoke exposure, and for understanding the benefits of smoke mitigation measures.
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Affiliation(s)
- Sam Heft-Neal
- Center on Food Security and the Environment, Stanford University, Stanford, CA, USA.
| | - Anne Driscoll
- Center on Food Security and the Environment, Stanford University, Stanford, CA, USA
| | - Wei Yang
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Gary Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Marshall Burke
- Center on Food Security and the Environment, Stanford University, Stanford, CA, USA; Department of Earth System Science, Stanford University, Stanford, CA, USA; National Bureau of Economic Research, Cambridge, MA, USA
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46
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Brunst KJ, Hsu HHL, Zhang L, Zhang X, Carroll KN, Just A, Coull BA, Kloog I, Wright RO, Baccarelli AA, Wright RJ. Prenatal particulate matter exposure and mitochondrial mutational load at the maternal-fetal interface: Effect modification by genetic ancestry. Mitochondrion 2022; 62:102-110. [PMID: 34785263 PMCID: PMC9175302 DOI: 10.1016/j.mito.2021.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/26/2021] [Accepted: 11/08/2021] [Indexed: 12/30/2022]
Abstract
Prenatal ambient particulate matter (PM2.5) exposure impacts infant development and alters placental mitochondrial DNA abundance. We investigated whether the timing of PM2.5 exposure predicts placental mitochondrial mutational load using NextGen sequencing in 283 multi-ethnic mother-infant dyads. We observed increased PM2.5exposure, particularly during mid- to late-pregnancy and among genes coding for NADH dehydrogenase and subunits of ATP synthase, was associated with a greater amount of nonsynonymous mutations. The strongest associations were observed for participants of African ancestry. Further work is needed to tease out the role of mitochondrial genetics and its impact on offspring development and emerging disease disparities.
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Affiliation(s)
- Kelly J Brunst
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, 160 Panzeca Way, Cincinnati, OH 45267, USA.
| | - Hsiao-Hsien Leon Hsu
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 17 East 102(nd) St. New York, NY 10029, USA.
| | - Li Zhang
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, 160 Panzeca Way, Cincinnati, OH 45267, USA.
| | - Xiang Zhang
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, 160 Panzeca Way, Cincinnati, OH 45267, USA.
| | - Kecia N Carroll
- Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, 17 East 102(nd) St. New York, NY 10029, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, 17 East 102(nd) St., New York, NY 10029, USA.
| | - Allan Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 17 East 102(nd) St. New York, NY 10029, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Ave., Boston, MA 02115, USA.
| | - Itai Kloog
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 17 East 102(nd) St. New York, NY 10029, USA; Department of Geography and Environmental Development, Ben-Gurion University of the Negev, P.O.B 653, Beer Sheva, Israel.
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 17 East 102(nd) St. New York, NY 10029, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, 17 East 102(nd) St., New York, NY 10029, USA.
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University Medical Center, 722 W 168(th) St. New York, NY 10032, USA.
| | - Rosalind J Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 17 East 102(nd) St. New York, NY 10029, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, 17 East 102(nd) St., New York, NY 10029, USA.
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47
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Behlen JC, Lau CH, Li Y, Dhagat P, Stanley JA, Rodrigues Hoffman A, Golding MC, Zhang R, Johnson NM. Gestational Exposure to Ultrafine Particles Reveals Sex- and Dose-Specific Changes in Offspring Birth Outcomes, Placental Morphology, and Gene Networks. Toxicol Sci 2021; 184:204-213. [PMID: 34609516 DOI: 10.1093/toxsci/kfab118] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Particulate matter (PM) causes adverse developmental outcomes following prenatal exposure, but the underlying biological mechanisms remain uncertain. Here we elucidate the effects of diesel exhaust ultrafine particle (UFP) exposure during pregnancy on placental and fetal development. Time-mated C57Bl/6n mice were gestationally exposed to UFPs at a low dose (LD, 100 µg/m3) or high dose (HD, 500 µg/m3) for 6 h daily. Phenotypic effects on fetuses and placental morphology at gestational day (GD) of 18.5 were evaluated, and RNA sequencing was characterized for transcriptomic changes in placental tissue from male and female offspring. A significant decrease in average placental weights and crown to rump lengths was observed in female offspring in the LD exposure group. Gestational UFP exposure altered placental morphology in a dose- and sex-specific manner. Average female decidua areas were significantly greater in the LD and HD groups. Maternal lacunae mean areas were increased in the female LD group, whereas fetal blood vessel mean areas were significantly greater in the male LD and HD groups. RNA sequencing indicated several disturbed cellular functions related to lipid metabolism, which were most pronounced in the LD group and especially in female placental tissue. Our findings demonstrate the vulnerability of offspring exposed to UFPs during pregnancy, highlighting sex-specific effects and emphasizing the importance of mitigating PM exposure to prevent adverse health outcomes.
