Air Pollution and Preterm Birth in the U.S. State of Georgia (2002–2006): Associations with Concentrations of 11 Ambient Air Pollutants Estimated by Combining Community Multiscale Air Quality Model (CMAQ) Simulations with Stationary Monitor Measurements

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Abstract

Background:

Previous epidemiologic studies suggest associations between preterm birth and ambient air pollution.

Objective:

We investigated associations between 11 ambient air pollutants, estimated by combining Community Multiscale Air Quality model (CMAQ) simulations with measurements from stationary monitors, and risk of preterm birth (< 37 weeks of gestation) in the U.S. state of Georgia.

Methods:

Birth records for singleton births ≥ 27 weeks of gestation with complete covariate information and estimated dates of conception between 1 January 2002 and 28 February 2006 were obtained from the Office of Health Indicators for Planning, Georgia Department of Public Health (n = 511,658 births). Daily pollutant concentrations at 12-km resolution were estimated for 11 ambient air pollutants. We used logistic regression with county-level fixed effects to estimate associations between preterm birth and average pollutant concentrations during the first and second trimester. Discrete-time survival models were used to estimate third-trimester and total pregnancy associations. Effect modification was investigated by maternal education, race, census tract poverty level, and county-level urbanicity.

Results:

Trimester-specific and total pregnancy associations (p < 0.05) were observed for several pollutants. All the traffic-related pollutants (carbon monoxide, nitrogen dioxide, PM2.5 elemental carbon) were associated with preterm birth [e.g., odds ratios for interquartile range increases in carbon monoxide during the first, second, and third trimesters and total pregnancy were 1.005 (95% CI: 1.001, 1.009), 1.007 (95% CI: 1.002, 1.011), 1.010 (95% CI: 1.006, 1.014), and 1.011 (95% CI: 1.006, 1.017)]. Associations tended to be higher for mothers with low educational attainment and African American mothers.

Conclusion:

Several ambient air pollutants were associated with preterm birth; associations were observed in all exposure windows.

Citation:

Hao H, Chang HH, Holmes HA, Mulholland JA, Klein M, Darrow LA, Strickland MJ. 2016. Air pollution and preterm birth in the U.S. state of Georgia (2002–2006): associations with concentrations of 11 ambient air pollutants estimated by combining Community Multiscale Air Quality Model (CMAQ) simulations with stationary monitor measurements. Environ Health Perspect 124:875–880; http://dx.doi.org/10.1289/ehp.1409651

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Most cited references 34

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Socioeconomic disparities in adverse birth outcomes: a systematic review.

Philip Blumenshine, Susan Egerter, Colleen J Barclay … (2010)

Adverse birth outcomes, such as preterm birth and low birth weight, have serious health consequences across the life course. Socioeconomic disparities in birth outcomes have not been the subject of a recent systematic review. The aim of this study was to systematically review the literature on the association of socioeconomic disadvantage with adverse birth outcomes, with specific attention to the strength and consistency of effects across socioeconomic measures, birth outcomes, and populations. Relevant articles published from 1999 to 2007 were obtained through electronic database searches and manual searches of reference lists. English-language studies from industrialized countries were included if (1) study objectives included examination of a socioeconomic disparity in a birth outcome and (2) results were presented on the association between a socioeconomic predictor and a birth outcome related to birth weight, gestational age, or intrauterine growth. Two reviewers extracted data and independently rated study quality; data were analyzed in 2008-2009. Ninety-three of 106 studies reported a significant association, overall or within a population subgroup, between a socioeconomic measure and a birth outcome. Socioeconomic disadvantage was consistently associated with increased risk across socioeconomic measures, birth outcomes, and countries; many studies observed racial/ethnic differences in the effect of socioeconomic measures. Socioeconomic differences in birth outcomes remain pervasive, with substantial variation by racial or ethnic subgroup, and are associated with disadvantage measured at multiple levels (individual/family, neighborhood) and time points (childhood, adulthood), and with adverse health behaviors that are themselves socially patterned. Future reviews should focus on identifying interventions to successfully reduce socioeconomic disparities in birth outcomes. 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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Ambient air pollution, birth weight and preterm birth: a systematic review and meta-analysis.

