Survey of Low Birthweight and Extremely Low Birthweight Events in a High Environmental Risk Area of Apulia, Italy

Paolo Trerotoli,Simona Leogrande,Sabrina Triggiani,Gabriella Serio,Nicola Bartolomeo,Aldo Sante Minerba,Antonella Mincuzzi

doi:10.1007/s41742-020-00294-x

Abstract

The association between environmental conditions and pregnancy outcome has been under investigation for a long time, but results appear to be inconclusive regarding damage to either the newborn or the mother. The aim of this study was to evaluate the distribution of hospitalization of newborns with low birthweight (< 2500 g) and extremely low birthweight (< 1000 g) in the geographical area of Taranto, Italy, which is characterized by high environmental risk because of industrial pollution. We analyzed the database of hospital discharge forms for the years 2001–2013 regarding hospital admission of newborns in the region of Apulia. The relative risk (RR) of hospitalization, adjusted for the deprivation index, was estimated using the Besag–York–Molliè Bayesian model. The city of Taranto, which has the highest environmental risk, had the highest RR for newborns with low birthweight (1.47, 95% uncertainty interval 1.38–1.56). Other geographical areas with high environmental pollution had higher RRs for low birth weight compared with the regional average. We found no geographical distribution pattern of extremely low birthweight that would suggest an association with environmental pollution.

Highlights

Birthweight less than 2500 g or less than 1500 g, small for gestational age fetus (SGA), and intrauterine growth restriction (IUGR) are pregnancy outcomes that can predict newborn health
In this paper we report the results of the analysis of hospital discharges for preterm infants with LBW and extremely LBW (ELBW) in the high environmental risk area of the largest steel manufacturing facilities in Europe (Taranto) and in the whole Apulia, to evaluate association between pregnancy outcomes and environmental pollution
LBW newborns in the Hospital Discharge Form Data Base (HDFDB) were identified according to the primary diagnosis or a secondary diagnosis using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 765.01–765.08 (Disorders relating to extreme immaturity of infant) or 765.11–765.18 (Disorders relating to other preterm infants)

Summary

Introduction

Birthweight less than 2500 g (low birth weight, LBW) or less than 1500 g (very low birth weight, VLBW), small for gestational age fetus (SGA), and intrauterine growth restriction (IUGR) are pregnancy outcomes that can predict newborn health. According to a recent report on birth and pregnancy; the rate of VLBW in Italy is 1% (Basili et al 2018). LBW can predict a greater need for hospital care, with higher costs for care; cost–benefit analyses are needed to evaluate actions and decisions regarding prevention of this pregnancy outcome. Interventions targeting health-related habits in the mother that are risk factors for pregnancy and for the fetus have not reversed the cost of care; prevention has often been more costly than infant care (Almond et al 2004)

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