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Adverse effects of exposure to air pollutants during fetal development and early life: with focus on pre-eclampsia, preterm delivery, and childhood asthma
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Air pollution exposure has been shown to have adverse effects on several health outcomes, and numerous studies have reported associations with cardiovascular morbidity, respiratory disease, and mortality. Over the last decade, an increasing number of studies have investigated possible associations with pregnancy outcomes, including preterm delivery. High levels of vehicle exhaust in residential neighborhoods have been associated with respiratory effects, including childhood asthma, and preterm birth is also associated with childhood asthma.

The first aim of this thesis was to investigate possible associations between air pollution exposure and pregnancy outcomes – primarily preterm delivery but also small for gestational age (SGA) and pre-eclampsia – in a large Swedish population (Papers I–III). The second aim was to study any association between exposure to high levels of vehicle exhaust during pregnancy and infancy and prescribed asthma medication in childhood (Paper IV).

Methods The study cohorts were constructed by matching other individual data to the Swedish Medical Birth Register. In the first two studies, air pollution data from monitoring stations were used, and in the third and fourth studies traffic intensity and dispersion model data were used.Preterm delivery was defined as giving birth before 37 weeks of gestation. SGA was defined as having a birth weight below the 10th percentile for a given duration of gestation. Pre-eclampsia was defined as having any of the ICD-10 diagnosis codes O11 (pre-existing hypertension with pre-eclampsia), O13 (gestational hypertension without significant proteinuria), O14 (gestational hypertension with significant proteinuria), or O15 (eclampsia). Childhood asthma medication was defined as having been prescribed asthma medication between the ages of five and six years.

Results We observed an association between ozone exposure during the first trimester and preterm delivery. First trimester ozone exposure was also associated with pre-eclampsia. The modeled concentration of nitrogen oxides at the home address was associated with pre-eclampsia, but critical time windows were not possible to investigate due to high correlations between time windows. We did not observe any association between air pollution exposure and SGA. High levels of vehicle exhaust at the home address, estimated by nitrogen oxides and traffic intensity, were associated with a lower risk of asthma medication.

Conclusion Air pollution exposure during pregnancy was associated with preterm delivery and pre-eclampsia. We did not observe any association between air pollution levels and intrauterine growth measured as SGA. No harmful effect of air pollution exposure during pregnancy or infancy on the risk of being prescribed asthma medication between five and six years of age was observed.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2014. , 33 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1679
Keyword [en]
Air pollution, pregnancy outcomes, asthma
National Category
Environmental Health and Occupational Health
Research subject
Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-93962ISBN: 978-91-7601-139-3 (print)OAI: oai:DiVA.org:umu-93962DiVA: diva2:752036
Public defence
2014-10-28, Betula, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2014-10-07 Created: 2014-10-02 Last updated: 2014-10-13Bibliographically approved
List of papers
1. Temporal variation in air pollution concentrations and preterm birth: a population based epidemiological study
Open this publication in new window or tab >>Temporal variation in air pollution concentrations and preterm birth: a population based epidemiological study
2012 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 9, no 1, 272-285 p.Article in journal (Refereed) Published
Abstract [en]

There is growing evidence of adverse birth outcomes due to exposure to air pollution during gestation. However, recent negative studies are also reported. The aim of this study was to assess the effect of ozone and vehicle exhaust exposure (NO2) on the length of the gestational period and risk of preterm delivery. We used data from the Swedish Medical Birth Registry on all vaginally delivered singleton births in the Greater Stockholm area who were conceived during 1987–1995 (n = 115,588). Daily average levels of NO2 (from three measuring stations) and ozone (two stations) were used to estimate trimester and last week of gestation average exposures. Linear regression models were used to assess the association between the two air pollutants and three exposure windows, while logistic regression models were used when analyzing associations with preterm delivery ( < 37 weeks gestation). Five percent were born preterm. The median gestational period was 40 weeks. Higher levels of ozone during the first trimester were associated with shorter gestation as well as with an elevated risk of preterm delivery, the odds ratio from the most complex model was 1.06 (95% CI: 1.00–1.13) per 10 μg/m3 increase in the mean daily 8-h maximum concentration. Higher levels of ozone during the second trimester were associated with shorter gestation but the elevated risk of preterm delivery was not statistically significant. Higher levels of ozone and NO2 during the last week of gestation were associated with a shorter duration of gestation and NO2 also with preterm delivery. There were no significant associations between first and second trimester NO2 exposure estimates and studied outcomes. The effect of first trimester ozone exposure, known to cause oxidative stress, was smallest among women who conceived during autumn when vitamin D status, important for fetal health, in Scandinavian women is the highest.Keywords: pregnancy; preterm birth; vehicle emissions; ozone; nitrogen dioxide