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Affiliation(s)
| | | | - Yixin Li
- Department of Chemistry, Texas A&M University, College Station, Texas 77843, USA
| | - Prit Dhagat
- Alabama School of Osteopathic Medicine, Dothan, Alabama 36303, USA
| | - Jone A Stanley
- Covance Laboratories, Inc., Greenfield, Indiana 46140, USA
| | | | | | - Renyi Zhang
- Department of Chemistry, Texas A&M University, College Station, Texas 77843, USA.,Department of Atmospheric Sciences, Texas A&M University, College Station, Texas 77843, USA
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48
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Ouidir M, Tekola-Ayele F, Canty T, Grantz KL, Sciscione A, Tong D, Jones RR, Sundaram R, Williams A, Stevens D, Mendola P. Acute ambient air pollution exposure and placental Doppler results in the NICHD fetal growth studies - Singleton cohort. ENVIRONMENTAL RESEARCH 2021; 202:111728. [PMID: 34297937 PMCID: PMC8578287 DOI: 10.1016/j.envres.2021.111728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/21/2021] [Accepted: 07/16/2021] [Indexed: 05/29/2023]
Abstract
BACKGROUND Increased placental vascular resistance is a proposed mechanism by which air pollution exposure during pregnancy lowers birth weight and increases pregnancy-induced hypertensive disorders. OBJECTIVE To examine the impact of acute air pollution exposure during pregnancy on uterine and umbilical artery Doppler indicators of placental vascular resistance. METHODS After a first ultrasound to confirm gestational age, 2562 pregnant women recruited in 12 clinics throughout the United States underwent up to five standardized ultrasounds with Doppler measurements. Exposures to 11 air pollutants were estimated for the hour of ultrasound and each of the 2 h prior to ultrasound at the clinics using the National Air Quality Forecast Capability reanalysis products. We used mixed logistic regression to study the longitudinal odds ratio (OR) of any, uni- or bi-lateral systolic and diastolic uterine artery notching compared to no notching and the longitudinal OR of abnormal end diastolic flow of the umbilical artery compared to forward flow. Uterine and umbilical artery resistance indexes were studied using linear mixed models. RESULTS Each inter-quartile range (IQR) increase of particulate matter < 2.5 μm, nitrate, ammonium, primary organic matter (POM) and nitrogen dioxide during the hour of ultrasound was associated with a decreased risk of unilateral systolic notch and with increased resistance index of the left uterine artery. For the umbilical artery, each IQR increase in ozone was associated with decreased resistance index (b: -0.26, 95 % CI: -0.52, -0.01) and with a decreased risk of abnormal end diastolic flow (OR: 0.36, 95 % CI: 0.14, 0.94); while each IQR increase of elemental carbon and POM was associated with increased risk of abnormal end diastolic flow (OR: 1.47, 95 % CI: 1.02, 2.13 and OR: 1.67, 95 % CI: 1.17, 2.39, respectively). DISCUSSION Our results suggest acute air pollution exposure may influence placental vascular resistance.
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Affiliation(s)
- Marion Ouidir
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Fasil Tekola-Ayele
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Timothy Canty
- Department of Atmospheric and Oceanic Science, University of Maryland, College Park, MD, USA
| | - Katherine L Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE, USA
| | - Daniel Tong
- Center for Spatial Science and Systems, George Mason University, Fairfax, VA, USA
| | - Rena R Jones
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Andrew Williams
- University of North Dakota, School of Medicine & Health Sciences, Grand Forks, ND, USA
| | - Danielle Stevens
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA; Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
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49
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Gonet T, Maher BA, Nyirő-Kósa I, Pósfai M, Vaculík M, Kukutschová J. Size-resolved, quantitative evaluation of the magnetic mineralogy of airborne brake-wear particulate emissions. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 288:117808. [PMID: 34329055 DOI: 10.1016/j.envpol.2021.117808] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/12/2021] [Accepted: 07/16/2021] [Indexed: 05/24/2023]
Abstract
Exposure to particulate air pollution has been associated with a variety of respiratory, cardiovascular and neurological problems, resulting in increased morbidity and mortality worldwide. Brake-wear emissions are one of the major sources of metal-rich airborne particulate pollution in roadside environments. Of potentially bioreactive metals, Fe (especially in its ferrous form, Fe2+) might play a specific role in both neurological and cardiovascular impairments. Here, we collected brake-wear particulate emissions using a full-scale brake dynamometer, and used a combination of magnetic measurements and electron microscopy to make quantitative evaluation of the magnetic composition and particle size of airborne emissions originating from passenger car brake systems. Our results show that the concentrations of Fe-rich magnetic grains in airborne brake-wear emissions are very high (i.e., ~100-10,000 × higher), compared to other types of particulate pollutants produced in most urban environments. From magnetic component analysis, the average magnetite mass concentration in total PM10 of brake emissions is ~20.2 wt% and metallic Fe ~1.6 wt%. Most brake-wear airborne particles (>99 % of particle number concentration) are smaller than 200 nm. Using low-temperature magnetic measurements, we observed a strong superparamagnetic signal (indicative of ultrafine magnetic particles, < ~30 nm) for all of the analysed size fractions of airborne brake-wear particles. Transmission electron microscopy independently shows that even the larger size fractions of airborne brake-wear emissions dominantly comprise agglomerates of ultrafine (<100 nm) particles (UFPs). Such UFPs likely pose a threat to neuronal and cardiovascular health after inhalation and/or ingestion. The observed abundance of ultrafine magnetite particles (estimated to constitute ~7.6 wt% of PM0.2) might be especially hazardous to the brain, contributing both to microglial inflammatory action and excess generation of reactive oxygen species.
