Ambient air pollution the risk of stillbirth: A prospective birth cohort study in Wuhan, China

Shaoping Yang, Yafei Tan, Hui Mei, Fang Wang, Na Li, Jinzhu Zhao, Yiming Zhang, Zhengmin Qian, Jen Jen Chang, Kevin M. Syberg, Anna Peng, Hong Mei, Dan Zhang, Yan Zhang, Shunqing Xu, Yuanyuan Li, Tongzhang Zheng, Bin Zhang

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Abstract

Background: Recent studies suggest that ambient air pollution exposure during pregnancy is associated with stillbirth occurrence. However, the results on the associations between ambient air pollutants and stillbirths are inconsistent and little is known about the gestational timing of sensitive periods for the effects of ambient air pollutants exposure on stillbirth. Objective: This study aimed to examine whether exposure to high levels of ambient air pollutants in a Chinese population is associated with an increased risk of stillbirth, and determine the gestational period when the fetus is most susceptible. Methods: We conducted a population-based cohort study in Wuhan, China, involving 95,354 births between June 10, 2011 and June 9, 2013. The exposure assessments were based on the daily mean concentrations of air pollutants obtained from the exposure monitor nearest to the pregnant women's residence. Logistic regression analyses were performed to determine the associations between stillbirths and exposure to each of the air pollutants at different pregnancy periods with adjustment for confounding factors. Results: Stillbirth increased with a 10 μg/m3 increase in particulate matter 2.5 (PM2.5) in each stage of pregnancy, and a significant association between carbon monoxide (CO) exposure and stillbirth was found during the third trimester (adjusted odds ratio (aOR): 1.01, 95% confidence interval (CI): 1.00–1.01) and in the entire pregnancy (aOR: 1.18, 95% CI: 1.04–1.34). Furthermore, an increased risk of stillbirth in the third trimester was associated with a 10 μg/m3 increase in PM10 (aOR: 1.08, 95% CI: 1.04–1.11), nitrogen dioxide (NO2) (aOR: 1.13, 95% CI: 1.07–1.21) and sulfur dioxide (SO2) (aOR: 1.26, 95% CI: 1.16–1.35). However, no positive association was observed between ozone exposure and stillbirth. In the two-pollutant models, PM2.5 and CO exposures were found to be consistently associated with stillbirth. Conclusions: Our study revealed that exposure to high levels of PM2.5, PM10, SO2, NO2 and CO increases the risk of stillbirth and the most susceptible gestational period to ambient air pollution exposure was in the third trimester. Further toxicological and prospective cohort studies with improved exposure assessments are needed to confirm the causal link between air pollutants and stillbirth.

Original languageEnglish (US)
Pages (from-to)502-509
Number of pages8
JournalInternational Journal of Hygiene and Environmental Health
Volume221
Issue number3
DOIs
StatePublished - Apr 2018

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Stillbirth
Air Pollution
China
Cohort Studies
Parturition
Air Pollutants
Odds Ratio
Particulate Matter
Confidence Intervals
Third Pregnancy Trimester
Carbon Monoxide
Pregnancy
Nitrogen Dioxide
Sulfur Dioxide
Ozone
Toxicology
Population
Pregnant Women
Fetus
Logistic Models

