Examining Joint Effects of Air Pollution Exposure and Social Determinants of Health in Defining “At‐Risk” Populations Under the Clean Air Act: Susceptibility of Pregnant Women to Hypertensive Disorders of Pregnancy

Abstract

Pregnant women are uniquely susceptible to adverse effects of air pollution exposure due to vulnerabilities and health consequences during pregnancy (e.g., hypertensive disorders of pregnancy [HDP]) compared to the general population. Because the Clean Air Act (CAA) creates a duty to protect at-risk groups, the regulatory assessment of at-risk populations has both policy and scientific foundations. Previously, pregnant women have not been specially protected in establishing the margin of safety for the ozone and particulate matter (PM) standards. Due to physiological changes, pregnant women can be at greater risk of adverse effects of air pollution and should be considered an at-risk population. Women with preexisting conditions, women experiencing poverty, and groups that suffer systematic discrimination may be particularly susceptible to cardiac effects of air pollutants during pregnancy. We rigorously reviewed 11 studies of over 1.3 million pregnant women in the United States to characterize the relationship between ozone or PM exposure and HDP. Findings were generally mixed, with a few studies reporting a joint association between ozone or PM and social determinants or pre-existing chronic health conditions related to HDP. Adequate evidence associates exposure to PM with an adverse effect of HDP among pregnant women not evident among non-gravid populations.

Association between ambient air pollution and cause-specific mortality in Cape Town, Durban, and Johannesburg, South Africa: any susceptible groups?

“…The increase in the levels of ambient air pollution is associated with increased adverse health effects (Trinh et al 2019;Chen et al 2019); and there is documented evidence that decreased exposure to air pollution decreases population mortality and morbidity and it increases life expectancy (Brønnum-Hansen, et al 2018;Hoffmann 2019). Increases in air pollution levels are associated with increases in health effects of susceptible groups such as children, the elderly, pregnant women, and people with chronic diseases (Stieb et al 2019;Koman et al 2018;Hooper et al 2018).…”

Maternal Exposure to Ambient Air Pollution and Risk of Preeclampsia: A Population-Based Cohort Study in Scania, Sweden

“…Adverse health effects following air pollution exposure seem to be especially substantial for vulnerable subgroups of the population, such as pregnant women and their unborn children [3,4]. For instance, exposure to ambient air pollution during pregnancy poses a significantly increased risk of low birth weight and prematurity [5,6], as well as maternal health conditions, such as preeclampsia [7].…”

Air Pollution in Kazakhstan and Its Health Risk Assessment

“…A number of works demonstrated pollution of atmospheric air as the primary environmental factor that causes a high level of health risk in urbanized areas [6781416]. Nowadays, the air basin of almost any settlement is polluted with hundreds of chemical substances, the level of which, as a rule, exceeds the maximum permissible threshold, and its combined effect is even more significant [151112].…”