The introduction to air pollution on pregnancy outcome (APPO) study: a multicenter cohort study

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Abstract

Objective

The air pollution on pregnancy outcome (APPO) study is a prospective hospital-based cohort study designed to investigate the maternal and fetal effects of a particulate matter with an aerodynamic below 10 μm (PM10) and PM2.5 (below 2.5 μm) exposure. This study aims to analyze a relationship between particulate matter and adverse pregnancy outcomes and to find related biomarkers and develop management guidelines.

Methods

About 1,200 pregnant women are recruited for 3 years (from January 2021 to December 2023) from seven university hospitals to investigate the effects of particulate matter on pregnancy complications and adverse pregnancy outcomes. We collect biological samples by 5 mL of maternal venous blood and 15 mL of urine in each trimester of pregnancy, and 5 mL of umbilical cord blood and 2×2×2 cm of placental tissue are collected after delivery. In addition, by applying PM10 and PM2.5 concentration values and time-activity patterns from the time weighted average model, the individual predicted exposure of air pollution for the pregnant women are obtained.

Results

The average exposure of PM10 and PM2.5 of the participants in the entire period of pregnancy, was exceeded the World Health Organization air quality guidelines (an annual level, PM10 >15 μg/m ³, PM2.5 >5 μg/m ³). Moreover, it was revealed that the PM concentration was increasing toward the 3rd trimester of pregnancy.

Conclusion

The APPO study will be able to identify the degree of exposure to air pollution in pregnant women and use it as basic data for estimating individual exposure to particulate matter. And the results of the APPO study will facilitate in the development of health management for pregnant women against air pollution.

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Most cited references 30

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A review of recent studies on malondialdehyde as toxic molecule and biological marker of oxidative stress.

Daniele Del Rio, Amanda Stewart, Nicoletta Pellegrini (2005)

Of the many biological targets of oxidative stress, lipids are the most involved class of biomolecules. Lipid oxidation gives rise to a number of secondary products. Malondialdehyde (MDA) is the principal and most studied product of polyunsaturated fatty acid peroxidation. This aldehyde is a highly toxic molecule and should be considered as more than just a marker of lipid peroxidation. Its interaction with DNA and proteins has often been referred to as potentially mutagenic and atherogenic. This review is intended to briefly describe the physiological origin of MDA, to highlight its toxicity, describe and comment on the most recent methods of detection and discuss its occurrence and significance in pathology. In vivo origin as well as reactivity and consequent toxicity of MDA are reviewed. The most recent and improved procedures for the evaluation of MDA in biological fluids are described and discussed. The evidence of the occurrence of increased MDA levels in pathology is described. In the assessment of MDA, the most common methods of detection are insufficiently sensitive and disturbed by interference coming from related species or overestimation derived from stressing analysis conditions. Moreover, no recent nutritional or medical trials report the use of one of the new and more reliable methods, some of which are undoubtedly accessible to virtually all the laboratories provided with a common HPLC or a spectrofluorimeter.

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Role of the chronic air pollution levels in the Covid-19 outbreak risk in Italy ☆

Daniele Fattorini, Francesco Regoli (2020)

After the initial outbreak in China, the diffusion in Italy of SARS-CoV-2 is exhibiting a clear regional trend with more elevated frequency and severity of cases in Northern areas. Among multiple factors possibly involved in such geographical differences, a role has been hypothesized for atmospheric pollution. We provide additional evidence on the possible influence of air quality, particularly in terms of chronicity of exposure on the spread viral infection in Italian regions. Actual data on Covid-19 outbreak in Italian provinces and corresponding long-term air quality evaluations, were obtained from Italian and European agencies, elaborated and tested for possible interactions. Our elaborations reveal that, beside concentrations, the chronicity of exposure may influence the anomalous variability of SARS-CoV-2 in Italy. Data on distribution of atmospheric pollutants (NO2, O3, PM2.5 and PM10) in Italian regions during the last 4 years, days exceeding regulatory limits, and years of the last decade (2010–2019) in which the limits have been exceeded for at least 35 days, highlight that Northern Italy has been constantly exposed to chronic air pollution. Long-term air-quality data significantly correlated with cases of Covid-19 in up to 71 Italian provinces (updated April 27, 2020) providing further evidence that chronic exposure to atmospheric contamination may represent a favourable context for the spread of the virus. Pro-inflammatory responses and high incidence of respiratory and cardiac affections are well known, while the capability of this coronavirus to bind particulate matters remains to be established. Atmospheric and environmental pollution should be considered as part of an integrated approach for sustainable development, human health protection and prevention of epidemic spreads but in a long-term and chronic perspective, since adoption of mitigation actions during a viral outbreak could be of limited utility.