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health

Cite this

Yang, Shaoping ; Tan, Yafei ; Mei, Hui ; Wang, Fang ; Li, Na ; Zhao, Jinzhu ; Zhang, Yiming ; Qian, Zhengmin ; Chang, Jen Jen ; Syberg, Kevin M. ; Peng, Anna ; Mei, Hong ; Zhang, Dan ; Zhang, Yan ; Xu, Shunqing ; Li, Yuanyuan ; Zheng, Tongzhang ; Zhang, Bin. / Ambient air pollution the risk of stillbirth : A prospective birth cohort study in Wuhan, China. In: International Journal of Hygiene and Environmental Health. 2018 ; Vol. 221, No. 3. pp. 502-509.
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title = "Ambient air pollution the risk of stillbirth: A prospective birth cohort study in Wuhan, China",
abstract = "Background: Recent studies suggest that ambient air pollution exposure during pregnancy is associated with stillbirth occurrence. However, the results on the associations between ambient air pollutants and stillbirths are inconsistent and little is known about the gestational timing of sensitive periods for the effects of ambient air pollutants exposure on stillbirth. Objective: This study aimed to examine whether exposure to high levels of ambient air pollutants in a Chinese population is associated with an increased risk of stillbirth, and determine the gestational period when the fetus is most susceptible. Methods: We conducted a population-based cohort study in Wuhan, China, involving 95,354 births between June 10, 2011 and June 9, 2013. The exposure assessments were based on the daily mean concentrations of air pollutants obtained from the exposure monitor nearest to the pregnant women's residence. Logistic regression analyses were performed to determine the associations between stillbirths and exposure to each of the air pollutants at different pregnancy periods with adjustment for confounding factors. Results: Stillbirth increased with a 10 μg/m3 increase in particulate matter 2.5 (PM2.5) in each stage of pregnancy, and a significant association between carbon monoxide (CO) exposure and stillbirth was found during the third trimester (adjusted odds ratio (aOR): 1.01, 95{\%} confidence interval (CI): 1.00–1.01) and in the entire pregnancy (aOR: 1.18, 95{\%} CI: 1.04–1.34). Furthermore, an increased risk of stillbirth in the third trimester was associated with a 10 μg/m3 increase in PM10 (aOR: 1.08, 95{\%} CI: 1.04–1.11), nitrogen dioxide (NO2) (aOR: 1.13, 95{\%} CI: 1.07–1.21) and sulfur dioxide (SO2) (aOR: 1.26, 95{\%} CI: 1.16–1.35). However, no positive association was observed between ozone exposure and stillbirth. In the two-pollutant models, PM2.5 and CO exposures were found to be consistently associated with stillbirth. Conclusions: Our study revealed that exposure to high levels of PM2.5, PM10, SO2, NO2 and CO increases the risk of stillbirth and the most susceptible gestational period to ambient air pollution exposure was in the third trimester. Further toxicological and prospective cohort studies with improved exposure assessments are needed to confirm the causal link between air pollutants and stillbirth.",
author = "Shaoping Yang and Yafei Tan and Hui Mei and Fang Wang and Na Li and Jinzhu Zhao and Yiming Zhang and Zhengmin Qian and Chang, {Jen Jen} and Syberg, {Kevin M.} and Anna Peng and Hong Mei and Dan Zhang and Yan Zhang and Shunqing Xu and Yuanyuan Li and Tongzhang Zheng and Bin Zhang",
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Yang, S, Tan, Y, Mei, H, Wang, F, Li, N, Zhao, J, Zhang, Y, Qian, Z, Chang, JJ, Syberg, KM, Peng, A, Mei, H, Zhang, D, Zhang, Y, Xu, S, Li, Y, Zheng, T & Zhang, B 2018, 'Ambient air pollution the risk of stillbirth: A prospective birth cohort study in Wuhan, China', International Journal of Hygiene and Environmental Health, vol. 221, no. 3, pp. 502-509. https://doi.org/10.1016/j.ijheh.2018.01.014

Ambient air pollution the risk of stillbirth : A prospective birth cohort study in Wuhan, China. / Yang, Shaoping; Tan, Yafei; Mei, Hui; Wang, Fang; Li, Na; Zhao, Jinzhu; Zhang, Yiming; Qian, Zhengmin; Chang, Jen Jen; Syberg, Kevin M.; Peng, Anna; Mei, Hong; Zhang, Dan; Zhang, Yan; Xu, Shunqing; Li, Yuanyuan; Zheng, Tongzhang; Zhang, Bin.

In: International Journal of Hygiene and Environmental Health, Vol. 221, No. 3, 04.2018, p. 502-509.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Ambient air pollution the risk of stillbirth

T2 - A prospective birth cohort study in Wuhan, China

AU - Yang, Shaoping

AU - Tan, Yafei

AU - Mei, Hui

AU - Wang, Fang

AU - Li, Na

AU - Zhao, Jinzhu

AU - Zhang, Yiming

AU - Qian, Zhengmin

AU - Chang, Jen Jen

AU - Syberg, Kevin M.

