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BMC Public Health
Published in: BMC Public Health 1/2023

Open Access 01-12-2023 | Premature Birth | Research

Impact of ambient air pollution exposure during pregnancy on adverse birth outcomes: generalized structural equation modeling approach

Authors: Aweke A. Mitku, Temesgen Zewotir, Delia North, Prakash Jeena, Kareshma Asharam, Sheena Muttoo, Hasheel Tularam, Rajen N. Naidoo

Published in: BMC Public Health | Issue 1/2023

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Abstract

Background

Air pollution and several prenatal factors, such as socio-demographic, behavioural, physical activity and clinical factors influence adverse birth outcomes. The study aimed to investigate the impact of ambient air pollution exposure during pregnancy adjusting prenatal risk factors on adverse birth outcomes among pregnant women in MACE birth cohort.

Methods

Data for the study was obtained from the Mother and Child in the Environment (MACE) birth cohort study in Durban, South Africa from 2013 to 2017. Land use regression models were used to determine household level prenatal exposure to PM2.5, SO2 and NOx. Six hundred and fifty-six births of pregnant females were selected from public sector antenatal clinics in low socio-economic neighbourhoods. We employed a Generalised Structural Equation Model with a complementary log–log-link specification.

Results

After adjustment for potential prenatal factors, the results indicated that exposure to PM2.5 was found to have both significant direct and indirect effects on the risk of all adverse birth outcomes. Similarly, an increased level of maternal exposure to SO2 during pregnancy was associated with an increased probability of being small for gestational age. Moreover, preterm birth act a mediating role in the relationship of exposure to PM2.5, and SO2 with low birthweight and SGA.