David Stieb, Li Chen, Maysoon Eshoul … (2012)

Low birth weight and preterm birth have a substantial public health impact. Studies examining their association with outdoor air pollution were identified using searches of bibliographic databases and reference lists of relevant papers. Pooled estimates of effect were calculated, heterogeneity was quantified, meta-regression was conducted and publication bias was examined. Sixty-two studies met the inclusion criteria. The majority of studies reported reduced birth weight and increased odds of low birth weight in relation to exposure to carbon monoxide (CO), nitrogen dioxide (NO(2)) and particulate matter less than 10 and 2.5 microns (PM(10) and PM(2.5)). Effect estimates based on entire pregnancy exposure were generally largest. Pooled estimates of decrease in birth weight ranged from 11.4 g (95% confidence interval -6.9-29.7) per 1 ppm CO to 28.1g (11.5-44.8) per 20 ppb NO(2), and pooled odds ratios for low birth weight ranged from 1.05 (0.99-1.12) per 10 μg/m(3) PM(2.5) to 1.10 (1.05-1.15) per 20 μg/m(3) PM(10) based on entire pregnancy exposure. Fewer effect estimates were available for preterm birth and results were mixed. Pooled odds ratios based on 3rd trimester exposures were generally most precise, ranging from 1.04 (1.02-1.06) per 1 ppm CO to 1.06 (1.03-1.11) per 20 μg/m(3) PM(10). Results were less consistent for ozone and sulfur dioxide for all outcomes. Heterogeneity between studies varied widely between pollutants and outcomes, and meta-regression suggested that heterogeneity could be partially explained by methodological differences between studies. While there is a large evidence base which is indicative of associations between CO, NO(2), PM and pregnancy outcome, variation in effects by exposure period and sources of heterogeneity between studies should be further explored. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

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Air pollution and birth outcomes: a systematic review.

Prakesh S. Shah, Taiba Balkhair (2011)

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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Author and article information

Journal

Journal ID (nlm-ta): Environ Health Perspect

Journal ID (iso-abbrev): Environ. Health Perspect

Journal ID (publisher-id): EHP

Title: Environmental Health Perspectives

Publisher: National Institute of Environmental Health Sciences

ISSN (Print): 0091-6765

ISSN (Electronic): 1552-9924

Publication date (Electronic): 20 October 2015

Publication date (Print): June 2016

Volume: 124

Issue: 6

Pages: 875-880

Affiliations

[1 ]Department of Environmental Health, and

[2 ]Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA

[3 ]Department of Physics, University of Nevada-Reno, Reno, Nevada, USA

[4 ]School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA

[5 ]Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA

Author notes

[† ]Address correspondence to M.J. Strickland, Department of Environmental Health, Emory University, 1518 Clifton Rd. NE, Mailstop 1518-002-2BB, Atlanta, GA 30322 USA. Telephone: (404) 712-8912. E-mail: mjstric@ 123456emory.edu

Article

Publisher ID: ehp.1409651

DOI: 10.1289/ehp.1409651

PMC ID: 4892915

PubMed ID: 26485731

SO-VID: 656ffa31-7e73-4d74-9a63-2b98be961b7a

License:

Publication of EHP lies in the public domain and is therefore without copyright. All text from EHP may be reprinted freely. Use of materials published in EHP should be acknowledged (for example, “Reproduced with permission from Environmental Health Perspectives”); pertinent reference information should be provided for the article from which the material was reproduced. Articles from EHP, especially the News section, may contain photographs or illustrations copyrighted by other commercial organizations or individuals that may not be used without obtaining prior approval from the holder of the copyright.

Air Pollution and Preterm Birth in the U.S. State of Georgia (2002–2006): Associations with Concentrations of 11 Ambient Air Pollutants Estimated by Combining Community Multiscale Air Quality Model (CMAQ) Simulations with Stationary Monitor Measurements

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Most cited references 34

Socioeconomic disparities in adverse birth outcomes: a systematic review.

Ambient air pollution, birth weight and preterm birth: a systematic review and meta-analysis.

Air pollution and birth outcomes: a systematic review.

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