Abstract
Premature birth is the result of a complex interaction among genetic, epigenetic, behavioral, socioeconomic, and environmental factors. We evaluated the possible associations between air pollution and the incidence of prematurity in spatial clusters of high and low prevalence in the municipality of São Paulo. It is a spatial case-control study. The residential addresses of mothers with live births that occurred in 2012 and 2013 were geo-coded. A spatial scan statistical test performed to identify possible low-prevalence and high-prevalence clusters of premature births. After identifying, the spatial clusters were drawn samples of cases and controls in each cluster. Mothers were interviewed face-to-face using questionnaires. Air pollution exposure was assessed by passive tubes (NO2 and O3) as well as by the determination of trace elements’ concentration in tree bark. Binary logistic regression models were applied to determine the significance of the risk of premature birth. Later prenatal care, urinary infection, and hypertension were individual risk factors for prematurity. Particles produced by traffic emissions (estimated by tree bark accumulation) and photochemical pollutants involved in the photochemical cycle (estimated by O3 and NO2 passive tubes) also exhibited significant and robust risks for premature births. The results indicate that air pollution is an independent risk factor for prematurity.
Highlights
Premature birth is the result of a complex interaction among genetic, epigenetic, behavioral, socioeconomic, and environmental factors [1,2]
We report the results of a case-control study conducted in three areas of São Paulo selected based on higher (2 spatial clusters) and lower prevalence (1 spatial cluster) of premature births using a combination of low-cost techniques designed to characterize the spatial variability of air pollution with high resolution
The majority of the cases selected for the Tremembé cluster (110%) and Pedreira (96%) were studied and the lowest rate of success was achieved for Jardim Ângela (69%) mostly because of improper addresses and other problems of access such as criminality
Summary
Premature birth is the result of a complex interaction among genetic, epigenetic, behavioral, socioeconomic, and environmental factors [1,2]. Prematurity is associated with increased morbidity and mortality in the first year of life [3,4]. Published data indicate that prematurity enhances the risk of chronic diseases in adulthood [5] such as type 2 diabetes [6], respiratory disease [7], cardiovascular disease [8], and attention deficit disorders [9]. Exposure to environmental contaminants exhibits associations with premature births [10]. Because of its conspicuous nature, air pollution may be responsible for a considerable attributed fraction of global premature births [11]. Using global satellite-based estimates of exposure, Malley et al [12] estimated that air pollution is responsible for 2.7 million premature births worldwide
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