Conclusions

Prenatal exposure to PM2.5 and SO2 pollution adversely affected birth outcomes after controlling for other prenatal risk factors. This suggests that local government officials have a responsibility for better control of air pollution and health care providers need to advise pregnant females about the risks of air pollution during pregnancy.
Appendix
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Literature
1.
Campbell E, Seabrook J. The influence of socioeconomic status on adverse birth outcomes. Can J Midwifery Res Pract. 2016;15:11–20.
2.
Campbell EE, Gilliland J, Dworatzek PD, De Vrijer B, Penava D, Seabrook JA. Socioeconomic status and adverse birth outcomes: a population-based Canadian sample. J Biosoc Sci. 2018;50(1):102–13.CrossRef
3.
Nowak AL, Giurgescu C. The built environment and birth outcomes: a systematic review. MCN Am J Matern Child Nurs. 2017;42(1):14–20.CrossRef
4.
Seabrook JA, Woods N, Clark A, De Vrijer B, Penava D, Gilliland J. The association between alcohol outlet accessibility and adverse birth outcomes: a retrospective cohort study. J Neonatal Perinatal Med. 2018;11(1):71–7.CrossRef
5.
Woods N, Gilliland J, Seabrook JA. The influence of the built environment on adverse birth outcomes. J Neonatal Perinatal Med. 2017;10(3):233–48.CrossRef
6.
Shah PS, Balkhair T. births KSGoDoPL: air pollution and birth outcomes: a systematic review. Environ Int. 2011;37(2):498–516.CrossRef
7.
Butler AS, Behrman RE. Preterm birth: causes, consequences, and prevention: National academies press. 2007.
8.
Wardlaw TM. Low birthweight: country, regional and global estimates: Unicef. 2004.
9.
Gladstone M, Oliver C, Van den Broek N. Survival, morbidity, growth and developmental delay for babies born preterm in low and middle income countries–a systematic review of outcomes measured. PLoS ONE. 2015;10(3): e0120566.CrossRef
10.
World Health Organization. Born too soon: the global action report on preterm birth. 2012.
11.
Kistnasamy EJ, Robins TG, Naidoo R, Batterman S, Mentz G, Jack C, Irusen E. The relationship between asthma and ambient air pollutants among primary school students in Durban, South Africa. Int J Environ Health. 2008;2(3–4):365–85.CrossRef
12.
Gluckman PD, Hanson MA, Cooper C, Thornburg KL. Effect of in utero and early-life conditions on adult health and disease. N Engl J Med. 2008;359(1):61–73.CrossRef
13.
Pedersen M, Giorgis-Allemand L, Bernard C, Aguilera I, Andersen AMN, Ballester F, Beelen RM, Chatzi L, Cirach M, Danileviciute A. Ambient air pollution and low birthweight: a European cohort study (ESCAPE). Lancet Respir Med. 2013;1(9):695–704.CrossRef
14.
Nieuwenhuijsen MJ, Dadvand P, Grellier J, Martinez D, Vrijheid M. Environmental risk factors of pregnancy outcomes: a summary of recent meta-analyses of epidemiological studies. Environ Health. 2013;12(1):6.CrossRef
15.
Yorifuji T, Kashima S, Doi H. Outdoor air pollution and term low birth weight in Japan. Environ Int. 2015;74:106–11.CrossRef
16.
Savitz DA, Bobb JF, Carr JL, Clougherty JE, Dominici F, Elston B, Ito K, Ross Z, Yee M, Matte TD. Ambient fine particulate matter, nitrogen dioxide, and term birth weight in New York. New York American journal of epidemiology. 2013;179(4):457–66.CrossRef
17.
Clemens T, Turner S, Dibben C. Maternal exposure to ambient air pollution and fetal growth in North-East Scotland: a population-based study using routine ultrasound scans. Environ Int. 2017;107:216–26.CrossRef
18.
Huang JV, Leung GM, Schooling CM. The association of air pollution with birthweight and gestational age: evidence from Hong Kong’s ‘Children of 1997’birth cohort. J Public Health. 2016;39(3):476–84.
19.
Mendoza-Ramirez J, Barraza-Villarreal A, Hernandez-Cadena L, de la Garza OH, Sangrador JLT, Torres-Sanchez LE, Cortez-Lugo M, Escamilla-Nuñez C, Sanin-Aguirre LH, Romieu I. Prenatal exposure to nitrogen oxides and its association with birth weight in a cohort of Mexican Newborns from Morelos, Mexico. Ann Glob Health. 2018;84(2):274.CrossRef
20.
Ritz B, Wilhelm M. Ambient air pollution and adverse birth outcomes: methodologic issues in an emerging field. Basic Clin Pharmacol Toxicol. 2008;102(2):182–90.CrossRef
21.
Guo L-Q, Chen Y, Mi B-B, Dang S-N, Zhao D-D, Liu R, Wang H-L, Yan H. Ambient air pollution and adverse birth outcomes: a systematic review and meta-analysis. J Zhejiang Univ-Sc B. 2019;20(3):238–52.CrossRef
