Seasonal response of the synergism of maternal comorbidities and long-term air pollution exposure on birth outcomes

doi:10.1016/j.ecoenv.2020.110232

Ecotoxicology and Environmental Safety

Volume 191, 15 March 2020, 110232

https://doi.org/10.1016/j.ecoenv.2020.110232 Get rights and content

Highlights

•
The seasonal response of maternal comorbidities effects with air pollution was investigated.
•
The associations between air pollution and PTB were modiﬁed by gestational hypertension and preeclampsia.
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The seasonal patterns of six studied air pollutants increased the risk of PTB in autumn and winter distinguishably.
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The seasonal response of PTB associated with the synergism of maternal comorbidities and long-term air pollution exposure.

Abstract

Air pollution has been considered as one of the most important factors associating with various birth outcomes. However, the seasonal response of maternal comorbidities effects associated with air pollution has not been investigated, especially in the city with distinguish seasonal pattern and long heating seasons. In this work, 69,945 live births were investigated from 2013 to 2016, and the seasonal relationship between air pollution and preterm birth and low birth weight were assessed, as well as the synergism of maternal comorbidities. Exposures of six pollutants were assigned to maternal residences during pregnancy. The potential effect modiﬁcation by maternal comorbidities on the associations was evaluated between prenatal air pollution and preterm birth (PTB), as well as effects of seasons and trimesters. Adjusting for seasonality, all six pollutants presented seasonal relationship with preterm birth, which CO, PM₁₀, NO₂, and PM_2.5 were with [odds ratio (OR) = 1.035 95% CI: 1.015, 1.055, OR = 1.039 95% CI: 1.034, 1.045, OR = 1.042, 95% CI: 1.029, 1.056 and OR = 1.085 95% CI 1.073, 1.097, respectively] for tenth quartile of 10 μg/m³ range increased in autumn (the beginning of heating season). For O₃, it associated with PTB in winter and spring with OR = 1.113 95% CI: 1.104, 1.123, and OR = 1.155 95% CI: 1.145, 1.165, respectively. The OR increase of PTB for exposure to all six pollutants was higher among women with preeclampsia and gestational hypertension. The associations between ambient air pollution and preterm birth were modiﬁed by gestational hypertension and preeclampsia. The seasonal patterns of six studied air pollutants increases the risk of PTB in autumn and winter distinguishably, which may due to the sudden increased concentrations of pollutants emitted by traditional heating. The seasonal response of the synergism of maternal comorbidities and long-term air pollution exposure on birth outcomes is supported by the data sets of preterm birth.

Graphical abstract

Introduction

Ambient air pollution has drawn a great attention by the world due to its high risk leading to adverse effect on human health (Stieb et al., 2012). In 2015, more than 99% of deaths due to household air pollution and approximately 89% of deaths due to ambient air pollution occurred in low-income and middle-income countries, which contributed to 50% of global deaths occurred in India and China (Landrigan, 2017). Ambient air pollution has heavily limited the developments of economy and human society (Trasande et al., 2016) as well as resulted in a variety of adverse effects on human body such as diabetes mellitus, asthma, respiratory diseases (Han et al., 2018).

There are numerous studies have reported the association between air pollution and increasing risk of adverse pregnancy outcomes, including preterm birth, birth defects and low birth weight (Chen et al., 2017; Hansen et al., 2006; Laurent et al., 2014). preterm birth (PTB) is one of the leading cause on neonatal morbidity and mortality with a negative effect on restricted fetal growth (Glinianaia et al., 2004), congenital defects and intrauterine and infant mortality (Lacasaña et al., 2005; Šrám et al., 2005). Therefore, it is important to fulfill the blank data sets of such study and enrich the database of worldwide cohorts in order to explain the confirmation relationship all around the world.

