Maternal exposure to ambient air pollution mixture and premature rupture of membranes: Evidence from a large cohort in Southern California (2008–2018)

Jiao, Anqi; Sun, Yi; Avila, Chantal; Chiu, Vicki; Molitor, John; Slezak, Jeff; Sacks, David A.; Chen, Jiu‐Chiuan; Benmarhnia, Tarik; Getahun, Darios; Wu, Jun

doi:10.1016/j.envint.2023.108030

Cited by 9 publications

(5 citation statements)

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“…Dadvand et al [ 17 ]were the first to establish a link between exposure to air pollution and the risk of preterm premature rupture of membranes. Similarly, in a more recent study in China, a focus on air pollutants such as PM 2.5 , PM 10 , NO 2 , and O 3 revealed consistent associations with an increased risk of PROM [ 11 ]. Furthermore, a longitudinal study conducted in the United States, encompassing 3264 women and 7121 singleton births, demonstrated that heightened PM 2.5 exposure during pregnancy was linked to an elevated risk of preterm birth.…”

Section: Discussionmentioning

confidence: 88%

“…Previous studies have provided initial insights into the association between pollutants and PROM, but further exploration of the key exposure windows remains to be completed. A large-scale cohort study in the United States identified the first and second months, as well as the seventh and eighth months, as crucial exposure windows for the association between AP exposure and PROM [ 11 ]. Additionally, a Chinese cohort study spanning nearly a decade found that the exposure window of AP to PROM primarily occurs between the 21 st and 24 th weeks of pregnancy [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Maternal Exposure to Environmental Air Pollution and Premature Rupture of Membranes: Evidence from Southern China

Yang,

Xu,

et al. 2024

Med Sci Monit

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Background Exposure to air pollution (AP) during pregnancy is associated with pre-labor rupture of membranes (PROM). However, there is limited research on this topic, and the sensitive exposure windows remain unclear. The present study assessed the association between AP exposure and the risk of PROM, as well as seeking to identify the sensitive time windows. Material/Methods This retrospective study analyzed 4276 pregnant women’s data from Tongling Maternal and Child Health Hospital from 2020 to 2022. We obtained air pollution data, including particulate matter (PM) with an aerodynamic diameter of ≤2.5 μm (PM 2.5 ), particulate matter with an aerodynamic diameter of ≤10 μm (PM 10 ), nitrogen dioxide (NO 2 ), and ozone (O 3 ), from the Tongling Ecology and Environment Bureau. Demographic information was extracted from medical records. We employed a distributed lag model to identify the sensitive exposure windows of prenatal AP affecting the risk of PROM. We conducted a sensitivity analysis based on pre-pregnancy BMI. Results We found a significant association between prenatal exposure to AP and increased PROM risk after adjusting for confounders, and the critical exposure windows of AP were the 6 th to 7 th months of pregnancy. In the underweight group, an increase of 10 μg/m 3 in PM 2.5 was associated with a risk of PROM, with an odds ratio (OR) of 1.48 (95% CI: 1.16, 1.89). Similarly, a 10 μg/m 3 increase in PM 10 was associated with a risk of PROM, with an OR of 1.45 (95% CI: 1.05, 1.77). Conclusions Prenatal exposure to AP, particularly during months 6–7 of pregnancy, is associated with an increased risk of PROM. This study extends and strengthens the evidence on the association between prenatal exposure to AP and the risk of PROM, specifically identifying the critical exposure windows.

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Maternal Exposure to Environmental Air Pollution and Premature Rupture of Membranes: Evidence from Southern China

Yang,

Xu,

et al. 2024

Med Sci Monit

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“…As an alternative method to the Cox proportional hazards model, the discrete-time approach is flexible and can be used to estimate associations over the event time based on the proportional hazards assumption or obtain estimates for different time points to relax the assumption. 26,[37][38][39] In this study, we estimated associations based on the proportional hazards assumption by using the discrete-time method in our main analysis and compared the results with that of the Cox proportional hazards model in the sensitivity analysis. We examined associations with long-term heat exposure during the entire pregnancy and by trimester.…”

