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J Epidemiol Community Health. 2017 Oct;71(10):1026-1036. doi: 10.1136/jech-2016-208674. Epub 2017 Aug 22.

Is atmospheric pollution exposure during pregnancy associated with individual and contextual characteristics? A nationwide study in France.

Author information

IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Inserm, CNRS, Université Grenoble Alpes joint research center, Grenoble, France.
Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA.
National Institute for Industrial Environment and Risks (INERIS), Verneuil en Halatte, France.
ASPA, ATMO Grand Est, Schiltigheim, France.
U1086 INSERM-UCN 'Anticipe', Caen, France.
Ined-Inserm-EFS joint unit Elfe, Paris, France.
Inserm Univ Paris Descartes, U1153 CRESS, Paris, France.



Exposure to atmospheric pollutants is a danger for the health of pregnant mother and children. Our objective was to identify individual (socioeconomic and behavioural) and contextual factors associated with atmospheric pollution pregnancy exposure at the nationwide level.


Among 14 921 women from the French nationwide ELFE (French Longitudinal Study of Children) mother-child cohort recruited in 2011, outdoor exposure levels of PM2.5, PM10 (particulate matter <2.5 µm and <10 µm in diameter) and NO2 (nitrogen dioxide) were estimated at the pregnancy home address from a dispersion model with 1 km resolution. We used classification and regression trees (CART) and linear regression to characterise the association of atmospheric pollutants with individual (maternal age, body mass index, parity, education level, relationship status, smoking status) and contextual (European Deprivation Index, urbanisation level) factors.


Patterns of associations were globally similar across pollutants. For the CART approach, the highest tertile of exposure included mainly women not in a relationship living in urban and socially deprived areas, with lower education level. Linear regression models identified different determinants of atmospheric pollutants exposure according to the residential urbanisation level. In urban areas, atmospheric pollutants exposure increased with social deprivation, while in rural areas a U-shaped relationship was observed.


We highlighted social inequalities in atmospheric pollutants exposure according to contextual characteristics such as urbanisation level and social deprivation and also according to individual characteristics such as education, being in a relationship and smoking status. In French urban areas, pregnant women from the most deprived neighbourhoods were those most exposed to health-threatening atmospheric pollutants.


air pollution; inequalities; nitrogen dioxide; particulate matter; social deprivation; socioeconomic status; urbanisation

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