Traffic-Related Air Pollution and Perinatal Mortality: A Case-Control Study

Article excerpt

BACKGROUND: Ambient levels of air pollution may affect the health of children, as indicated by studies of infant and perinatal mortality. Scientific evidence has also correlated low birth weight and pre-term birth, which are important determinants of perinatal death, with air pollution. However, most of these studies used ambient concentrations measured at monitoring sites, which may not consider differential exposure to pollutants found at elevated concentrations near heavy-traffic roadways.

OBJECTIVES: Our goal was to examine the association between traffic-related pollution and perinatal mortality.

METHODS: We used the information collected for a case--control study conducted in 14 districts in the City of Sao Paulo, Brazil, regarding risk factors for perinatal deaths. We geocoded the residential addresses of cases (fetal and early neonatal deaths) and controls (children who survived the 28th day of life) and calculated a distance-weighted traffic density (DWTD) measure considering all roads contained in a buffer surrounding these homes.

RESULTS: Logistic regression revealed a gradient of increasing risk of early neonatal death will higher exposure to traffic-related air pollution. Mothers exposed to the highest quartile of the DWTD compared with those less exposed exhibited approximately 50% increased risk (adjusted odds ratio = 1.47; 95% confidence interval, 0.67-3.19). Associations for fetal mortality were less; consistent.

CONCLUSIONS: These results suggest that motor vehicle exhaust exposures may be a risk factor for perinatal mortality.

KEY WORDS: air pollution, epidemiology, geographic information systems, perinatal mortality, traffic density. Environ Health Perspect 117:127-132 (2009). doi: 10.1289/ehp.ll679 available via:[Online 22 September 2008]


Child mortality has decreased substantially in Brazil in past decades; nonetheless, it still has higher values than those found in developed countries (Vermelho et al. 2002). Perinatal death--those that occur in utero ([greater than or equal to]22 weeks of gestation or fetal deaths) and in the first 6 days of life (early neonatal deaths)--contribute most to this situation. Perinatal mortality is an indicator of mother and child health and may reflect the conditions of reproductive health, which is related to socioeconomic position, quality of antenatal care, and delivery characteristics (Jackson et al. 1999). Some of the several risk factors identified for perinatal mortality include mother-related factors and complications in pregnancy, labor, and delivery, which may affect both the newborn and the fetus (e.g., maternal hypertension, placenta previa, premature placental detachment, and other morphologic and functional abnormalities of the placenta); respiratory and cardiovascular disorders specific to the perinatal period; infections; and disorders related to the length of pregnancy and fetal growth [e.g., intrauterine growth restriction (IUGR), preterm birth, and low birth weight] (Almeida et al. 2007; Conde-Agudelo et al. 2000; Kramer et al. 2002; Schoeps et al. 2000; Kramer et al. 2002; Schoeps et al. 2007). More recently, studies have indicated that exposure to air pollution may be associated with low birth weight and preterm birth (Ritz and Yu 1999; Ritz et al. 2000), both of which are important risk factors for perinatal death. In addition, urban air pollution has also been directly implicated in perinatal mortality (Lin et al. 2004; Nishioka et al. 2000; Pereira et al. 1998). The association between deaths in the neonatal period (0-28 days of life) and air pollution was also identified in the studies by Lipfert et al. (2000) and Hajat et al. (2007).

However, these studies assessed the exposure to air pollution based on the average concentration of pollutants obtained from air quality monitoring stations. This direct measuring system reflects the levels of pollutants in a relatively large area. …