Academic journal article Environmental Health Perspectives

Ambient Air Pollution and Pregnancy Outcomes: A Review of the Literature

Academic journal article Environmental Health Perspectives

Ambient Air Pollution and Pregnancy Outcomes: A Review of the Literature

Article excerpt

Over the last decade or so, a large number of studies have investigated the possible adverse effects of ambient air pollution on birth outcomes. We reviewed these studies, which were identified by a systematic search of the main scientific databases. Virtually all reviewed studies were population based, with information on exposure to air pollution derived from routine monitoring sources. Overall, there is evidence implicating air pollution in adverse effects on different birth outcomes, but the strength of the evidence differs between outcomes. The evidence is sufficient to infer a causal relationship between particulate air pollution and respiratory deaths in the postneonatal period. For air pollution and birth weight the evidence suggests causality, but further studies are needed to confirm an effect and its size and to clarify the most vulnerable period of pregnancy and the role of different pollutants. For preterm births and intrauterine growth retardation (IUGR) the evidence as yet is insufficient to infer causality, but the available evidence justifies further studies. Molecular epidemiologic studies suggest possible biologic mechanisms for the effect on birth weight, premature birth, and IUGR and support the view that the relation between pollution and these birth outcomes is genuine. For birth defects, the evidence base so far is insufficient to draw conclusions. In terms of exposure to specific pollutants, particulates seem the most important for infant deaths, and the effect on IUGR seems linked to polycyclic aromatic hydrocarbons, but the existing evidence does not allow precise identification of the different pollutants or the timing of exposure that can result in adverse pregnancy outcomes. Key words: air pollution, intrauterine growth retardation, low birth weight, molecular epidemiology, PAHs, particulate matter, PMI0, premature birth, reproductive effects, S[O.sub.2].

Environ Health Perspect 113:375-382 (2005). doi: 10.1289/ehp.6362 available via http://dx.doLorg/[Online 4 January 2005]


There is extensive evidence that ambient air pollution affects human health (e.g., Brunekreef and Holgate 2002; Kunzli et al. 2000; Pope et al. 2002). Most studies have focused on the effects of air pollution on adult mortality and respiratory morbidity (Dockery et al. 1993; Schwartz and Marcus 1990). However, some age groups appear to be more susceptible than others. For example, it has been shown that the effects are larger in the elderly than in the general adult population (Saldiva et al. 1995). Studies on childhood health risks, such as respiratory symptoms or hospital admissions for asthma, suggest that the opposite end of the age spectrum is also more vulnerable to air pollution than is the general population (Dockery and Pope 1994; Heinrich et al. 1999; Schwartz et al. 1994). In addition to these "traditional" end points in children, there is now emerging evidence that air pollution is also associated with elevated risk of adverse pregnancy outcomes (Glinianaia et al. 2004; Maisonet et al. 2004).

The study of birth outcomes is an important emerging field of environmental epidemiology. Birth outcomes are important in their own right because they are important indicators of the health of the newborns and infants. In addition, low birth weight (LBW), intrauterine growth retardation (IUGR), and impaired growth in the first years of life are known to influence the subsequent health status of individuals, including increased mortality and morbidity in childhood and an elevated risk of hypertension, coronary heart disease, and non-insulin-dependent diabetes in adulthood (Barker 1995; Osmond and Baker 2000).

It is increasingly apparent that there is a critical period of development when the timing of exposure and the dose absorption rate can be even more important for the biologic effects than is the overall dose (Axelrod et al. 2001). Fetuses, in particular, are considered to be highly susceptible to a variety of toxicants because of their exposure pattern and physiologic immaturity (Perera et al. …

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