Epidemiologic studies addressing the relationship between ambient air pollution and fetal development are accumulating worldwide. Studies conducted in China (Wang et al. 1997;Xu et al. 1995), Brazil (Pereira et al. 1998), the Czech Republic (Bobak and Leon 1999;Dejmek et al. 1999;Perera et al. 1999), Mexico (Loomis et al. 1999), Korea (Ha et al. 2001), and the United States (Woodruff et al. 1997) linked ambient air pollution exposure during pregnancy with term low birth weight (LBW), intrauterine growth retardation (IUGR), preterm birth, and perinatal mortality. We recently reported that increases in carbon monoxide, particulate matter < 10 µm in aerodynamic diameter (PM 10 ), and ozone concentrations during vulnerable pregnancy periods increased the risk of term LBW (Ritz and Yu 1999), preterm delivery (Ritz et al. 2000), and certain cardiac malformations, such as ventricular septal defects (Ritz et al. 2002). CO is released directly in motor vehicle exhaust and does not react readily in the atmosphere to form other compounds. Fine (< 2.5 µm) and ultrafine (< 0.1 µm) particles are also released directly in vehicle exhaust but undergo physical and chemical transformations in the atmosphere as they disperse from the roadway (Zhu et al. 2002). The consistently observed associations between ambient CO concentrations and adverse birth outcomes in our previous studies suggest that compounds in motor vehicle exhaust (either CO or associated compounds such as fine and ultrafine particles) may affect fetal development.In our previous studies (Ritz and Yu 1999;Ritz et al. 2000Ritz et al. , 2002, air pollution exposure assessment was based on measurements taken at ambient monitoring stations during specific pregnancy periods. Although such measures may adequately reflect average exposure of pregnant women to background air pollution concentrations in their neighborhood, they may not take into account differential exposure within neighborhoods due to proximity to heavy-traffic roadways and freeways. Women residing closer to these sources may experience greater exposure to potentially toxic compounds released directly in vehicle exhaust or formed in the atmosphere adjacent to roadways. Therefore, we examined whether residential proximity to heavy-traffic roadways, such as freeways and major arterials, during pregnancy was associated with the risk of term LBW and preterm birth in infants born to women living in Los Angeles County, California, between 1994-1996 using a case-control study design.
MethodsSubjects. We used birth certificates, provided by the California Department of Health Services (Sacramento, CA), to identify study subjects and to determine their gestational age, birth weight, and values for covariates included in our analyses. We included infants born to women living in the 28 Los Angeles County zip codes evaluated in earlier work (Ritz and Yu 1999;Ritz et al. 2000) and 84 additional zip codes selected to capture areas intersected by freeways and major arterials and collectors (Figure 1). Overall we included...