The acute effect and lag effect analysis between exposures to ambient air pollutants and spontaneous abortion: a case-crossover study in China, 2017–2019

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Abstract

Introduction

Recent studies demonstrated that living in areas with high ambient air pollution may have adverse effects on pregnancy outcomes, but few studies have investigated its association with spontaneous abortion. Further investigation is needed to explore the acute effect and lag effect of air pollutants exposure on spontaneous abortion.

Objective

To investigate the acute effect and lag effect between exposure to ambient air pollutants and spontaneous abortion.

Methods

Research data of spontaneous abortion were collected from the Chongqing Health Center for Women and Children (CQHCWC) in China. The daily ambient air pollution exposure measurements were estimated for each woman using inverse distance weighting from monitoring stations. A time-stratified, case-crossover design combined with distributed lag linear models was applied to assess the associations between spontaneous pregnancy loss and exposure to each of the air pollutants over lags 0–7 days, adjusted for temperature and relative humidity.

Results

A total of 1399 women who experienced spontaneous pregnancy loss events from November 1, 2016, to September 30, 2019, were selected for this study. Maternal exposure to particulate matter 2.5 (PM _2.5), particle matter 10 (PM ₁₀) nitrogen dioxide (NO ₂), and sulfur dioxide (SO ₂) exhibited a significant association with spontaneous abortion. For every 20 μg/m ³ increase in PM _2.5, PM ₁₀, NO ₂, and SO ₂, the RRs were 1.18 (95% CI: 1.06, 1.34), 1.12 (95% CI, 1.04–1.20), 1.15 (95% CI: 1.02, 1.30), and 1.92 (95% CI: 1.18, 3.11) on lag day 3, lag day 3, lag day 0, and lag day 3, respectively. In two-pollutant model combined with PM _2.5 and PM ₁₀, a statistically significant increase in spontaneous abortion incidence of 18.0% ( RR = 1.18, 95% CI: 1.06, 1.32) was found for a 20 μg/m ³ increase in PM _2.5 exposure, and 11.2% ( RR = 1.11, 95% CI: 1.03, 1.20) for a 20 μg/m ³ increase in PM ₁₀ exposure on lag day 3, similar to single-pollutant model analysis.

Conclusion

Maternal exposure to high levels of PM _2.5, PM ₁₀, NO ₂, and SO ₂ during pregnancy may increase the risk of spontaneous abortion for acute effects and lag effects. Further research to explore sensitive exposure time windows is needed.

Related collections

Most cited references 35

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Case-crossover analyses of air pollution exposure data: referent selection strategies and their implications for bias.

Holly Janes, Lianne Sheppard, Thomas Lumley (2005)

The case-crossover design has been widely used to study the association between short-term air pollution exposure and the risk of an acute adverse health event. The design uses cases only; for each individual case, exposure just before the event is compared with exposure at other control (or "referent") times. Time-invariant confounders are controlled by making within-subject comparisons. Even more important in the air pollution setting is that time-varying confounders can also be controlled by design by matching referents to the index time. The referent selection strategy is important for reasons in addition to control of confounding. The case-crossover design makes the implicit assumption that there is no trend in exposure across the referent times. In addition, the statistical method that is used-conditional logistic regression-is unbiased only with certain referent strategies. We review here the case-crossover literature in the air pollution context, focusing on key issues regarding referent selection. We conclude with a set of recommendations for choosing a referent strategy with air pollution exposure data. Specifically, we advocate the time-stratified approach to referent selection because it ensures unbiased conditional logistic regression estimates, avoids bias resulting from time trend in the exposure series, and can be tailored to match on specific time-varying confounders.

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Association between ambient fine particulate matter and preterm birth or term low birth weight: An updated systematic review and meta-analysis.

