Ambient air pollution and low birthweight: a European cohort study (ESCAPE).
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Pedersen Marie, Giorgis-Allemand Lise, Bernard Claire, Aguilera Inmaculada, Andersen Anne-Marie Nybo, Ballester Ferran, Beelen Rob M J, Chatzi Leda, Cirach Marta, Danileviciute Asta, Dedele Audrius, Eijsden Manon van, Estarlich Marisa, Fernández-Somoano Ana, Fernández Mariana F, Forastiere Francesco, Gehring Ulrike, Grazuleviciene Regina, Gruzieva Olena, Heude Barbara, Hoek Gerard, de Hoogh Kees, van den Hooven Edith H, Håberg Siri E, Jaddoe Vincent W V, Klümper Claudia, Korek Michal, Krämer Ursula, Lerchundi Aitana, Lepeule Johanna, Nafstad Per, Nystad Wenche, Patelarou Evridiki, Porta Daniela, Postma Dirkje, Raaschou-Nielsen Ole, Rudnai Peter, Sunyer Jordi, Stephanou Euripides, Sørensen Mette, Thiering Elisabeth, Tuffnell Derek, Varró Mihály J, Vrijkotte Tanja G M, Wijga Alet, Wilhelm Michael, Wright John, Nieuwenhuijsen Mark J, Pershagen Göran, Brunekreef Bert, Kogevinas Manolis, Slama Rémy
Аннотация
METHODS: We pooled data from 14 population-based mother-child cohort studies in 12 European countries. Overall, the study population included 74 178 women who had singleton deliveries between Feb 11, 1994, and June 2, 2011, and for whom information about infant birthweight, gestational age, and sex was available. The primary outcome of interest was low birthweight at term (weight <2500 g at birth after 37 weeks of gestation). Mean concentrations of particulate matter with an aerodynamic diameter of less than 2·5 μm (PM2·5), less than 10 μm (PM10), and between 2·5 μm and 10 μm during pregnancy were estimated at maternal home addresses with temporally adjusted land-use regression models, as was PM2·5 absorbance and concentrations of nitrogen dioxide (NO2) and nitrogen oxides. We also investigated traffic density on the nearest road and total traffic load. We calculated pooled effect estimates with random-effects models.
FINDINGS: A 5 μg/m(3) increase in concentration of PM2·5 during pregnancy was associated with an increased risk of low birthweight at term (adjusted odds ratio [OR] 1·18, 95% CI 1·06-1·33). An increased risk was also recorded for pregnancy concentrations lower than the present European Union annual PM2·5 limit of 25 μg/m(3) (OR for 5 μg/m(3) increase in participants exposed to concentrations of less than 20 μg/m(3) 1·41, 95% CI 1·20-1·65). PM10 (OR for 10 μg/m(3) increase 1·16, 95% CI 1·00-1·35), NO2 (OR for 10 μg/m(3) increase 1·09, 1·00-1·19), and traffic density on nearest street (OR for increase of 5000 vehicles per day 1·06, 1·01-1·11) were also associated with increased risk of low birthweight at term. The population attributable risk estimated for a reduction in PM2·5 concentration to 10 μg/m(3) during pregnancy corresponded to a decrease of 22% (95% CI 8-33%) in cases of low birthweight at term.
INTERPRETATION: Exposure to ambient air pollutants and traffic during pregnancy is associated with restricted fetal growth. A substantial proportion of cases of low birthweight at term could be prevented in Europe if urban air pollution was reduced.
FUNDING: The European Union.