22.
Gortzak-Uzan L, Hallak M, Press F, Katz M, Shoham-Vardi I. Teenage pregnancy: risk factors for adverse perinatal outcome. J Matern Fetal Med. 2001;10(6):393–7.CrossRef
23.
Kenny LC, Lavender T, McNamee R, O’Neill SM, Mills T, Khashan AS. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort. PLoS ONE. 2013;8(2): e56583.CrossRef
24.
Tshotetsi L, Dzikiti L, Hajison P, Feresu S. Maternal factors contributing to low birth weight deliveries in Tshwane District, South Africa. PLoS ONE. 2019;14(3): e0213058.CrossRef
25.
Du M-k, Ge L-y, Zhou M-l. Ying J, Qu F, Dong M-y, Chen D-q: Effects of pre-pregnancy body mass index and gestational weight gain on neonatal birth weight. J Zhejiang Univ-Sc B. 2017;18(3):263–71.CrossRef
26.
Harville EW, Rabito FA. Housing conditions and birth outcomes: the national child development study. Environ Res. 2018;161:153–7.CrossRef
27.
Myers B, Koen N, Donald KA, Nhapi RT, Workman L, Barnett W, Hoffman N, Koopowitz S, Zar HJ, Stein DJ. Effect of hazardous alcohol use during pregnancy on growth outcomes at birth: findings from a South African cohort study. Alcohol Clin Exp Res. 2018;42(2):369–77.CrossRef
28.
Vanker A, Barnett W, Brittain K, Gie R, Koen N, Myers B, Stein D, Zar H. Antenatal and early life tobacco smoke exposure in an African birth cohort study. Int J Tuberc Lung Dis. 2016;20(6):729–37.CrossRef
29.
Hoyle RH. Handbook of structural equation modeling: Guilford press. 2012.
30.
Baum CF, Lööf H, Nabavi P, Stephan A. A new approach to estimation of the R&D–innovation–productivity relationship. Econ Innov Technol. 2017;26(1–2):121–33.CrossRef
31.
Fox J, Weisberg S. An R companion to applied regression: Sage publications. 2018.
32.
Naidoo RN, Robins TG, Batterman S, Mentz G, Jack C. Ambient pollution and respiratory outcomes among schoolchildren in Durban, South Africa. S Afr J Child Health. 2013;7(4):127–34.CrossRef
33.
Mitku AA, Zewotir T, North D, Naidoo RN. exploratory Data Analysis of Adverse Birth outcomes and exposure to oxides of nitrogen Using interactive parallel coordinates plot technique. Sci Rep. 2020;10(1):1–9.CrossRef
34.
Muttoo S, Ramsay L, Brunekreef B, Beelen R, Meliefste K, Naidoo RN. Land use regression modelling estimating nitrogen oxides exposure in industrial south Durban, South Africa. Sci Total Environ. 2018;610:1439–47.CrossRef
35.
Jeena PM, Asharam K, Mitku AA, Naidoo P. Naidoo RNJBp, childbirth: Maternal demographic and antenatal factors, low birth weight and preterm birth: findings from the mother and child in the environment (MACE) birth cohort. Durban, South Africa. 2020;20(1):1–11.
36.
Mitku AA, Zewotir T, North D, Jeena P, Asharam K, Muttoo S, Naidoo RN. The spatial modification of the non-linear effects of ambient oxides of nitrogen during pregnancy on birthweight in a South African birth cohort. Environ Res. 2020;183:109239.CrossRef
37.
Eeftens M, Beelen R, de Hoogh K, Bellander T, Cesaroni G, Cirach M, Declercq C, Dedele A, Dons E, de Nazelle A. Development of land use regression models for PM2. 5, PM2. 5 absorbance, PM10 and PMcoarse in 20 European study areas; results of the ESCAPE project. EnvironSci Tech. 2012;46(20):11195–205.CrossRef
38.
Tularam H, Ramsay LF, Muttoo S, Brunekreef B, Meliefste K, de Hoogh K. Naidoo RNJEP: A hybrid air pollution/land use regression model for predicting air pollution concentrations in Durban. South Africa. 2021;274: 116513.
39.
Sun L, Hu Y, Qi H, Maternal-Fetal Medicine Committee. A Summary of Chinese Expert Consensus on Fetal Growth Restriction (An Update on the 2019 Version). Matern Fetal Med. 2022;4(3):162–8.CrossRef
40.
Bardin R, Aviram A, Hiersch L, Hadar E, Gabbay-Benziv R. False diagnosis of small for gestational age and macrosomia–clinical and sonographic predictors. J Matern Fetal Neonatal Med. 2022;35(8):1539–45.CrossRef
41.
Mitku AA, Zewotir T, North D, Naidoo RN. Exploratory data analysis of adverse birth outcomes and exposure to oxides of nitrogen using interactive parallel coordinates plot technique. Sci Rep. 2020;10(1):1–9.CrossRef
42.
Nocita M, Stevens A, van Wesemael B, Aitkenhead M, Bachmann M, Barthès B, Dor EB, Brown DJ, Clairotte M, Csorba A, Dardenne P. Soil spectroscopy: An alternative to wet chemistry for soil monitoring. Adv Agronomy. 2015;132:139–59.CrossRef
