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Ambient air pollution and pregnancy outcomes: a review of the literature

 

Table Of Contents


Thesis Abstract

Ambient air pollution has been a growing concern due to its potential impacts on pregnancy outcomes. This review aims to summarize the existing literature on the relationship between ambient air pollution and various pregnancy outcomes. The review includes studies that have investigated the effects of different air pollutants such as particulate matter (PM), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) on pregnancy outcomes including preterm birth, low birth weight, and birth defects. Studies have shown consistent associations between exposure to air pollution during pregnancy and adverse outcomes such as preterm birth and low birth weight. The mechanisms through which air pollution may affect pregnancy outcomes include oxidative stress, inflammation, and placental dysfunction. Additionally, air pollution exposure during pregnancy has been linked to an increased risk of birth defects, although more research is needed to establish causality. Particulate matter, especially fine particles (PM2.5), has been extensively studied in relation to pregnancy outcomes. Several studies have reported positive associations between PM2.5 exposure during pregnancy and adverse outcomes such as preterm birth and low birth weight. Nitrogen dioxide, a common traffic-related pollutant, has also been linked to adverse pregnancy outcomes, with some studies reporting increased risks of preterm birth and low birth weight with higher NO2 exposure. Sulfur dioxide and carbon monoxide, primarily derived from industrial sources and vehicle emissions, have been less studied in relation to pregnancy outcomes. Limited evidence suggests potential associations between SO2 exposure and adverse pregnancy outcomes, although more research is needed to confirm these findings. Similarly, the evidence on the effects of carbon monoxide on pregnancy outcomes is scarce and inconsistent. Ozone, a secondary pollutant formed by chemical reactions in the atmosphere, has been associated with adverse respiratory outcomes but its effects on pregnancy outcomes are less well-established. Some studies have reported positive associations between ozone exposure during pregnancy and adverse birth outcomes, while others have found no significant effects. In conclusion, ambient air pollution is a complex mixture of pollutants that may have detrimental effects on pregnancy outcomes. While existing evidence suggests that exposure to air pollution during pregnancy is associated with an increased risk of adverse outcomes such as preterm birth, low birth weight, and birth defects, more research is needed to elucidate the underlying mechanisms and establish causality. Efforts to reduce air pollution levels and protect pregnant women from exposure are crucial for promoting healthy pregnancies and improving birth outcomes.

Thesis Overview

REVIEW OF THE LITERATURE

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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