Abstract
BackgroundPreterm birth (PTB, birth before 37 weeks of gestation) has been associated with adverse health outcomes across the lifespan. Evidence on the association between PTB and prenatal exposure to air pollutants is inconsistent, and is especially lacking for ethnic/racial minority populations.MethodsWe obtained data on maternal characteristics and behaviors and PTB and other birth outcomes for women participating in the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) cohort, who lived in municipalities located along the North Coast of Puerto Rico. We assessed pre-natal PM2.5 exposures for each infant based on the nearest US Environmental Protection Agency monitor. We estimated prenatal phthalate exposures as the geometric mean of urinary measurements obtained during pregnancy. We then examined the association between PM2.5 and PTB using modified Poisson regression and assessed modification of the association by phthalate exposure levels and sociodemographic factors such as maternal age and infant gender.ResultsAmong 1092 singleton births, 9.1% of infants were born preterm and 92.9% of mothers had at least a high school education. Mothers had a mean (standard deviation) age of 26.9 (5.5) years and a median (range) of 2.0 (1.0–8.0) pregnancies. Nearly all women were Hispanic white, black, or mixed race. Median (range) prenatal PM2.5 concentrations were 6.0 (3.1–19.8) μ g/m3. Median (interquartile range) prenatal phthalate levels were 14.9 (8.9–26.0) and 14.5 (8.4–26.0), respectively, for di-n-butyl phthalate (DBP) and di-isobutyl phthalate (DiBP). An interquartile range increase in PM2.5 was associated with a 1.2% (95% CI 0.4, 2.1%) higher risk of PTB. There was little difference in PTB risk in strata of infant sex, mother’s age, family income, history of adverse birth outcome, parity, and pre-pregnancy body mass index. Pregnancy urinary phthalate metabolite levels did not modify the PM2.5-PTB association.ConclusionAmong ethnic minority women in Puerto Rico, prenatal PM2.5 exposure is associated with a small but significant increase in risk of PTB.
Highlights
Preterm birth (PTB) is the largest cause of infant death in the United States, and has been associated with morbidity and mortality throughout the lifespan [1,2,3]
We examined the association of prenatal PM2.5 exposure and PTB in a predominantly Hispanic and black cohort of Puerto Rican women, and assessed whether PTB risk varied by maternal sociodemographic factors, and infant sex
Study design and population We identified all live singleton births that occurred between August 2011 and August 2018 to women enrolled in the ongoing Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) prospective cohort study
Summary
Preterm birth (PTB) is the largest cause of infant death in the United States, and has been associated with morbidity and mortality throughout the lifespan [1,2,3]. Postneonatal morbidity due to jaundice, impaired kidney function, infectious agents, and respiratory distress is higher among prematurely-born infants [4]. Children born prematurely are more likely to exhibit psycho-behavioral, developmental, and neurocognitive deficits, higher incidence of asthma and chronic lung diseases, and are more predisposed to hearing loss, dental problems, retinopathy, cerebral palsy, cardiovascular disorders, gastrointestinal diseases and infections affecting the lungs and brain [2, 4, 5]. Given its burden, skewed ethnic/racial risk profile, and economic and health consequences, developing a better understanding of the modifiable correlates of PTB remains essential. Preterm birth (PTB, birth before 37 weeks of gestation) has been associated with adverse health outcomes across the lifespan. Evidence on the association between PTB and prenatal exposure to air pollutants is inconsistent, and is especially lacking for ethnic/racial minority populations
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