43.
Hoyle RH. Structural equation modeling: Concepts, issues, and applications: Sage. 1995.
44.
Bollen KA. Structural equations with latent variables Wile. 1989.
45.
Muthén B. A general structural equation model with dichotomous, ordered categorical, and continuous latent variable indicators. Psychometrika. 1984;49(1):115–32.CrossRef
46.
Burnham KP, Anderson DR. Multimodel inference: understanding AIC and BIC in model selection. Sociol Methods Res. 2004;33(2):261–304.CrossRef
47.
Statistics S. General household survey 2015 statistical release P0318. Pretoria: Statistics South Africa; 2016.
48.
Li X, Huang S, Jiao A, Yang X, Yun J, Wang Y, Xue X, Chu Y, Liu F, Liu Y. Association between ambient fine particulate matter and preterm birth or term low birth weight: an updated systematic review and meta-analysis. Environ Pollut. 2017;227:596–605.CrossRef
49.
Cutland CL, Lackritz EM, Mallett-Moore T, Bardají A, Chandrasekaran R, Lahariya C, Nisar MI, Tapia MD, Pathirana J, Kochhar SJV. Low birth weight: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine. 2017;35(48Part A):6492.CrossRef
50.
Blakely T, McKenzie S, Carter K. Misclassification of the mediator matters when estimating indirect effects. J Epidemiol Community Health. 2013;67(5):458–66.CrossRef
51.
Ha S, Hu H, Roussos-Ross D, Haidong K, Roth J, Xu X. The effects of air pollution on adverse birth outcomes. Environ Res. 2014;134:198–204.CrossRef
52.
Mainolfi MB, Salihu HM, Wilson RE, Mbah AK. Low-level exposure to air pollution and risk of adverse birth outcomes in Hillsborough County, Florida. J Occup Environ Med. 2013;55(5):490–4.CrossRef
53.
Stieb DM, Chen L, Beckerman BS, Jerrett M, Crouse DL, Omariba DWR, Peters PA, van Donkelaar A, Martin RV, Burnett RT. Associations of pregnancy outcomes and PM2. 5 in a national Canadian study. Environ Health Perspect. 2016;124(2):243–9.CrossRef
54.
Brauer M, Lencar C, Tamburic L, Koehoorn M, Demers P, Karr C. A cohort study of traffic-related air pollution impacts on birth outcomes. Environ Health Perspect. 2008;116(5):680–6.CrossRef
55.
Qian Z, Liang S, Yang S, Trevathan E, Huang Z, Yang R, Wang J, Hu K, Zhang Y, Vaughn M. Ambient air pollution and preterm birth: a prospective birth cohort study in Wuhan, China. Int J Hyg Environ Health. 2016;219(2):195–203.CrossRef
56.
Li X, Huang S, Jiao A, Yang X, Yun J, Wang Y, Xue X, Chu Y, Liu F, Liu Y. Association between ambient fine particulate matter and preterm birth or term low birth weight: an updated systematic review and meta-analysis. Environ Pollut. 2017;227:596–605.CrossRef
57.
Beta J, Akolekar R, Ventura W, Syngelaki A, Nicolaides KH. Prediction of spontaneous preterm delivery from maternal factors, obstetric history and placental perfusion and function at 11–13 weeks. Prenat Diagn. 2011;31(1):75–83.CrossRef
58.
Damaso EL, Rolnik DL, Cavalli RC, Quintana SM, Duarte G, da Silva Costa F, Marcolin A. Prediction of preterm birth by maternal characteristics and medical history in the Brazilian population. J Pregnancy. 2019;2019:4395217.CrossRef
59.
Soneji S, Beltrán-Sánchez H. Association of maternal cigarette smoking and smoking cessation with preterm Birth. JAMA Netw Open. 2019;2(4):e192514–e192514.CrossRef
60.
Ion R, Bernal AL. Smoking and preterm birth. Reprod Sci. 2015;22(8):918–26.CrossRef
61.
Guan T, Xue T, Gao S, Hu M, Liu X, Qiu X, Liu X, Zhu T. Acute and chronic effects of ambient fine particulate matter on preterm births in Beijing, China: a time-series model. Sci Total Environ. 2019;650:1671–7.CrossRef
62.
Koullali B, Oudijk MA, Nijman TA, Mol BW, Pajkrt E. Risk assessment and management to prevent preterm birth. Semin Fetal Neonatal Med. 2016;21(2):80–8.CrossRef
Metadata
Title
Impact of ambient air pollution exposure during pregnancy on adverse birth outcomes: generalized structural equation modeling approach
Authors
Aweke A. Mitku
Temesgen Zewotir
Delia North
Prakash Jeena
Kareshma Asharam
Sheena Muttoo
Hasheel Tularam
Rajen N. Naidoo
Publication date
01-12-2023
Publisher
BioMed Central
Keyword
Premature Birth
Published in
BMC Public Health / Issue 1/2023
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-022-14971-3

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