Ambient Air Pollution and Pregnancy-Induced Hypertensive Disorders

Pedersen, Marie; Stayner, Leslie T.; Slama, Rémy; Sørensen, Mette; Figueras, F.; Nieuwenhuijsen, Mark; Raaschou-Nielsen, Ole; Dadvand, Payam

doi:10.1161/hypertensionaha.114.03545

Cited by 281 publications

(194 citation statements)

References 41 publications

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“…Our findings are consistent with the results of 2 previous meta-analyses that summarized the associations between air pollution exposure during pregnancy and pregnancy-induced hypertensive disorders. 35, 36 Pedersen et al found that pregnancy-induced hypertensive disorders were significantly associated with a 5 μg/m 3 increment in PM 2.5 (OR=1.57; 95% CI: 1.26-1.96), a 10-μg/ m 3 increment in NO 2 (OR=1.20; 95% CI: 1.00-1.44), and a 10 μg/m 3 increment in PM 10 (OR=1.13; 95% CI: 1.02-1.26).…”

Section: Discussionmentioning

confidence: 99%

Associations of Short-Term and Long-Term Exposure to Ambient Air Pollutants With Hypertension

et al. 2016

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C ardiovascular disease is the leading cause of death in the world. It is responsible for ≈30% of all deaths or ≈17.5 million people in 2012.1 As the major risk factor for cardiovascular disease, hypertension has been identified as the most important cause of disability and the leading risk factor for death globally and causes ≈16.5% of all deaths.2 The causes of hypertension are complex and are related to genetic factors, lifestyle, diet structure, and environmental factors, including air pollution.3 Since the 1990s, many epidemiological studies have investigated the associations between air pollution exposure and hypertension. However, the results remain controversial. Some studies have shown an association, 4-8 whereas other studies have found either no association or an association only for selected pollutants or limitation based on short-term or long-term exposure.9-12 These inconsistent and controversial results indicate the need to quantitatively synthesize and interpret the available evidence to provide more explicit information for policy decisions and clinical use. Meta-analysis is the most commonly used statistical technique to quantitatively synthesize results from ≥2 separate studies. 13 To our knowledge, there is only one meta-analysis that summarized the association between exposure to traffic-related air pollution and hypertension.14 However, this study included only cohort studies conducted in the Europe and mainly focused on the traffic-related air pollutants, which might limit the external validity of their findings. Therefore, more such meta-analyses are urgently needed.The previous published studies on hypertension and air pollution can be broadly divided into 2 categories: short-term and long-term studies. The former estimate the acute effects of air pollution exposure and mostly include time-series analyses over a few days. The latter evaluate the chronic effects of air pollution, such as cohort survival analyses over years of exposure. 15The short-term and long-term effects of air pollution may have Abstract-Hypertension is a major disease of burden worldwide. Previous studies have indicated that air pollution might be a risk factor for hypertension, but the results were controversial. To fill this gap, we performed a meta-analysis of epidemiological studies to investigate the associations of short-term and long-term exposure to ambient air pollutants with hypertension. We searched all of the studies published before September 1, 2015, on the associations of ozone (O 3 ), carbon monoxide (CO), nitrogen oxide (NO 2 and NO X ), sulfur dioxide (SO 2 ), and particulate matter (PM 10 and PM 2.5 ) with hypertension in the English electronic databases. A pooled odds ratio (OR) for hypertension in association with each 10 μg/m 3 increase in air pollutant was calculated by a random-effects model (for studies with significant heterogeneity) or a fixed-effect model (for studies without significant heterogeneity). A total of 17 studies examining the effects of short-term (n=6) and long-term exposure ...

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Section: Discussionmentioning

confidence: 99%

Associations of Short-Term and Long-Term Exposure to Ambient Air Pollutants With Hypertension

et al. 2016

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“…Indeed, 2 recent metaanalyses suggest heterogeneity in the association between air pollution and various pregnancy hypertensive disorders (10,11), among which gestational hypertension (GH) is common but has received less research attention. Specifically, given that only 3 (12)(13)(14) of 17 studies in one meta-analysis (10) reported specific data on GH, no synthesis could be derived for this outcome separately. Furthermore, several important methodological issues preclude firm conclusions from the previous data.…”

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confidence: 99%

“…First, 16 of the 17 studies included in the meta-analysis by Pedersen et al (10) used birth certificate data, which often do not allow separation of GH from other subtypes of hypertensive disorders during pregnancy, as opposed to medical records and/or hospital discharge data. Second, all 3 studies on air pollution and GH as a separate outcome are singlecity based (12)(13)(14), if not from a single hospital (12), which potentially limits exposure contrasts (15).…”

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confidence: 99%

“…Second, all 3 studies on air pollution and GH as a separate outcome are singlecity based (12)(13)(14), if not from a single hospital (12), which potentially limits exposure contrasts (15). In the few studies with a relatively large geographic coverage, none adjusted for location or used any other approaches to reduce residual confounding due to spatial factors (10). Further, data on more source-specific measures are lacking, such as elemental composition of the particulate matter and hazardous air toxics, including polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds (VOCs).…”

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Ambient Air Pollution and Risk of Gestational Hypertension

