Preterm birth associated with maternal fine particulate matter exposure: A global, regional and national assessment

Christopher S Malley,Johan C.I Kuylenstierna,Harry W Vallack,Daven K Henze,Hannah Blencowe,Mike R Ashmore

doi:10.1016/j.envint.2017.01.023

Abstract

Reduction of preterm births (<37 completed weeks of gestation) would substantially reduce neonatal and infant mortality, and deleterious health effects in survivors. Maternal fine particulate matter (PM2.5) exposure has been identified as a possible risk factor contributing to preterm birth. The aim of this study was to produce the first estimates of ambient PM2.5-associated preterm births for 183 individual countries and globally. To do this, national, population-weighted, annual average ambient PM2.5 concentration, preterm birth rate and number of livebirths were combined to calculate the number of PM2.5-associated preterm births in 2010 for 183 countries. Uncertainty was quantified using Monte-Carlo simulations, and analyses were undertaken to investigate the sensitivity of PM2.5-associated preterm birth estimates to assumptions about the shape of the concentration-response function at low and high PM2.5 exposures, inclusion of provider-initiated preterm births, and exposure to indoor air pollution.Globally, in 2010, the number of PM2.5-associated preterm births was estimated as 2.7 million (1.8–3.5 million, 18% (12–24%) of total preterm births globally) with a low concentration cut-off (LCC) set at 10μgm−3, and 3.4 million (2.4–4.2 million, 23% (16–28%)) with a LCC of 4.3μgm−3. South and East Asia, North Africa/Middle East and West sub-Saharan Africa had the largest contribution to the global total, and the largest percentage of preterm births associated with PM2.5. Sensitivity analyses showed that PM2.5-associated preterm birth estimates were 24% lower when provider-initiated preterm births were excluded, 38–51% lower when risk was confined to the PM2.5 exposure range in the studies used to derive the effect estimate, and 56% lower when mothers who live in households that cook with solid fuels (and whose personal PM2.5 exposure is likely dominated by indoor air pollution) were excluded. The concentration-response function applied here derives from a meta-analysis of studies, most of which were conducted in the US and Europe, and its application to the areas of the world where we estimate the greatest effects on preterm births remains uncertain. Nevertheless, the substantial percentage of preterm births estimated to be associated with anthropogenic PM2.5 (18% (13%–24%) of total preterm births globally) indicates that reduction of maternal PM2.5 exposure through emission reduction strategies should be considered alongside mitigation of other risk factors associated with preterm births.

Highlights

Preterm birth is a ‘major cause of [postnatal] death and a significant cause of long-term loss of human potential’ (Howson et al, 2012)
Calculation of the country, regional (GBD regional groupings shown in Fig. S1) and global cumulative incidence of preterm birth associated with PM2.5 exposure (i.e. PM2.5-associated preterm births) requires a relationship linking PM2.5 exposure during pregnancy to preterm birth frequency, as well as the number of livebirths, the preterm birth rate, and maternal PM2.5 exposure for each country
The estimated 14.9 million annual preterm births globally have been identified as a major global health issue due to their substantial contribution to neonatal and infant mortality, and the long-lasting health effects in survivors

Summary

Introduction

Preterm birth (at b37 completed weeks of gestation) is a ‘major cause of [postnatal] death and a significant cause of long-term loss of human potential’ (Howson et al, 2012). There is a substantial longterm health impact from preterm birth due to increased risk both of death and of developing a wide range of chronic physical and neurological disabilities compared to full term births (Blencowe et al, 2013b; Calkins and Devaskar, 2011; Howson et al, 2012; Loftin et al, 2010; Rogers and Velten, 2011). High preterm birth rates have been calculated for both high and low-income countries (Blencowe et al, 2012). High preterm birth rates have been calculated for both high and low-income countries (Blencowe et al, 2012). Behrman and Butler (2007) estimated that preterm birth had an economic impact of $26.2 billion in the US in 2005 ($51, 600 per preterm birth).

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