Abstract
ObjectiveTo test the hypothesis that exposure to fine particulate air pollution (PM2.5) is associated with stillbirth.Study DesignGeo-spatial population-based cohort study using Ohio birth records (2006-2010) and local measures of PM2.5, recorded by the EPA (2005-2010) via 57 monitoring stations across Ohio. Geographic coordinates of the mother’s residence for each birth were linked to the nearest PM2.5 monitoring station and monthly exposure averages calculated. The association between stillbirth and increased PM2.5 levels was estimated, with adjustment for maternal age, race, education level, quantity of prenatal care, smoking, and season of conception.ResultsThere were 349,188 live births and 1,848 stillbirths of non-anomalous singletons (20-42 weeks) with residence ≤10 km of a monitor station in Ohio during the study period. The mean PM2.5 level in Ohio was 13.3 μg/m3 [±1.8 SD, IQR(Q1: 12.1, Q3: 14.4, IQR: 2.3)], higher than the current EPA standard of 12 μg/m3. High average PM2.5 exposure through pregnancy was not associated with a significant increase in stillbirth risk, adjOR 1.21(95% CI 0.96,1.53), nor was it increased with high exposure in the 1st or 2nd trimester. However, exposure to high levels of PM2.5 in the third trimester of pregnancy was associated with 42% increased stillbirth risk, adjOR 1.42(1.06,1.91).ConclusionsExposure to high levels of fine particulate air pollution in the third trimester of pregnancy is associated with increased stillbirth risk. Although the risk increase associated with high PM2.5 levels is modest, the potential impact on overall stillbirth rates could be robust as all pregnant women are potentially at risk.
Highlights
The stillbirth rate is higher in the US compared to many developed countries. [1,2] The US stillbirth rate in 2006 was 6.0 per 1000 births,[3] almost 50% higher than the Healthy People 2010 goal of 4.1 per 1000.[4]
High average PM2.5 exposure through pregnancy was not associated with a significant increase in stillbirth risk, adjOR 1.21(95% CI 0.96,1.53), nor was it increased with high exposure in the 1st or 2nd trimester
Exposure to high levels of fine particulate air pollution in the third trimester of pregnancy is associated with increased stillbirth risk
Summary
The stillbirth rate (fetal death 20 weeks of gestation) is higher in the US compared to many developed countries. [1,2] The US stillbirth rate in 2006 was 6.0 per 1000 births,[3] almost 50% higher than the Healthy People 2010 goal of 4.1 per 1000.[4]. The stillbirth rate (fetal death 20 weeks of gestation) is higher in the US compared to many developed countries. A variety of pre-existing medical, socioeconomic, prenatal, genetic, and environmental factors influence a woman’s individual risk of stillbirth. Exposure to harmful environmental pollutants is associated with adverse health outcomes and pregnancy complications.[5,6] Airborne particulate matter (PM) is a complex mixture of extremely small particles and liquid droplets including acids, organic chemicals, metals, and soil or dust particles. The US Environmental Protection Agency (EPA) has air quality standards for particle pollution, and monitors local levels via stationary monitoring stations throughout the US. The US EPA National Ambient Air Quality Standard (NAAQS) for annual mean level of PM2.5 is currently 12 μg/m3.[7]
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