Abstract
The purpose of this review was to summarize existing epidemiological evidence of the association between quantitative estimates of indoor air pollution and all-day personal exposure with adverse birth outcomes including fetal growth, prematurity and miscarriage. We carried out a systematic literature search of MEDLINE and EMBASE databases with the aim of summarizing and evaluating the results of peer-reviewed epidemiological studies undertaken in “westernized” countries that have assessed indoor air pollution and all-day personal exposure with specific quantitative methods. This comprehensive literature search identified 16 independent studies which were deemed relevant for further review and two additional studies were added through searching the reference lists of all included studies. Two reviewers independently and critically appraised all eligible articles using the Critical Appraisal Skills Programme (CASP) tool. Of the 18 selected studies, 14 adopted a prospective cohort design, three were case-controls and one was a retrospective cohort study. In terms of pollutants of interest, seven studies assessed exposure to electro-magnetic fields, four studies assessed exposure to polycyclic aromatic hydrocarbons, four studies assessed PM2.5 exposure and three studies assessed benzene, phthalates and noise exposure respectively. Furthermore, 12 studies examined infant growth as the main birth outcome of interest, six examined spontaneous abortion and three studies assessed gestational age at birth and preterm delivery. This survey demonstrates that there is insufficient research on the possible association of indoor exposure and early life effects and that further research is needed.
Highlights
The root cause of many adverse birth outcomes is not well understood, there is growing evidence that the environment can play an important role
The developing fetus is thought to be susceptible to environmental pollutants and birth outcomes that may be influenced by exposure to environmental factors include gestational duration, infant growth, miscarriage/pregnancy loss and congenital anomalies [1]
A large body of evidence demonstrates that, in addition to parental smoking [2,3,4] and environmental tobacco smoke (ETS) [5], outdoor and indoor air pollutants may increase the risk of adverse birth outcomes, including low birth weight (LBW), premature births, and intrauterine growth retardation (IUGR) [1,6,7,8]
Summary
The root cause of many adverse birth outcomes is not well understood, there is growing evidence that the environment can play an important role. A large body of evidence demonstrates that, in addition to parental smoking [2,3,4] and environmental tobacco smoke (ETS) [5], outdoor and indoor air pollutants may increase the risk of adverse birth outcomes, including low birth weight (LBW), premature births, and intrauterine growth retardation (IUGR) [1,6,7,8]. Several studies have associated maternal exposure to ambient air pollution (especially PM2.5) during pregnancy and a heightened risk of preterm delivery (PTD), low birth weight (LBW) and other adverse health effects [9]. A number of studies conducted in developing countries have addressed the effect of exposure to indoor air pollution (IAP) (mainly from solid fuel combustion processes) on diseases, such as respiratory infection, chronic obstructive pulmonary disease, cataract, asthma, heart diseases and adverse birth outcomes [11]. When women using solid fuel were compared with those using cleaner fuels it was found that solid fuel use was associated with increased risk of LBW and stillbirth (OR 1.38, 95% CI 1.25 to 1.52 and OR 1.51, 95% CI 1.23 to 1.85) [12]
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