Section: Discussionmentioning

confidence: 99%

“…From 2008 to 2018, we identified 425 722 singleton pregnancies in a large pregnancy cohort from Kaiser Permanente Southern California, an integrated health care organization providing high-quality services throughout Southern California. We obtained detailed information on demographic characteristics, medical histories, self-reported lifestyles, and residential changes throughout pregnancy from KPSC’s electronic health records . The gestational age of pregnancies in the KPSC cohort ranged from 20 to 47 weeks and was estimated based on early pregnancy ultrasonography examinations or self-reported last menstrual period (eMethods in Supplement 1).…”

Section: Methodsmentioning

confidence: 99%

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Analysis of Heat Exposure During Pregnancy and Severe Maternal Morbidity

Jiao,

Sun,

Avila

et al. 2023

JAMA Netw Open

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ImportanceThe rate of severe maternal morbidity (SMM) is continuously increasing in the US. Evidence regarding the associations of climate-related exposure, such as environmental heat, with SMM is lacking.ObjectiveTo examine associations between long- and short-term maternal heat exposure and SMM.Design, Setting, and ParticipantsThis retrospective population-based epidemiological cohort study took place at a large integrated health care organization, Kaiser Permanente Southern California, between January 1, 2008, and December 31, 2018. Data were analyzed from February to April 2023. Singleton pregnancies with data on SMM diagnosis status were included.ExposuresModerate, high, and extreme heat days, defined as daily maximum temperatures exceeding the 75th, 90th, and 95th percentiles of the time series data from May through September 2007 to 2018 in Southern California, respectively. Long-term exposures were measured by the proportions of different heat days during pregnancy and by trimester. Short-term exposures were represented by binary variables of heatwaves with 9 different definitions (combining percentile thresholds with 3 durations; ie, ≥2, ≥3, and ≥4 consecutive days) during the last gestational week.Main Outcomes and MeasuresThe primary outcome was SMM during delivery hospitalization, measured by 20 subconditions excluding blood transfusion. Discrete-time logistic regression was used to estimate associations with long- and short-term heat exposure. Effect modification by maternal characteristics and green space exposure was examined using interaction terms.ResultsThere were 3446 SMM cases (0.9%) among 403 602 pregnancies (mean [SD] age, 30.3 [5.7] years). Significant associations were observed with long-term heat exposure during pregnancy and during the third trimester. High exposure (≥80th percentile of the proportions) to extreme heat days during pregnancy and during the third trimester were associated with a 27% (95% CI, 17%-37%; P &lt; .001) and 28% (95% CI, 17%-41%; P &lt; .001) increase in risk of SMM, respectively. Elevated SMM risks were significantly associated with short-term heatwave exposure under all heatwave definitions. The magnitude of associations generally increased from the least severe (HWD1: daily maximum temperature &gt;75th percentile lasting for ≥2 days; odds ratio [OR], 1.32; 95% CI, 1.17-1.48; P &lt; .001) to the most severe heatwave exposure (HWD9: daily maximum temperature &gt;95th percentile lasting for ≥4 days; OR, 2.39; 95% CI, 1.62-3.54; P &lt; .001). Greater associations were observed among mothers with lower educational attainment (OR for high exposure to extreme heat days during pregnancy, 1.43; 95% CI, 1.26-1.63; P &lt; .001) or whose pregnancies started in the cold season (November through April; OR, 1.37; 95% CI, 1.24-1.53; P &lt; .001).Conclusions and RelevanceIn this retrospective cohort study, long- and short-term heat exposure during pregnancy was associated with higher risk of SMM. These results might have important implications for SMM prevention, particularly in a changing climate.