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Affiliation(s)
- Tomasz Gonet
- Centre for Environmental Magnetism & Palaeomagnetism, Lancaster Environment Centre, Lancaster University, Lancaster, LA1 4YQ, United Kingdom.
| | - Barbara A Maher
- Centre for Environmental Magnetism & Palaeomagnetism, Lancaster Environment Centre, Lancaster University, Lancaster, LA1 4YQ, United Kingdom
| | - Ilona Nyirő-Kósa
- MTA-PE Air Chemistry Research Group, 10 Egyetem Street, H-8200, Veszprém, Hungary
| | - Mihály Pósfai
- Research Institute of Biomolecular and Chemical Engineering, University of Pannonia, Veszprém, H8200, Hungary
| | - Miroslav Vaculík
- Nanotechnology Centre, VSB-Technical University of Ostrava, 708 00, Ostrava-Poruba, Czech Republic; Centre for Advanced Innovative Technologies, VSB-Technical University of Ostrava, 708 00, Ostrava-Poruba, Czech Republic
| | - Jana Kukutschová
- Centre for Advanced Innovative Technologies, VSB-Technical University of Ostrava, 708 00, Ostrava-Poruba, Czech Republic; Faculty of Materials Science and Technology, VSB-Technical University of Ostrava, 708 00, Ostrava, Czech Republic
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50
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Giudice LC, Llamas-Clark EF, DeNicola N, Pandipati S, Zlatnik MG, Decena DCD, Woodruff TJ, Conry JA. Climate change, women's health, and the role of obstetricians and gynecologists in leadership. Int J Gynaecol Obstet 2021; 155:345-356. [PMID: 34694628 PMCID: PMC9298078 DOI: 10.1002/ijgo.13958] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/16/2021] [Accepted: 09/28/2021] [Indexed: 11/07/2022]
Abstract
Climate change is one of the major global health threats to the world's population. It is brought on by global warming due in large part to increasing levels of greenhouse gases resulting from human activity, including burning fossil fuels (carbon dioxide), animal husbandry (methane from manure), industry emissions (ozone, nitrogen oxides, sulfur dioxide), vehicle/factory exhaust, and chlorofluorocarbon aerosols that trap extra heat in the earth's atmosphere. Resulting extremes of weather give rise to wildfires, air pollution, changes in ecology, and floods. These in turn result in displacement of populations, family disruption, violence, and major impacts on water quality and availability, food security, public health and economic infrastructures, and limited abilities for civil society to maintain citizen safety. Climate change also has direct impacts on human health and well-being. Particularly vulnerable populations are affected, including women, pregnant women, children, the disabled, and the elderly, who comprise the majority of the poor globally. Additionally, the effects of climate change disproportionally affect disadvantaged communities, including low income and communities of color, and lower-income countries that are at highest risk of adverse impacts when disasters occur due to inequitable distribution of resources and their socioeconomic status. The climate crisis is tilting the risk balance unfavorably for women's sexual and reproductive health and rights as well as newborn and child health. Obstetrician/gynecologists have the unique opportunity to raise awareness, educate, and advocate for mitigation strategies to reverse climate change affecting our patients and their families. This article puts climate change in the context of women's reproductive health as a public health issue, a social justice issue, a human rights issue, an economic issue, a political issue, and a gender issue that needs our attention now for the health and well-being of this and future generations. FIGO joins a broad coalition of international researchers and the medical community in stating that the current climate crisis presents an imminent health risk to pregnant people, developing fetuses, and reproductive health, and recognizing that we need society-wide solutions, government policies, and global cooperation to address and reduce contributors, including fossil fuel production, to climate change.
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Affiliation(s)
- Linda C Giudice
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Erlidia F Llamas-Clark
- Department of Obstetrics and Gynecology, Division of Ultrasound, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Nathaniel DeNicola
- Department of Obstetrics and Gynecology, Johns Hopkins Health System, Washington, District of Columbia, USA
| | - Santosh Pandipati
- Obstetrix Medical Group/Mednax (Maternal-Fetal Medicine), Campbell, California, USA
| | - Marya G Zlatnik
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal Fetal Medicine, Program on Reproductive Health and the Environment, Environmental Research and Translation for Health (EaRTH) Center, University of California, San Francisco, San Francisco, California, USA
| | - Ditas Cristina D Decena
- Departments of Anatomy, Clinical Epidemiology and Public Health International, University of Santo Tomas, Manila, Philippines
| | - Tracey J Woodruff
- Program on Reproductive Health and the Environment, Environmental Research and Translation for Health (EaRTH) Center, University of California, San Francisco, San Francisco, California, USA
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