Until recently, the majority studies have gathered the socioeconomic status and basic health information as covariates, however some of the maternal complications are affected preterm birth in some degree, including oligohydramnios, placental abruption (Ananth et al., 2004), premature rupture of membranes (Goldenberg et al., 2008), and thyroid dysfunction (Casey et al., 2005). Most of the studies have either excluded part of mentioned complications or lack of sufficient data. The aim of the study is to investigate associations of air pollutants (SO₂, CO, O₃, PM_2.5, PM₁₀, and NO₂) exposures with preterm birth and low birth weight in an understudied area, Hohhot, which characterizes a relative high pollution level and long-term heating period. This work provides the opportunity to investigate maternal complications as covariates to identify critical windows of air pollution exposure for the risk of preterm birth and low birth weight. It is very helpful to regard the influence of air pollution on maternal and fetal health in a large population-based case and control study for the cities with high air pollution levels and long-term heating period located in cold regions.

Section snippets

Study area

Hohhot is the capital city of Inner Mongolia Autonomous Region, China. The city is encircled by Yinshan Mountain to the east and north. This work has focused on the central city with 260 km² administrative area and 2.08million population out of total administrative area 17,224 km² and a total population 3.08 million (Hohhot Statistic Bureau, 2011). The built-up region is generally the central area of an urban field with the densest population. Hohhot features a cold semi-arid climate, the

Results

This study contained 69,945 live births in the analyses of which 5842 preterm birth (8.4% of total population) and 3277 low birth weights (4.7% of total population), respectively. PTB occurred at different age ranging in <25, 25–30, 30–35, and >35 with a number of 595 (10.18%), 2455 (42.02%), 1773 (30.35%) and 1019 (17.44%), respectively. Higher risk of preterm birth risk was observed among women age groups 25–29 and 30–34 due to the pregnant selection in fertile age and the variation in

Discussion

In this work, we have assigned robust exposure estimates of SO₂, CO, PM₁₀, O₃, NO₂ and PM_2.5 to a population-based cohort from majority hospitals’ records and examined the effects of those air pollutants on PTB and LBW to selected maternal comorbidities. Firstly, gestational hypertension, preeclampsia, polyhydramnios, placental abruption and fetal distress posed elevated risk for both PTB and LBW along with increasing exposure of all the pollutants. Secondly, premature rupture of membranes and

Conflict of interest disclosures

The scientific Research Committees and Ethics Committees of The Affiliated Hospital of Inner Mongolia Medical University approved the study involving the use of the hospital records and the authors declare that they have no conﬂict of interest.

CRediT authorship contribution statement

Boyi Zhao: Conceptualization, Methodology, Writing - original draft. Min Wang: Data curation, Writing - original draft. Changwei Lü: Conceptualization, Methodology, Writing - review & editing. Ling Feng: Software, Writing - review & editing. Hua Ma: Software, Data curation. Haixia Meng: Data curation. Muge Qi: Conceptualization, Methodology. Qingyun Fan: Data curation. Haoji Wang: Software, Validation. Haijun Zhou: Software, Validation. Jiang He: Conceptualization, Supervision.

Declaration of competing interest

Acknowledgments

This work is supported by Science and Technology Major Projects of Inner Mongolia (21800–5173909), National Natural Science Foundation of China (41763014) and the Youth innovation foundation of Inner Mongolia Medical University (no. YKD2017QNCX087).

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¹: Co-first authors.

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Seasonal response of the synergism of maternal comorbidities and long-term air pollution exposure on birth outcomes

Highlights

Abstract

Graphical abstract

Introduction

Section snippets

Study area

Results

Discussion

Conflict of interest disclosures

CRediT authorship contribution statement

Declaration of competing interest

Acknowledgments

The Lancet

The Lancet

Sci. Total Environ.

Environ. Res.

Environ. Res.

Environ. Int.

Int. J. Hyg Environ. Health

Environ. Int.

Semin. Perinatol.

Environ. Res.

Environ. Res.

Med. Hypotheses

Environ. Int.

Atmos. Res.

Atmos. Res.

Preterm premature rupture of membranes, intrauterine infection, and oligohydramnios: risk factors for placental abruption

Obstet. Gynecol.

The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity

Bull. World Health Organ.

Subclinical hypothyroidism and pregnancy outcomes

Obstet. Gynecol.

Exposure to low concentrations of air pollutants and adverse birth outcomes in Brisbane, Australia, 2003-2013

Sci. Total Environ.

Outdoor air pollution, preterm birth, and low birth weight: analysis of the world health organization global survey on maternal and perinatal health

Environ. Health Perspect.