AU - Peng, Anna

AU - Mei, Hong

AU - Zhang, Dan

AU - Zhang, Yan

AU - Xu, Shunqing

AU - Li, Yuanyuan

AU - Zheng, Tongzhang

AU - Zhang, Bin

PY - 2018/4

Y1 - 2018/4

N2 - Background: Recent studies suggest that ambient air pollution exposure during pregnancy is associated with stillbirth occurrence. However, the results on the associations between ambient air pollutants and stillbirths are inconsistent and little is known about the gestational timing of sensitive periods for the effects of ambient air pollutants exposure on stillbirth. Objective: This study aimed to examine whether exposure to high levels of ambient air pollutants in a Chinese population is associated with an increased risk of stillbirth, and determine the gestational period when the fetus is most susceptible. Methods: We conducted a population-based cohort study in Wuhan, China, involving 95,354 births between June 10, 2011 and June 9, 2013. The exposure assessments were based on the daily mean concentrations of air pollutants obtained from the exposure monitor nearest to the pregnant women's residence. Logistic regression analyses were performed to determine the associations between stillbirths and exposure to each of the air pollutants at different pregnancy periods with adjustment for confounding factors. Results: Stillbirth increased with a 10 μg/m3 increase in particulate matter 2.5 (PM2.5) in each stage of pregnancy, and a significant association between carbon monoxide (CO) exposure and stillbirth was found during the third trimester (adjusted odds ratio (aOR): 1.01, 95% confidence interval (CI): 1.00–1.01) and in the entire pregnancy (aOR: 1.18, 95% CI: 1.04–1.34). Furthermore, an increased risk of stillbirth in the third trimester was associated with a 10 μg/m3 increase in PM10 (aOR: 1.08, 95% CI: 1.04–1.11), nitrogen dioxide (NO2) (aOR: 1.13, 95% CI: 1.07–1.21) and sulfur dioxide (SO2) (aOR: 1.26, 95% CI: 1.16–1.35). However, no positive association was observed between ozone exposure and stillbirth. In the two-pollutant models, PM2.5 and CO exposures were found to be consistently associated with stillbirth. Conclusions: Our study revealed that exposure to high levels of PM2.5, PM10, SO2, NO2 and CO increases the risk of stillbirth and the most susceptible gestational period to ambient air pollution exposure was in the third trimester. Further toxicological and prospective cohort studies with improved exposure assessments are needed to confirm the causal link between air pollutants and stillbirth.

AB - Background: Recent studies suggest that ambient air pollution exposure during pregnancy is associated with stillbirth occurrence. However, the results on the associations between ambient air pollutants and stillbirths are inconsistent and little is known about the gestational timing of sensitive periods for the effects of ambient air pollutants exposure on stillbirth. Objective: This study aimed to examine whether exposure to high levels of ambient air pollutants in a Chinese population is associated with an increased risk of stillbirth, and determine the gestational period when the fetus is most susceptible. Methods: We conducted a population-based cohort study in Wuhan, China, involving 95,354 births between June 10, 2011 and June 9, 2013. The exposure assessments were based on the daily mean concentrations of air pollutants obtained from the exposure monitor nearest to the pregnant women's residence. Logistic regression analyses were performed to determine the associations between stillbirths and exposure to each of the air pollutants at different pregnancy periods with adjustment for confounding factors. Results: Stillbirth increased with a 10 μg/m3 increase in particulate matter 2.5 (PM2.5) in each stage of pregnancy, and a significant association between carbon monoxide (CO) exposure and stillbirth was found during the third trimester (adjusted odds ratio (aOR): 1.01, 95% confidence interval (CI): 1.00–1.01) and in the entire pregnancy (aOR: 1.18, 95% CI: 1.04–1.34). Furthermore, an increased risk of stillbirth in the third trimester was associated with a 10 μg/m3 increase in PM10 (aOR: 1.08, 95% CI: 1.04–1.11), nitrogen dioxide (NO2) (aOR: 1.13, 95% CI: 1.07–1.21) and sulfur dioxide (SO2) (aOR: 1.26, 95% CI: 1.16–1.35). However, no positive association was observed between ozone exposure and stillbirth. In the two-pollutant models, PM2.5 and CO exposures were found to be consistently associated with stillbirth. Conclusions: Our study revealed that exposure to high levels of PM2.5, PM10, SO2, NO2 and CO increases the risk of stillbirth and the most susceptible gestational period to ambient air pollution exposure was in the third trimester. Further toxicological and prospective cohort studies with improved exposure assessments are needed to confirm the causal link between air pollutants and stillbirth.

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