Heat and air pollution exposure as triggers of delivery: A survival analysis of population-based pregnancy cohorts in Rome and Barcelona |
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| Institution: | 1. Department of Epidemiology, Lazio Regional Health Service, Rome, Italy;2. Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain;3. Universitat Pompeu Fabra (UPF), Barcelona, Spain;4. CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain;1. School of Public Health, Xinxiang Medical University, Xinxiang 453003, China;2. Henan International Collaborative Laboratory for Air Pollution Health Effects and Intervention, Xinxiang 453003, China;3. The First Affiliated Hospital of Xinxiang Medical University, Xinxiang 453100, China;4. Xinxiang Medical University, Xinxiang 453003, China;5. National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China;1. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia;2. Center for Environmental and Respiratory Health Research and Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland;3. School of Public Health, The University of Queensland, Brisbane, Queensland, Australia;1. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia;2. School of Public Health, The University of Queensland, Brisbane, Queensland, Australia;1. Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China;2. National Center for Human Genetic Resources, Beijing, China;3. National Research Institute for Family Planning, Beijing, China;4. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia;5. Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA;6. Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, USA;7. Department of Maternal and Child Health, National Health and Family Planning Commission of the PRC, Beijing, China |
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| Abstract: | IntroductionEnvironmental exposures have been linked to length of gestation but the question as to during which weeks of gestation pregnancies are most susceptible still remains little explored.We estimated the effect of maximum apparent temperature and air pollution levels on risk of birth by week of gestation.MethodsWe analyzed two cohorts of singleton live births in Rome (2001–2010) and Barcelona (2007–2012). Maximum apparent temperature (MAT), PM10, O3 and NO2 were analyzed in the warm period (1st April–31st October).Gestational week-specific hazard ratios of giving birth associated to a 1-unit increase in exposure were estimated fitting Cox regression models adjusted for seasonality, and demographic and clinical characteristics of the mother.ResultsWe observed 78,633 births (5.5% preterm) in Rome and 27,255 (4.5% preterm) in Barcelona. The highest hazard ratios for 1 °C increase in MAT were in the 22nd–26th weeks of gestation, 1.071, (95% CI 1.052–1.091) in Rome and 1.071 (95% CI 1.036–1.106) in Barcelona, and decreased to 1.032 (95% CI 1.026–1.038) and 1.033 (95% CI 1.020–1.045) at the 36th week of gestation, respectively. Similar associations and trends were observed for PM10 and NO2 after adjusting for MAT. O3 showed similar trends but weaker associations.ConclusionsWe found, consistently in Rome and Barcelona, an increased risk of delivery for a unit increase in MAT, PM10, NO2 and O3, especially in the second half of the second trimester, thus effectively increasing the risk of preterm and particularly early preterm birth. Results may help to increase awareness of these risks among public-health regulators and clinicians, leading to better preventive strategies. |
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