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      Assessing the impact of race, social factors and air pollution on birth outcomes: a population-based study


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          Both air pollution exposure and socioeconomic status (SES) are important indicators of children’s health. Using highly resolved modeled predictive surfaces, we examine the joint effects of air pollution exposure and measures of SES in a population level analysis of pregnancy outcomes in North Carolina (NC).


          Daily measurements of particulate matter <2.5 μm in aerodynamic diameter (PM 2.5) and ozone (O 3) were calculated through a spatial hierarchical Bayesian model which produces census-tract level point predictions. Using multilevel models and NC birth data from 2002–2006, we examine the association between pregnancy averaged PM 2.5 and O 3, individual and area-based SES indicators, and birth outcomes.


          Maternal race and education, and neighborhood household income were associated with adverse birth outcomes. Predicted concentrations of PM 2.5 and O 3 were also associated with an additional effect on reductions in birth weight and increased risks of being born low birth weight and small for gestational age.


          This paper builds on and complements previous work on the relationship between pregnancy outcomes and air pollution exposure by using 1) highly resolved air pollution exposure data; 2) a five-year population level sample of pregnancies; and 3) including personal and areal level measures of social determinants of pregnancy outcomes. Results show a stable and negative association between air pollution exposure and adverse birth outcomes. Additionally, the more socially disadvantaged populations are at a greater risk; controlling for both SES and environmental stressors provides a better understanding of the contributing factors to poor children’s health outcomes.

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          Most cited references39

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          Fetal nutrition and cardiovascular disease in adult life.

          Babies who are small at birth or during infancy have increased rates of cardiovascular disease and non-insulin-dependent diabetes as adults. Some of these babies have low birthweights, some are small in relation to the size of their placentas, some are thin at birth, and some are short at birth and fail to gain weight in infancy. This paper shows how fetal undernutrition at different stages of gestation can be linked to these patterns of early growth. The fetuses' adaptations to undernutrition are associated with changes in the concentrations of fetal and placental hormones. Persisting changes in the levels of hormone secretion, and in the sensitivity of tissues to them, may link fetal undernutrition with abnormal structure, function, and disease in adult life.
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            Air pollution and birth outcomes: a systematic review.

            Several mechanisms are suspected to underlie adverse birth outcomes among mothers exposed to air pollutants, including inflammation, direct toxic effects on fetuses and the placenta, displacement of the oxygen-hemoglobin dissociation curve, and formation of DNA adducts. To systematically review the association between air pollutants and birth outcomes of low birth weight (LBW), preterm (PTB) and small for gestational age (SGA) births. Electronic databases and bibliographies of identified articles were searched for English language studies reporting on birth outcomes. Included studies were assessed for risks of bias in the selection, exposure assessment, confounder adjustment, analyses, outcomes assessment, and attrition. Unadjusted and adjusted estimates from included studies were extracted. Methodological differences between the studies were evaluated. A total of 41 studies, mostly with a moderate risk of biases due to indirect assessment methods employed, met the eligibility criteria. Exposure to sulphur dioxide was associated with PTB, exposure to fine particulate matter (PM) of ≤2.5 μM was associated with LBW, PTB and SGA births, and exposure to coarse PM of ≤10 μM was associated with SGA births. The evidence for nitrous oxide, nitrogen dioxide, ozone and carbon monoxide was inconclusive. Reported associations, and lack thereof, between individual air pollutants and birth outcomes have differed across published studies. This heterogeneity and/or absence of association may be due to difficulty in quantifying exposure, method of ascertainment, time of measurement and collinearity between pollutants. Important future research directions include developing improved methods to detect the duration and intensity of exposure, including entire populations, as well as performing well-designed nested studies that ascertain complete outcomes, avoiding residual confounding, and adjusting for residential mobility. Copyright © 2010 Elsevier Ltd. All rights reserved.
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              Socio-economic disparities in pregnancy outcome: why do the poor fare so poorly?

              In this paper, we review the evidence bearing on socio-economic disparities in pregnancy outcome, focusing on aetiological factors mediating the disparities in intrauterine growth restriction (IUGR) and preterm birth. We first summarise what is known about the attributable determinants of IUGR and preterm birth, emphasising their quantitative contributions (aetiological fractions) from a public health perspective. We then review studies relating these determinants to socio-economic status and, combined with the evidence about their aetiological fractions, reach some tentative conclusions about their roles as mediators of the socio-economic disparities. Cigarette smoking during pregnancy appears to be the most important mediating factor for IUGR, with low gestational weight gain and short stature also playing substantial roles. For preterm birth, socio-economic gradients in bacterial vaginosis and cigarette smoking appear to explain some of the socio-economic disparities; psychosocial factors may prove even more important, but their aetiological links with preterm birth require further clarification. Research that identifies and quantifies the causal pathways and mechanisms whereby social disadvantage leads to higher risks of IUGR and preterm birth may eventually help to reduce current disparities and improve pregnancy outcome across the entire socio-economic spectrum.

                Author and article information

                Environ Health
                Environ Health
                Environmental Health
                BioMed Central
                29 January 2014
                : 13
                : 4
                [1 ]U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA
                [2 ]Children’s Environmental Health Initiative, School of Natural Resources and Environment, University of Michigan, Ann Arbor, Michigan, USA
                [3 ]Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
                Copyright © 2014 Gray et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

                : 27 March 2013
                : 31 July 2013

                Public health
                air pollution,exposure predictions,socioeconomic status,pregnancy outcomes
                Public health
                air pollution, exposure predictions, socioeconomic status, pregnancy outcomes


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