Place, publisher, year, edition, pages
Basel: MDPI Publishing, 2012
Keyword
pregnancy, preterm birth, vehicle emissions, ozone, nitrogen dioxide
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-52224 (URN)10.3390/ijerph9010272 (DOI)000299532000018 ()
Available from: 2012-02-14 Created: 2012-02-14 Last updated: 2017-12-07Bibliographically approved
2. Air pollution exposure in early pregnancy and adverse pregnancy outcomes: a register-based cohort study
Open this publication in new window or tab >>Air pollution exposure in early pregnancy and adverse pregnancy outcomes: a register-based cohort study
2013 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 2, e001955- p.Article in journal (Refereed) Published
Abstract [en]

Objectives: Our aim was to study the possible associations between exposure to elevated levels of air pollution, ozone (O-3) and vehicle exhaust (NOx), during early gestation, and adverse pregnancy outcomes such as pre-eclampsia, preterm birth and small for gestational age.

Design: Prospective register-based cohort study. Setting: The Swedish Medical Birth Register includes data on all deliveries during 1998 to 2006 in Greater Stockholm, Sweden. The national Patient Register and the Prescribed Drug Register were used to collect information on maternal asthma.

Participants: All singleton pregnancies, conceived at the earliest in August 1997 and at the latest in February 2006, were included, n=120 755.

Outcome measures: We studied preterm birth, small for gestational age and pre-eclampsia. Results: 4.4% of pregnancies resulted in a preterm birth. The prevalence of pre-eclampsia was 2.7%. We observed an association between first trimester O-3 and preterm birth (OR 1.04, 95% CI 1.01 to 1.08) as well as an association with pre-eclampsia (OR 1.04, 95% CI 1.01 to 1.08), per 10 mu g/m(3) increase in O-3. We observed no association between first trimester NOx and adverse pregnancy outcomes. No associations were observed between any of the air pollutants and small for gestational age.

Conclusions: Increased levels of O-3 during the first trimester increased the risk of pre-eclampsia and preterm birth. Air pollutants did not exhibit any effects on fetal growth restriction. We estimated 1 in every 20 cases of pre-eclampsia to be associated with O-3 exposure.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2013
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-67609 (URN)10.1136/bmjopen-2012-001955 (DOI)000315087200013 ()
Available from: 2013-05-22 Created: 2013-03-25 Last updated: 2017-12-06Bibliographically approved
3. Traffic pollution at home address and pregnancy outcomes
Open this publication in new window or tab >>Traffic pollution at home address and pregnancy outcomes
(English)Manuscript (preprint) (Other academic)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-93955 (URN)
Available from: 2014-10-02 Created: 2014-10-02 Last updated: 2014-10-07Bibliographically approved
4. Traffic pollution exposure at home during pregnancy and infancy and childhood asthma medication
Open this publication in new window or tab >>Traffic pollution exposure at home during pregnancy and infancy and childhood asthma medication
(English)Manuscript (preprint) (Other academic)
National Category
Environmental Health and Occupational Health
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-93960 (URN)
Available from: 2014-10-02 Created: 2014-10-02 Last updated: 2014-10-07Bibliographically approved

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