There is abundant scientific evidence indicating that ambient air pollution is associated with a variety of mortality and morbidity outcomes ranging from cardiovascular and respiratory diseases to effects in early life and during pregnancy (Landrigan et al. Lancet 2018;391:462–512). A recent updated estimate from the World Health Organization, indicating that nine out of 10 people in the world breathe air containing high levels of pollutants, reinforces the role of poor ambient air quality as one of the greatest threats to human health in present times. This is because human exposure is practically ubiquitous. For those living in urbanised areas pollution comes mainly from the burning of fossil fuels in transport, industry, and energy production, but air pollution can also be generated by many other process, such as mining industry operations, which involve the emission of particulate matter composed of noxious materials like copper, cadmium, and lead. Arrieta and Guillen show the effect of exposure to mining pollution on birth weight in a community in the Andean region. Their study contributes to the growing body of evidence indicating that pregnant women exposed to atmospheric contaminants are at an increased risk for infants with low birth weight or intrauterine growth restriction (Vrijheid et al. Int J Hyg Environ Health 2016;219:331–342). The underlying mechanisms of these potential adverse effects is not completely understood. Air pollution, in general, induces oxidative stress, inflammation, and haemodynamic changes, which are supposed to impair oxygen and nutrient transport to the fetus, causing anthropometric adverse effects (Laurent et al. Environ Res, 2014;134,488–495). Emitted in several process including mining operations, toxic heavy metals such as lead can accumulate in the placenta, causing abnormal function and reducing nutrient transfer. In particular, lead could also impair fetal bone growth by competing with calcium for deposition into bone, and reducing fetal thyroid hormones (Taylor et al. BJOG 2015;122,322–328). The study by Arrieta and Guillen brings important contributions to the field. Although they did not examine the direct relationship of mining pollution with low birth weight, one expects that reductions on mean birth weight will result in some otherwise normal weight babies being born at <2500 g, increasing their risk of infant mortality and other health outcomes. In addition, they took advantage of a unique natural experiment to show increases in birth weight that followed sharp reductions in air pollution associated with the closure of the mine. Like the landmark study conducted in the Utah Valley in the 1980's (Pope et al. Arch Environ Health 1992;47:211–217), natural experiments ranks high for the strength of evidence for epidemiology, and there are not many studies reported in the air pollution literature using this design. Finally, an important message from their study is that partial or small reductions in air pollution levels might not be enough to provide substantive protection to the health of the population. Only stringent environmental regulations that can lower air pollution levels considerably will be truly effective. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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