Environmental pollution and social factors as contributors to preterm birth in Fresno County

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Abstract

Background

Environmental pollution exposure during pregnancy has been identified as a risk factor for preterm birth. Most studies have evaluated exposures individually and in limited study populations.

Methods

We examined the associations between several environmental exposures, both individually and cumulatively, and risk of preterm birth in Fresno County, California. We also evaluated early (< 34 weeks) and spontaneous preterm birth. We used the Communities Environmental Health Screening Tool and linked hospital discharge records by census tract from 2009 to 2012. The environmental factors included air pollution, drinking water contaminants, pesticides, hazardous waste, traffic exposure and others. Social factors, including area-level socioeconomic status (SES) and race/ethnicity were also evaluated as potential modifiers of the relationship between pollution and preterm birth.

Results

In our study of 53,843 births, risk of preterm birth was associated with higher exposure to cumulative pollution scores and drinking water contaminants. Risk of preterm birth was twice as likely for those exposed to high versus low levels of pollution. An exposure-response relationship was observed across the quintiles of the pollution burden score. The associations were stronger among early preterm births in areas of low SES.

Conclusions

In Fresno County, we found multiple pollution exposures associated with increased risk for preterm birth, with higher associations among the most disadvantaged. This supports other evidence finding environmental exposures are important risk factors for preterm birth, and furthermore the burden is higher in areas of low SES. This data supports efforts to reduce the environmental burden on pregnant women.

Electronic supplementary material

The online version of this article (10.1186/s12940-018-0414-x) contains supplementary material, which is available to authorized users.

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Most cited references 25

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Ambient air pollution, birth weight and preterm birth: a systematic review and meta-analysis.

David Stieb, Li Chen, Maysoon Eshoul … (2012)

Low birth weight and preterm birth have a substantial public health impact. Studies examining their association with outdoor air pollution were identified using searches of bibliographic databases and reference lists of relevant papers. Pooled estimates of effect were calculated, heterogeneity was quantified, meta-regression was conducted and publication bias was examined. Sixty-two studies met the inclusion criteria. The majority of studies reported reduced birth weight and increased odds of low birth weight in relation to exposure to carbon monoxide (CO), nitrogen dioxide (NO(2)) and particulate matter less than 10 and 2.5 microns (PM(10) and PM(2.5)). Effect estimates based on entire pregnancy exposure were generally largest. Pooled estimates of decrease in birth weight ranged from 11.4 g (95% confidence interval -6.9-29.7) per 1 ppm CO to 28.1g (11.5-44.8) per 20 ppb NO(2), and pooled odds ratios for low birth weight ranged from 1.05 (0.99-1.12) per 10 μg/m(3) PM(2.5) to 1.10 (1.05-1.15) per 20 μg/m(3) PM(10) based on entire pregnancy exposure. Fewer effect estimates were available for preterm birth and results were mixed. Pooled odds ratios based on 3rd trimester exposures were generally most precise, ranging from 1.04 (1.02-1.06) per 1 ppm CO to 1.06 (1.03-1.11) per 20 μg/m(3) PM(10). Results were less consistent for ozone and sulfur dioxide for all outcomes. Heterogeneity between studies varied widely between pollutants and outcomes, and meta-regression suggested that heterogeneity could be partially explained by methodological differences between studies. While there is a large evidence base which is indicative of associations between CO, NO(2), PM and pregnancy outcome, variation in effects by exposure period and sources of heterogeneity between studies should be further explored. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

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Socioeconomic status and health: the potential role of environmental risk exposure.

Gary Evans, Elyse Kantrowitz (2002)

Among several viable explanations for the ubiquitous SES-health gradient is differential exposure to environmental risk. We document evidence of inverse relations between income and other indices of SES with environmental risk factors including hazardous wastes and other toxins, ambient and indoor air pollutants, water quality, ambient noise, residential crowding, housing quality, educational facilities, work environments, and neighborhood conditions. We then briefly overview evidence that such exposures are inimical to health and well-being. We conclude with a discussion of the research and policy implications of environmental justice, arguing that a particularly salient feature of poverty for health consequences is exposure to multiple environmental risk factors.

