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Environ Res. 2018 Nov;167:144-159. doi: 10.1016/j.envres.2018.07.008. Epub 2018 Jul 5.

Ambient air pollution and pregnancy outcomes: A comprehensive review and identification of environmental public health challenges.

Author information

1
National institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia. Electronic address: petra.klepac@nijz.si.
2
University of Ljubljana, Faculty of Pharmacy, Aškerčeva 7, 1000 Ljubljana, Slovenia. Electronic address: igor.locatelli@ffa.uni-lj.si.
3
Department of Obstetrics and Gynecology, Reproductive Unit, University Medical Centre Ljubljana, Zaloška 3, 1525 Ljubljana, Slovenia. Electronic address: sara_korosec@hotmail.com.
4
Swiss Tropical and Public Health Institute (SwissTPH), Socinstrasse 57, 4002 Basel, Switzerland; University of Basel, Petersplatz 1, 4001 Basel, Switzerland. Electronic address: nino.kuenzli@swisstph.ch.
5
National institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia; University of Ljubljana, Faculty of Medicine, Vrazov trg 2, 1000 Ljubljana, Slovenia. Electronic address: andreja.kukec@mf.uni-lj.si.

Abstract

There is a growing number of studies on the association between ambient air pollution and adverse pregnancy outcomes, but their results have been inconsistent. Consequently, a comprehensive review of this research area is needed. There was a wide variability in studied pregnancy outcomes, observed gestational windows of exposure, observed ambient air pollutants, applied exposure assessment methods and statistical analysis methods Gestational duration, preterm birth, (low) birth weight, and small for gestational age/intrauterine growth restriction were most commonly investigated pregnancy outcomes. Gestational windows of exposure typically included were whole pregnancy period, 1st, 2nd, 3rd trimester, first and last gestational months. Preterm birth was the outcome most extensively studied across various gestational windows, especially at the beginning and at the end of pregnancy. Particulate matter, nitrogen dioxide, ozone, and carbon monoxide were the most commonly used markers of ambient air pollution. Continuous monitoring data were frequently combined with spatially more precisely modelled estimates of exposure. Exposure to particulate matter and ozone over the entire pregnancy was significantly associated with higher risk for preterm birth: the pooled effect estimates were 1.09 (1.03-1.16) per 10 μg/m3 increase in particulate matter with an aerodynamic diameter of 10 µm or less (PM10),1.24 (1.08-1.41) per 10 μg/m3 increase in particulate matter with an aerodynamic diameter of 2.5 µm or less (PM2.5), and 1.03 (1.01-1.04) per 10 ppb increase in ozone. For pregnancy outcomes other than PTB, ranges of observed effect estimates were reported due to smaller number of studies included in each gestational window of exposure. Further research is needed to link the routine pregnancy outcome data with spatially and temporally resolved ambient air pollution data, while adjusting for commonly defined confounders. Methods for assessing exposure to mixtures of pollutants, indoor air pollution exposure, and various other environmental exposures, need to be developed.

KEYWORDS:

Ambient air pollution; Identification of public health challenges; Pregnancy outcomes

PMID:
30014896
DOI:
10.1016/j.envres.2018.07.008
[Indexed for MEDLINE]

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