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Association of Air Pollution and Heat Exposure With Preterm Birth, Low Birth Weight, and Stillbirth in the US: A Systematic Review

JAMA Network Open, 2020-06, Vol.3 (6), p.e208243 [Peer Reviewed Journal]

2020. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;Copyright 2020 Bekkar B et al. . ;ISSN: 2574-3805 ;EISSN: 2574-3805 ;EISSN: 2689-0186 ;DOI: 10.1001/jamanetworkopen.2020.8243 ;PMID: 32556259

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  • Title:
    Association of Air Pollution and Heat Exposure With Preterm Birth, Low Birth Weight, and Stillbirth in the US: A Systematic Review
  • Author: Bekkar, Bruce ; Pacheco, Susan ; Basu, Rupa ; DeNicola, Nathaniel
  • Subjects: Air Pollution - statistics & numerical data ; Birth weight ; Cross-sectional studies ; Environmental Health ; Female ; Hot Temperature ; Humans ; Infant, Low Birth Weight ; Maternal Exposure - statistics & numerical data ; Observational Studies as Topic ; Online Only ; Original Investigation ; Pollutants ; Pregnancy ; Premature birth ; Premature Birth - epidemiology ; Stillbirth ; Stillbirth - epidemiology ; Systematic review ; United States
  • Is Part Of: JAMA Network Open, 2020-06, Vol.3 (6), p.e208243
  • Description: IMPORTANCE: Knowledge of whether serious adverse pregnancy outcomes are associated with increasingly widespread effects of climate change in the US would be crucial for the obstetrical medical community and for women and families across the country. OBJECTIVE: To investigate prenatal exposure to fine particulate matter (PM2.5), ozone, and heat, and the association of these factors with preterm birth, low birth weight, and stillbirth. EVIDENCE REVIEW: This systematic review involved a comprehensive search for primary literature in Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, PubMed, ClinicalTrials.gov website, and MEDLINE. Qualifying primary research studies included human participants in US populations that were published in English between January 1, 2007, and April 30, 2019. Included articles analyzed the associations between air pollutants or heat and obstetrical outcomes. Comparative observational cohort studies and cross-sectional studies with comparators were included, without minimum sample size. Additional articles found through reference review were also considered. Articles analyzing other obstetrical outcomes, non-US populations, and reviews were excluded. Two reviewers independently determined study eligibility. The Arskey and O’Malley scoping review framework was used. Data extraction was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. FINDINGS: Of the 1851 articles identified, 68 met the inclusion criteria. Overall, 32 798 152 births were analyzed, with a mean (SD) of 565 485 (783 278) births per study. A total of 57 studies (48 of 58 [84%] on air pollutants; 9 of 10 [90%] on heat) showed a significant association of air pollutant and heat exposure with birth outcomes. Positive associations were found across all US geographic regions. Exposure to PM2.5 or ozone was associated with increased risk of preterm birth in 19 of 24 studies (79%) and low birth weight in 25 of 29 studies (86%). The subpopulations at highest risk were persons with asthma and minority groups, especially black mothers. Accurate comparisons of risk were limited by differences in study design, exposure measurement, population demographics, and seasonality. CONCLUSIONS AND RELEVANCE: This review suggests that increasingly common environmental exposures exacerbated by climate change are significantly associated with serious adverse pregnancy outcomes across the US.
  • Publisher: United States: American Medical Association
  • Language: English
  • Identifier: ISSN: 2574-3805
    EISSN: 2574-3805
    EISSN: 2689-0186
    DOI: 10.1001/jamanetworkopen.2020.8243
    PMID: 32556259
  • Source: Journals@Ovid Open Access Journal Collection Rolling
    MEDLINE
    Alma/SFX Local Collection
    ProQuest Central
    DOAJ Directory of Open Access Journals
    JAMA Network (Open Access)
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