Associations of prenatal ambient air pollution exposures with asthma in middle childhood

We examined associations between prenatal fine particulate matter (PM_2.5), nitrogen dioxide (NO₂), and ozone (O₃) exposures and child respiratory outcomes through age 8–9 years in 1279 ECHO-PATHWAYS Consortium mother-child dyads. We averaged spatiotemporally modeled air pollutant exposures during four fetal lung development phases: pseudoglandular (5–16 weeks), canalicular (16–24 weeks), saccular (24–36 weeks), and alveolar (36+ weeks). We estimated adjusted relative risks (RR) for current asthma at age 8–9 and asthma with recent exacerbation or atopic disease, and odds ratios (OR) for wheezing trajectories using modified Poisson and multinomial logistic regression, respectively. Effect modification by child sex, maternal asthma, and prenatal environmental tobacco smoke was explored. Across all outcomes, 95% confidence intervals (CI) included the null for all estimates of associations between prenatal air pollution exposures and respiratory outcomes. Pseudoglandular PM_2.5 exposure modestly increased risk of current asthma (RR_adj = 1.15, 95% CI: 0.88–1.51); canalicular PM_2.5 exposure modestly increased risk of asthma with recent exacerbation (RR_adj = 1.26, 95% CI: 0.86–1.86) and persistent wheezing (OR_adj = 1.28, 95% CI: 0.86–1.89). Similar findings were observed for O₃, but not NO₂, and associations were strengthened among mothers without asthma. While not statistically distinguishable from the null, trends in effect estimates suggest some adverse associations of early pregnancy air pollution exposures with child respiratory conditions, warranting confirmation in larger samples.