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Ambient Air Pollution and Pregnancy Outcomes: A Review of the Literature

Radim J. Sram, Blanka Binkova, Jan Dejmek (posthumous) … (2005)

Over the last decade or so, a large number of studies have investigated the possible adverse effects of ambient air pollution on birth outcomes. We reviewed these studies, which were identified by a systematic search of the main scientific databases. Virtually all reviewed studies were population based, with information on exposure to air pollution derived from routine monitoring sources. Overall, there is evidence implicating air pollution in adverse effects on different birth outcomes, but the strength of the evidence differs between outcomes. The evidence is sufficient to infer a causal relationship between particulate air pollution and respiratory deaths in the postneonatal period. For air pollution and birth weight the evidence suggests causality, but further studies are needed to confirm an effect and its size and to clarify the most vulnerable period of pregnancy and the role of different pollutants. For preterm births and intrauterine growth retardation (IUGR) the evidence as yet is insufficient to infer causality, but the available evidence justifies further studies. Molecular epidemiologic studies suggest possible biologic mechanisms for the effect on birth weight, premature birth, and IUGR and support the view that the relation between pollution and these birth outcomes is genuine. For birth defects, the evidence base so far is insufficient to draw conclusions. In terms of exposure to specific pollutants, particulates seem the most important for infant deaths, and the effect on IUGR seems linked to polycyclic aromatic hydrocarbons, but the existing evidence does not allow precise identification of the different pollutants or the timing of exposure that can result in adverse pregnancy outcomes.

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Author and article information

Contributors

Amy M. Padula:

ORCID: http://orcid.org/0000-0003-1435-4814

Amy.Padula@ucsf.edu

Hongtai Huang: Hongtai.Huang@ucsf.edu

Rebecca J. Baer: Rjbaer@ucsd.edu

Laura M. August: Laura.August@oehha.ca.gov

Marta M. Jankowska: Majankowska@ucsd.edu

Laura L. Jellife-Pawlowski: Laura.Jelliffe@ucsf.edu

Marina Sirota: Marina.Sirota@ucsf.edu

Tracey J. Woodruff: Tracey.Woodruff@ucsf.edu

Journal

Journal ID (nlm-ta): Environ Health

Journal ID (iso-abbrev): Environ Health

Title: Environmental Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1476-069X

Publication date (Electronic): 29 August 2018

Publication date PMC-release: 29 August 2018

Publication date Collection: 2018

Volume: 17

Electronic Location Identifier: 70

Affiliations

[1 ]ISNI 0000 0001 2297 6811, GRID grid.266102.1, Department of Obstetrics, Gynecology and Reproductive Sciences, , University of California, ; 550 16th Street, Mail Stop 0132, San Francisco, CA 94143 USA

[2 ]ISNI 0000 0001 2297 6811, GRID grid.266102.1, Department of Pediatrics, , University of California, ; San Francisco, USA

[3 ]ISNI 0000 0001 2107 4242, GRID grid.266100.3, Department of Pediatrics, , University of California, ; San Diego, USA

[4 ]ISNI 0000 0001 0704 4602, GRID grid.428205.9, Office of Environmental Health Hazard Assessment, , California Environmental Protection Agency, ; Sacramento, USA

[5 ]ISNI 0000 0001 2107 4242, GRID grid.266100.3, Calit2/Qualcomm Institute, , University of California, ; San Diego, USA

[6 ]ISNI 0000 0001 2297 6811, GRID grid.266102.1, Department of Epidemiology and Biostatistics, , University of California, ; San Francisco, USA

Author information

Amy M. Padula http://orcid.org/0000-0003-1435-4814

Article

Publisher ID: 414

DOI: 10.1186/s12940-018-0414-x

PMC ID: 6114053

PubMed ID: 30157858

SO-VID: e43a6e3d-c234-4733-b3be-6e104180b9f2

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 8 December 2017

Date accepted : 21 August 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000066, National Institute of Environmental Health Sciences;

Award ID: R00ES021470

Award Recipient : Amy M. Padula

Funded by: U.S. National Library of Medicine (US)

Award ID: K01LM012381

Award Recipient : Marina Sirota

Funded by: Mark and Lynn Benioff

Award ID: UCSF7027075

Custom metadata

ScienceOpen disciplines: Public health

Keywords: preterm birth,environmental exposure,social factors,prematurity,pollution

Data availability:

ScienceOpen disciplines: Public health

Keywords: preterm birth, environmental exposure, social factors, prematurity, pollution

Environmental pollution and social factors as contributors to preterm birth in Fresno County

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Pneumonia, sex, and the environment

Most cited references 25

Ambient air pollution, birth weight and preterm birth: a systematic review and meta-analysis.

Socioeconomic status and health: the potential role of environmental risk exposure.

Ambient Air Pollution and Pregnancy Outcomes: A Review of the Literature

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