Association between ambient air pollution a week prior to delivery and preterm birth using a nationwide study in Sweden

IF 4.5 2区 医学 Q1 INFECTIOUS DISEASES International journal of hygiene and environmental health Pub Date : 2024-08-18 DOI:10.1016/j.ijheh.2024.114443
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Abstract

Background

Air pollution exposure has been linked with increased risk of preterm birth, which is one of the leading causes of infant mortality. Limited studies have attempted to explore these associations in low-polluted areas. In this study, we aimed to assess the association between short-term exposure to ambient air pollution and preterm birth in Sweden.

Method

In this population-based study we included preterm births between 2014 and 2019 from the Swedish Pregnancy Register. We applied a spatiotemporal model to estimate daily levels of particulate matter <2.5 μm (PM2.5), PM < 10 μm (PM10), nitrogen dioxide (NO2), and ozone (O3) at the residential address of each participant. We applied a time-stratified case-crossover design with conditional logistic regression analysis to estimate odds ratios (OR) of preterm birth per 10 μg/m3 (PM10, NO2, O3) and 5 μg/m3 (PM2.5) increase in air pollution exposure at 0–6-day lag. Two-pollutant models were applied to evaluate the independent association of each exposure on preterm birth. We also stratified by maternal characteristics to identify potential effect modifiers.

Results

28,216 (4.5%) preterm births were included. An increase in O3 exposure was associated with increased odds of preterm birth [OR = 1.06 per 10 μg/m3 (95% CI, 1.02; 1.10]. PM2.5 and PM10 were not significantly associated with preterm birth, and NO2 displayed a negative nonlinear association with preterm birth. We did not observe any notable effect modification, but we found suggestive larger associations between O3 and preterm birth when stratifying by male sex, spontaneous delivery, and spring season.

Conclusions

Increased O3 exposure one week before delivery was associated with an increased risk of preterm birth in Sweden, a country with levels of air pollution below the current World Health Organization air quality guidelines. Increases in O3 levels with climate change make these findings especially concerning.

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瑞典全国性研究:分娩前一周环境空气污染与早产之间的关系
背景空气污染暴露与早产风险增加有关,而早产是婴儿死亡的主要原因之一。试图在低污染地区探讨这些关联的研究非常有限。在这项研究中,我们旨在评估瑞典环境空气污染短期暴露与早产之间的关联。方法在这项基于人群的研究中,我们纳入了瑞典妊娠登记册中 2014 年至 2019 年间的早产儿。我们采用时空模型估算了每位参与者居住地址的颗粒物<2.5 μm(PM2.5)、可吸入颗粒物<10 μm(PM10)、二氧化氮(NO2)和臭氧(O3)的日水平。我们采用时间分层病例交叉设计和条件逻辑回归分析,估算了空气污染暴露每增加 10 μg/m3(PM10、二氧化氮、臭氧)和 5 μg/m3(PM2.5),滞后 0-6 天的早产几率比例(OR)。采用双污染物模型来评估每种暴露与早产的独立关联。我们还根据产妇特征进行了分层,以确定潜在的效应调节因子。O3暴露量的增加与早产几率的增加有关[OR = 1.06 per 10 μg/m3 (95% CI, 1.02; 1.10]。PM2.5 和 PM10 与早产的关系不大,而 NO2 与早产的关系呈非线性负相关。我们没有观察到任何明显的效应修正,但在对男性性别、自然分娩和春季进行分层时,我们发现 O3 与早产之间存在更大的关联。随着气候变化,空气中的臭氧含量也会增加,因此这些发现尤其令人担忧。
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来源期刊
CiteScore
11.50
自引率
5.00%
发文量
151
审稿时长
22 days
期刊介绍: The International Journal of Hygiene and Environmental Health serves as a multidisciplinary forum for original reports on exposure assessment and the reactions to and consequences of human exposure to the biological, chemical, and physical environment. Research reports, short communications, reviews, scientific comments, technical notes, and editorials will be peer-reviewed before acceptance for publication. Priority will be given to articles on epidemiological aspects of environmental toxicology, health risk assessments, susceptible (sub) populations, sanitation and clean water, human biomonitoring, environmental medicine, and public health aspects of exposure-related outcomes.
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