Xiangyu Li, Shuqiong Huang, Anqi Jiao … (2017)

An increasing number of studies have been conducted to determine a possible linkage between maternal exposure to ambient fine particulate matter and effects on the developing human fetus that can lead to adverse birth outcomes, but, the present results are not consistent. A total of 23 studies published before July 2016 were collected and analyzed and the mean value of reported exposure to fine particulate matter (PM2.5) ranged from 1.82 to 22.11 We found a significantly increased risk of preterm birth with interquartile range increase in PM2.5 exposure throughout pregnancy (odds ratio (OR) = 1.03; 95% conditional independence (CI): 1.01-1.05). The pooled OR for the association between PM2.5 exposure, per interquartile range increment, and term low birth weight throughout pregnancy was 1.03 (95% CI: 1.02-1.03). The pooled ORs for the association between PM2.5 exposure per 10 increment, and term low birth weight and preterm birth were 1.05 (95% CI: 0.98-1.12) and 1.02 (95% CI: 0.93-1.12), respectively throughout pregnancy. There is a significant heterogeneity in most meta-analyses, except for pooled OR per interquartile range increase for term low birth weight throughout pregnancy. We here show that maternal exposure to fine particulate air pollution increases the risk of preterm birth and term low birth weight. However, the effect of exposure time needs to be further explored. In the future, prospective cohort studies and personal exposure measurements needs to be more widely utilized to better characterize the relationship between ambient fine particulate exposure and adverse birth outcomes.

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Maternal exposure to fine particulate matter (PM2.5) and pregnancy outcomes: a meta-analysis.

Xiaoxia Zhu, Ying Liu, Yanyan Chen … (2015)

A growing body of evidence has investigated the association between maternal exposure to PM2.5 (particulate matter with aerodynamic diameter 2.5 μm) during pregnancy and adverse pregnancy outcomes. However, the results of those studies are not consistent. To synthetically quantify the relationship between maternal exposure to PM2.5 during pregnancy and pregnancy outcomes (the change in birth weight, low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA), and stillbirth), a meta-analysis of 25 published observational epidemiological studies that met our selection criteria was conducted. Results suggested a 10 μg/m(3) increase in PM2.5 was positively associated with LBW (odds ratio (OR) = 1.05; 95 % confidence interval (CI), 1.02-1.07), PTB (OR = 1.10; 95 % CI, 1.03-1.18), and SGA (OR = 1.15; 95 % CI, 1.10-1.20) based on entire pregnancy exposure, and pooled estimate of decrease in birth weight was 14.58 g (95 % CI, 9.86-19.31); however, there was no evidence of a statistically significant effect of per 10 μg/m(3) increase in PM2.5 exposure on the risk of stillbirth (OR = 1.18; 95 % CI, 0.69-2.04). With respect to three different gestation periods, no significant risks were found in PTB, stillbirth, and the first trimester on the change of birth weight with a 10 μg/m(3) increase in PM2.5. In this study, a comprehensive quantitative analysis of the results show that PM2.5 can increase the risk of LBW, PTB, and SGA; pregnant women need to take effective measures to reduce PM2.5 exposure.

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Author and article information

Contributors

Xiaoli Liu: liuxiaolicqfy@163.com

Journal

Journal ID (nlm-ta): Environ Sci Pollut Res Int

Journal ID (iso-abbrev): Environ Sci Pollut Res Int

Title: Environmental Science and Pollution Research International

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0944-1344

ISSN (Electronic): 1614-7499

Publication date (Electronic): 6 May 2022

Publication date PMC-release: 6 May 2022

Publication date (Print): 2022

Volume: 29

Issue: 44

Pages: 67380-67389

Affiliations

[1 ]Chongqing Health Center for Women and Children, Chongqing, 401147 China

[2 ]GRID grid.410570.7, ISNI 0000 0004 1760 6682, Institute of Toxicology, College of Preventive Medicine, , Army Medical University (Third Military Medical University), ; Chongqing, 400038 China

[3 ]GRID grid.33199.31, ISNI 0000 0004 0368 7223, School of Public Health, Tongji Medical College, , Huazhong University of Science and Technology, ; Wuhan, 430030 China

Author notes

Responsible Editor: Lotfi Aleya

Article

Publisher ID: 20379

DOI: 10.1007/s11356-022-20379-8

PMC ID: 9492619

PubMed ID: 35522417

SO-VID: 7941f87f-e0de-48b0-8785-0f1c0ea8b6ee

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 24 December 2021

Date accepted : 18 April 2022

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100012669, Natural Science Foundation Project of Chongqing, Chongqing Science and Technology Commission;

Award ID: cstc2020jcyj-msxmX0511

Award Recipient : Wenzheng Zhou