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Fine Particulate Matter, Its Constituents, and Spontaneous Preterm Birth

Jiao,

Reilly,

Benmarhnia

et al. 2024

JAMA Netw Open

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ImportanceThe associations of exposure to fine particulate matter (PM2.5) and its constituents with spontaneous preterm birth (sPTB) remain understudied. Identifying subpopulations at increased risk characterized by socioeconomic status and other environmental factors is critical for targeted interventions.ObjectiveTo examine associations of PM2.5 and its constituents with sPTB.Design, Setting, and ParticipantsThis population-based retrospective cohort study was conducted from 2008 to 2018 within a large integrated health care system, Kaiser Permanente Southern California. Singleton live births with recorded residential information of pregnant individuals during pregnancy were included. Data were analyzed from December 2023 to March 2024.ExposuresDaily total PM2.5 concentrations and monthly data on 5 PM2.5 constituents (sulfate, nitrate, ammonium, organic matter, and black carbon) in California were assessed, and mean exposures to these pollutants during pregnancy and by trimester were calculated. Exposures to total green space, trees, low-lying vegetation, and grass were estimated using street view images. Wildfire-related exposure was measured by the mean concentration of wildfire-specific PM2.5 during pregnancy. Additionally, the mean exposure to daily maximum temperature during pregnancy was calculated.Main Outcomes and MeasuresThe primary outcome was sPTB identified through a natural language processing algorithm. Discrete-time survival models were used to estimate associations of total PM2.5 concentration and its 5 constituents with sPTB. Interaction terms were used to examine the effect modification by race and ethnicity, educational attainment, household income, and exposures to green space, wildfire smoke, and temperature.ResultsAmong 409 037 births (mean [SD] age of mothers at delivery, 30.3 [5.8] years), there were positive associations of PM2.5, black carbon, nitrate, and sulfate with sPTB. Adjusted odds ratios (aORs) per IQR increase were 1.15 (95% CI, 1.12-1.18; P &lt; .001) for PM2.5 (IQR, 2.76 μg/m3), 1.15 (95% CI, 1.11-1.20; P &lt; .001) for black carbon (IQR, 1.05 μg/m3), 1.09 (95% CI, 1.06-1.13; P &lt; .001) for nitrate (IQR, 0.93 μg/m3), and 1.06 (95% CI, 1.03-1.09; P &lt; .001) for sulfate (IQR, 0.40 μg/m3) over the entire pregnancy. The second trimester was the most susceptible window; for example, aORs for total PM2.5 concentration were 1.07 (95% CI, 1.05-1.09; P &lt; .001) in the first, 1.10 (95% CI, 1.08-1.12; P &lt; .001) in the second, and 1.09 (95% CI, 1.07-1.11; P &lt; .001) in the third trimester. Significantly higher aORs were observed among individuals with lower educational attainment (eg, less than college: aOR, 1.16; 95% CI, 1.12-1.21 vs college [≥4 years]: aOR, 1.10; 95% CI, 1.06-1.14; P = .03) or income (&lt;50th percentile: aOR, 1.17; 95% CI, 1.14-1.21 vs ≥50th percentile: aOR, 1.12; 95% CI, 1.09-1.16; P = .02) or who were exposed to limited green space (&lt;50th percentile: aOR, 1.19; 95% CI, 1.15-1.23 vs ≥50th percentile: aOR, 1.12; 95% CI, 1.09-1.15; P = .003), more wildfire smoke (≥50th percentile: aOR, 1.19; 95% CI, 1.16-1.23 vs &lt;50th percentile: aOR, 1.13; 95% CI, 1.09-1.16; P = .009), or extreme heat (aOR, 1.51; 95% CI, 1.42-1.59 vs mild temperature: aOR, 1.11; 95% CI, 1.09-1.14; P &lt; .001).Conclusions and RelevanceIn this study, exposures to PM2.5 and specific PM2.5 constituents during pregnancy were associated with increased odds of sPTB. Socioeconomic status and other environmental exposures modified this association.

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Maternal exposure to ambient air pollution mixture and premature rupture of membranes: Evidence from a large cohort in Southern California (2008–2018)

Cited by 9 publications

References 67 publications

Maternal Exposure to Environmental Air Pollution and Premature Rupture of Membranes: Evidence from Southern China

Maternal Exposure to Environmental Air Pollution and Premature Rupture of Membranes: Evidence from Southern China

Analysis of Heat Exposure During Pregnancy and Severe Maternal Morbidity

Fine Particulate Matter, Its Constituents, and Spontaneous Preterm Birth

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