Abstract
Preterm birth is the largest contributor to neonatal mortality globally and it is also associated with several adverse health outcomes. Recent studies have found an association between maternal exposure to air pollution and an increased risk for preterm birth. As a constituent of air pollution, ozone is a highly reactive molecule with several negative health effects when present near earth’s surface. This health impact assessment aims to estimate the proportion of preterm births—in current and future situations—attributable to maternal ozone exposure in 30 European countries (EU30). A literature search was performed using relevant keywords, followed by meta-analysis with STATA software in which five studies investigating exposure-response relationship of interest were included. The attributable proportion, and number of cases, was modelled with the software AirQ+ against current and future European ozone concentrations. According to our meta-analysis, the relative risk for giving birth preterm was calculated to 1.027 (95% CI 1.009–1.046) per 10 μg m−3 increase in ozone concentration. This rendered 7.1% (95% CI 2.5–11.7) of preterm births attributable to maternal ozone exposure to in EU30 during 2010, which is equal to approximately 27 900 cases. By 2050, the projected decrease in ozone precursor emissions rendered an estimated 30% decrease of ozone attributable preterm births. Not taking emission change into account, due to climate change the ozone-related preterm birth burden might slightly increase by 2050 in Central and Southern Europe, and decrease in Eastern and Northern Europe. In summation, these numbers make a substantial impact on public health.
Highlights
Preterm birth is commonly defined as birth before the gestational age of 37 weeks, and predisposes children several hazards with both immediate and future health
Isoprene chemistry is based on an adapted version of the Carter one-product mechanism [44, 46], while other gas-phase chemistry is based on the EMEP MSC-W EMChem09 scheme of Simpson et al [47] with reaction rate updates following the recommendations of International Union of Pure and Applied Chemistry (IUPAC) [41, 48]
Calculation of attributable effects To estimate the proportion and number of preterm births caused by maternal ozone exposure in Europe, the exposure-response function was applied to the ozone levels in each respective country
Summary
Preterm birth is commonly defined as birth before the gestational age of 37 weeks, and predisposes children several hazards with both immediate and future health. In 2015 alone, preterm birth caused globally approximately 1 million deaths before the age of 5 [1] This equates to more than 2700 premature deaths daily, ranking complications emanating from preterm birth the largest contributor of neonatal death globally [2]; it is the alarming number of mortalities caused by preterm birth which pose a global threat to children’s health. It is important to acknowledge that the hazardous consequences of prematurity are not necessarily limited to a defined time-period surrounding childhood, but may likewise affect an individual’s health and life far into adult years [6]. Several risk factors surrounding preterm birth have previously been established, including facets of basic maternal lifestyle choices such as physical activity, diet, alcohol consumption, and tobacco use. The role of more complex contributors, such as genetics and environmental factors, is less explored, albeit some associations have been suggested [3]
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