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Environ Health. 2018 Feb 20;17(1):19. doi: 10.1186/s12940-018-0363-4.

Cumulative exposure to environmental pollutants during early pregnancy and reduced fetal growth: the Project Viva cohort.

Author information

1
Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA, 02215, USA. lrokoff@mail.harvard.edu.
2
Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA, 02215, USA.
3
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
4
Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
5
Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
6
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
7
Center for Environmental Research and Children's Health, University of California, Berkeley, CA, USA.
8
Division of Epidemiology, University of California, Berkeley School of Public Health, Berkeley, CA, USA.
9
Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
10
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
11
Pediatric Endocrinology and Diabetes, Maine Medical Center, Portland, ME, USA.
12
Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA.

Abstract

BACKGROUND:

Reduced fetal growth is associated with perinatal and later morbidity. Prenatal exposure to environmental pollutants is linked to reduced fetal growth at birth, but the impact of concomitant exposure to multiple pollutants is unclear. The purpose of this study was to examine interactions between early pregnancy exposure to cigarette smoke, traffic pollution, and select perfluoroalkyl substances (PFASs) on birth weight-for-gestational age (BW/GA).

METHODS:

Among 1597 Project Viva mother-infant pairs, we assessed maternal cigarette smoking by questionnaire, traffic pollution at residential address by black carbon land use regression model, and plasma concentration of select PFASs in early pregnancy. We calculated sex-specific BW/GA z-scores, an index of fetal growth, from national reference data. We fit covariate-adjusted multi-pollutant linear regression models and examined interactions between exposures, using a likelihood-ratio test to identify a best-fit model.

RESULTS:

Two hundred six (13%) mothers smoked during pregnancy. Mean [standard deviation (SD)] for black carbon was 0.8 (0.3) μg/m3, perfluorooctane sulfonate (PFOS) was 29.1 (16.5) ng/mL, and BW/GA z-score was 0.19 (0.96). In the best-fit model, BW/GA z-score was lower in infants of mothers exposed to greater black carbon [- 0.08 (95% CI: -0.15, - 0.01) per interquartile range (IQR)]. BW/GA z-score (95% CI) was also lower in infants of mothers who smoked [- 0.09 (- 0.23, 0.06)] or were exposed to greater PFOS [- 0.03 (- 0.07, 0.02) per IQR], although confidence intervals crossed the null. There were no interactions between exposures. In secondary analyses, instead of PFOS, we examined perfluorononanoate (PFNA) [mean (SD): 0.7 (0.4) ng/mL], a PFAS more closely linked to lower BW/GA in our cohort. The best-fit multi-pollutant model included positive two-way interactions between PFNA and both black carbon and smoking (p-interactions = 0.03).

CONCLUSIONS:

Concurrent prenatal exposures to maternal smoking, black carbon, and PFOS are additively associated with lower fetal growth, whereas PFNA may attenuate associations of smoking and black carbon with lower fetal growth. It is important to examine interactions between multiple exposures in relation to health outcomes, as effects may not always be additive and may shed light on biological pathways.

KEYWORDS:

Air pollution; Birth weight; Epidemiology; Perfluoroalkyl substances; Pregnancy; Smoking

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