Zhu¹,

Zhang²,

Liu³

et al. 2017

American Journal of Epidemiology

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Air pollution has been linked to hypertension in the general population, but data on gestational hypertension (GH) are limited. We investigated criteria air pollutants and air toxics during the period before conception and in early gestation in relation to GH risk in the Consortium on Safe Labor/Air Quality and Reproductive Health Study (United States, 2002. Modified Community Multi-scale Air Quality models estimated air pollution exposures for 6,074 singleton pregnancies in which GH was present and 199,980 normotensive pregnancies. Generalized estimating equations estimated relative risks per interquartile-range increment for pollutants and high exposure (≥75th percentile) for air toxics after adjustment for major risk factors. For an interquartile-range increment, GH risk was significantly increased by 18% for sulfur dioxide during the 3 months before conception and, during gestational weeks 1-20, 17% for nitrogen oxides, 10% for particulate matter with an aerodynamic diameter <2.5 μm, 7% for particulate matter with an aerodynamic diameter <10 μm, and 22% for sulfur dioxide. High exposures to several polycyclic aromatic hydrocarbons before conception and during the first trimester were significantly associated with 8%-20% higher risk of GH. Further, preconceptional exposures to several volatile organic compounds were significantly associated with 11%-19% higher risk. Our findings suggest that early exposures to criteria air pollutants, particularly from transport emissions, and high exposure to several air toxics before conception may increase GH risk.

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“…Moreover, predisposing cardiovascular or metabolic risks for endothelial dysfunction, as part of an enhanced systemic inflammatory response, might dominate in the origin of late onset PE. Meta-analyses of epidemiological studies investigating the association between exposure to ambient air pollution and pregnancy-induced hypertensive disorders including gestational hypertension and PE report that exposure to air pollution (in particular nitrogen oxides and particulate matter) increases the risk of HDP [3]. The HELLP syndrome is a pregnancy-specific disease characterized by hemolysis (due to microangiopathic hemolytic anemia), elevated lactate dehydrogenase (LDH), elevated liver enzymes caused by acute liver damage, and a platelet count decreased by the enhanced consumption [4].…”

Section: Introductionmentioning

confidence: 99%

HELLP syndrome: a complication or a new autoimmune syndrome?

Triggianese¹,

Perricone²,

Perricone³

et al. 2014

Reumatologia

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Słowa kluczowe: zespół HELLP, powikłania ciąży, możliwości terapeutyczne. S t r e s z c z e n i eZespół HELLP (hemolysis, elevated liver enzymes, low platelets) jest schorzeniem występującym u kobiet w ciąży. Składają się na niego następujące objawy: hemoliza ze zwiększonym stężeniem dehydrogenazy mleczanowej, zwiększonym stężeniem enzymów wątro-bowych oraz obniżona liczba płytek krwi. Zespół HELLP uznawany jest za ciężką postać zaburzeń nadciśnieniowych wywołanych cią-żą, do których należą także stan przedrzucawkowy oraz rzucawka. Objawy zaburzeń zaczynają pojawiać się od 20. tygodnia ciąży. Wszystkie te choroby mają charakter wieloukładowy, specyficzny dla ciąży i wiążą się ze wzrostem ciśnienia krwi oraz podwyższo-ną chorobowością/śmiertelnością noworodków i matek. Badania obserwacyjne wskazują, że leczenie zespołu HELLP lekami steroidowymi może przynieść poprawę parametrów hematologicznych i biochemicznych u matek, a także poprawę rokowania u noworodków. Celem niniejszej pracy jest wykazanie, że zespół HELLP można uznać za niezależne schorzenie autoimmunologiczne. Biomarkery immunologiczne mogą być użytecznym narzędziem usprawniają-cym diagnostykę i leczenie kobiet z zespołem HELLP dzięki określe-niu etiologii leżącej u podłoża tego zespołu. Address for correspondence:Prof. Caterina De Carolis, MD, Gynaecology and Obstetrics II, Azienda Ospedaliera San Giovanni-Addolorata, Via dell' Amba Aradam 9, 00184 Rome, Italy, phone: +39-0677055657, e-mail: c.decarolis@fastwebnet.it Submitted: 3.10.2014 S u m m a r yThe HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome is a pregnancy-specific disease characterized by hemolysis with elevated lactate dehydrogenase, elevated liver enzymes, and decreased platelet count. It is considered a severe variant of the hypertensive disorders that occur during pregnancy together with the pre-eclampsia (PE) and the eclampsia giving symptoms in the mother from 20 weeks' gestation onward. All these conditions are multi-system pregnancy-related diseases associated with an increase in blood pressure and in both the perinatal and the maternal morbidity/mortality. Observational studies suggest that steroid treatment in HELLP syndrome may improve the hematological and biochemical features in the mother and the perinatal outcome. The present review aims to show that the HELLP syndrome may be considered as an autoimmune disorder itself. Biomarkers of the immune system can be a useful tool improving the diagnostic and therapeutic management of women with HELLP by delineating the underlying etiology of this syndrome.

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Ambient Air Pollution and Pregnancy-Induced Hypertensive Disorders

Cited by 281 publications

References 41 publications

Associations of Short-Term and Long-Term Exposure to Ambient Air Pollutants With Hypertension

Associations of Short-Term and Long-Term Exposure to Ambient Air Pollutants With Hypertension

Ambient Air Pollution and Risk of Gestational Hypertension

HELLP syndrome: a complication or a new autoimmune syndrome?

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