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Air Pollution and COVID-19: The Role of Particulate Matter in the Spread and Increase of COVID-19’s Morbidity and Mortality

Silvia Comunian, Dario Dongo, Chiara Milani … (2020)

Sars-Cov-2 virus (COVID-19) is a member of the coronavirus family and is responsible for the pandemic recently declared by the World Health Organization. A positive correlation has been observed between the spread of the virus and air pollution, one of the greatest challenges of our millennium. COVID-19 could have an air transmission and atmospheric particulate matter (PM) could create a suitable environment for transporting the virus at greater distances than those considered for close contact. Moreover, PM induces inflammation in lung cells and exposure to PM could increase the susceptibility and severity of the COVID-19 patient symptoms. The new coronavirus has been shown to trigger an inflammatory storm that would be sustained in the case of pre-exposure to polluting agents. In this review, we highlight the potential role of PM in the spread of COVID-19, focusing on Italian cities whose PM daily concentrations were found to be higher than the annual average allowed during the months preceding the epidemic. Furthermore, we analyze the positive correlation between the virus spread, PM, and angiotensin-converting enzyme 2 (ACE2), a receptor involved in the entry of the virus into pulmonary cells and inflammation.

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Author and article information

Journal

Journal ID (nlm-ta): Obstet Gynecol Sci

Journal ID (iso-abbrev): Obstet Gynecol Sci

Title: Obstetrics & Gynecology Science

Publisher: Korean Society of Obstetrics and Gynecology

ISSN (Print): 2287-8572

ISSN (Electronic): 2287-8580

Publication date (Print): May 2023

Publication date (Electronic): 27 March 2023

Volume: 66

Issue: 3

Pages: 169-180

Affiliations

[1 ]Department of Obstetrics and Gynecology, Ewha Womans University Mokdong Hospital, Ewha Medical Research Institute College of Medicine, Seoul, Korea

[2 ]Department of Obstetrics and Gynecology, Ewha Womans University Seoul Hospital, Seoul, Korea

[3 ]Department of Obstetrics and Gynecology, Yonsei University, Seoul, Korea

[4 ]Department of Obstetrics and Gynecology, Yonsei University Gangnam Severance Hospital, Seoul, Korea

[5 ]Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Korea

[6 ]Department of Obstetrics and Gynecology, Kangwon National University Hospital, Chuncheon, Korea

[7 ]Department of Obstetrics and Gynecology, Keimyung University Dongsan Medical Center, Daegu, Korea

[8 ]Department of Obstetrics and Gynecology, Ulsan University Hospital, Ulsan, Ewha Medical Research Institute, Ewha Womans University, Seoul, Korea

[9 ]Department of Environmental Science and Engineering, Ewha Medical Research Institute, Ewha Womans University, Seoul, Korea

[10 ]Department of Preventive Medicine, College of Medicine, Ewha Medical Research Institute, Ewha Womans University, Seoul, Korea

Author notes

Corresponding author: Young Ju Kim, MD, PhD, Department of Obstetrics and Gynecology, Ewha Womans University Mokdong Hospital, Ewha Medical Research Institute College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985 Korea, E-mail: kkyj@ 123456ewha.ac.kr

[*]

The APPO study group also includes current members: Jeong Eun Lee, Hwa Jeong Kim, So Jeong In, Hye Won Kim, and Bo Ra Kim.

Author information

Young Ju Kim http://orcid.org/0000-0002-3153-3008

Article

Publisher ID: ogs-22278

DOI: 10.5468/ogs.22278

PMC ID: 10191769

PubMed ID: 36973177

SO-VID: 4bbcb00f-a641-4708-a445-460b63ad8b1a

License:

Articles published in Obstet Gynecol Sci are open-access, distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 17 October 2022

Date revision received : 18 December 2022

Date accepted : 15 February 2023

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The introduction to air pollution on pregnancy outcome (APPO) study: a multicenter cohort study

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Abstract

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Pneumonia, sex, and the environment

Most cited references 30

A review of recent studies on malondialdehyde as toxic molecule and biological marker of oxidative stress.

Role of the chronic air pollution levels in the Covid-19 outbreak risk in Italy ☆

Air Pollution and COVID-19: The Role of Particulate Matter in the Spread and Increase of COVID-19’s Morbidity and Mortality

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