A Time-Series Analysis of Air Pollution and Preterm Birth in Pennsylvania, 1997-2001
Sagiv, Sharon K., Mendola, Pauline, Loomis, Dana, Herring, Amy H., Neas, Lucas M., Savitz, David A., Poole, Charles, Environmental Health Perspectives
Preterm delivery can lead to serious infant health outcomes, including death and lifelong disability. Small increases in preterm delivery risk in relation to spatial gradients of air pollution have been reported, but previous studies may have controlled inadequately for individual factors. Using a time-series analysis, which eliminates potential confounding by individual risk factors that do not change over short periods of time, we investigated the effect of ambient outdoor particulate matter with diameter [less than or equal to] 10 [micro]m (P[M.sub.10]) and sulfur dioxide on risk for preterm delivery. Daily counts of preterm births were obtained from birth records in four Pennsylvania counties from 1997 through 2001. We observed increased risk for preterm delivery with exposure to average P[M.sub.10] and S[O.sub.2] in the 6 weeks before birth [respectively, relative risk (RR) = 1.07; 95% confidence interval (CI), 0.98-1.18 per 50 [micro]g/[m.sup.3] increase; RR = 1.15; 95% CI, 1.00-1.32 per 15 ppb increase], adjusting for long-term preterm delivery trends, co-pollutants, and offsetting by the number of gestations at risk. We also examined lags up to 7 days before the birth and found an acute effect of exposure to PMI0 2 days and 5 days before birth (respectively, RR = 1.10; 95% CI, 1.00-1.21; RR = 1.07; 95% CI, 0.98-1.18) and S[O.sub.2] 3 days before birth (RR = 1.07; 95% CI, 0.99-1.15), adjusting for covariates, including temperature, dew point temperature, and day of the week. The results from this time-series analysis, which provides evidence of an increase in preterm birth risk with exposure to P[M.sub.10] and S[O.sub.2] are consistent with prior investigations of spatial contrasts. Key words: air pollution, environmental epidemiology, particulate matter, pregnancy, preterm birth, sulfur dioxide. doi:10.1289/ehp.7646 available via http://dx.doi.org/[Online 2 February 2005]
Preterm delivery can lead to neonatal mortality as well as an array of infant morbidities that range from pulmonary to neurologic outcomes (Martin et al. 2002). The prevalence of preterm delivery was 11.6% in the United States in the year 2000 (Centers for Disease Control and Prevention 1999; Martin et al. 2002). Fewer than half of preterm births in developed countries can be attributed to known risk factors (Berkowitz and Pepiernik 1993; Kramer 1987). There is a clear need to explore causes of preterm delivery that might be modifiable, such as environmental exposures.
A small number of previous studies have explored the association between criteria air pollutants--carbon monoxide, nitrogen dioxide, ozone, sulfur dioxide, particulate matter with diameter [less than or equal to] 10 [micro]m (P[M.sub.10]), and in some cases total suspended particulates (TSP)--and preterm delivery by examining spatial exposure contrasts between individuals based on the place of residence at birth (Bobak 2000; Liu et al. 2003; Maroziene and Grazuleviciene 2002; Ritz et al. 2000; Xu et al. 1995). Although these studies varied with regard to the pollutant(s) evaluated, the most consistent findings reported were for positive associations between P[M.sub.10]/TSP and S[O.sub.2] late in pregnancy and preterm delivery (Bobak 2000; Liu et al. 2003; Ritz et al. 2000; Xu et al. 1995).
Relying on spatial analyses comparing high-exposure areas with low-exposure areas, previous studies have been subject to the effects of confounding by individual risk factors, such as maternal smoking and unmeasured or unknown risk factors. To date, no study has looked at the effect of air pollution on preterm delivery using a time-series analysis with exposure contrasts over time rather than space. Time-series analysis removes the influence of covariates that vary across individuals but not within individuals over short periods of time.
We investigated the associations during the years 1997 through 2001 of risk for preterm delivery with average concentrations of ambient outdoor P[M. …