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Association of Long-term Exposure to Airborne Particulate Matter of 1 μm or Less With Preterm Birth in China.
JAMA Pediatr. 2018 03 05; 172(3):e174872.JP

Abstract

Importance

Airborne particulate matter pollution has been associated with preterm birth (PTB) in some studies. However, most of these studies assessed only populations living near monitoring stations, and the association of airborne particulate matter having a median diameter of 1 μm or less (PM1) with PTB has not been studied.

Objective

To evaluate whether PM1 concentrations are associated with the risk of PTB.

Design, Setting, and Participants

This national cohort study used National Free Preconception Health Examination Project data collected in 324 of 344 prefecture-level cities from 30 provinces of mainland China. In total, 1 300 342 healthy singleton pregnancies were included from women who were in labor from December 1, 2013, through November 30, 2014. Data analysis was conducted between December 1, 2016, and April 1, 2017.

Exposures

Predicted weekly PM1 concentration data collected using satellite remote sensing, meteorologic, and land use information matched with the home addresses of pregnant women.

Main Outcomes and Measures

Preterm birth (<37 gestational weeks). Gestational age was assessed using the time since the first day of the last menstrual period. Cox proportional hazards regression analysis was used to examine the associations between trimester-specific PM1 concentrations and PTB after controlling for temperature, seasonality, spatial variation, and individual covariates.

Results

Of the 1 300 342 singleton live births at the gestational age of 20 to 45 weeks included in this study, 104 585 (8.0%) were preterm. In fully adjusted models, a PM1 concentration increase of 10 μg/m3 over the entire pregnancy was significantly associated with increased risk of PTB (hazard ratio [HR], 1.09; 95% CI, 1.09-1.10), very PTB as defined as gestational age from 28 through 31 weeks (HR, 1.20; 95% CI, 1.18-1.23), and extremely PTB as defined as 20 through 27 weeks' gestation (HR, 1.29; 95% CI, 1.25-1.34). Pregnant women who were older (30-50 years) at conception (HR, 1.13; 95% CI, 1.11-1.14), were overweight before pregnancy (HR, 1.13; 95% CI, 1.11-1.15), had a rural household registration (HR, 1.09; 95% CI, 1.09-1.10), worked as farmers (HR, 1.10; 95% CI, 1.09-1.11), and conceived in autumn (HR, 1.48; 95% CI, 1.46-1.50) appeared to be more sensitive to PM1 exposure than their counterparts.

Conclusions and Relevance

Results from this national cohort study examining more than 1.3 million births indicated that exposure to PM1 air pollution was associated with an increased risk of PTB in China. These findings will provide evidence to inform future research studies, public health interventions, and environmental policies.

Authors+Show Affiliations

Environmental and Spatial Epidemiology Research Center, National Human Genetic Resources Center, Beijing, China. National Research Institute for Family Planning, Beijing, China.Environmental and Spatial Epidemiology Research Center, National Human Genetic Resources Center, Beijing, China. Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China.Institute for Environment and Climate Research, Jinan University, Guangzhou, China. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.Environmental and Spatial Epidemiology Research Center, National Human Genetic Resources Center, Beijing, China. Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China.Center on the Early Life Origins of Disease, Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland. Department of Pediatrics, School of Medicine, The Johns Hopkins University, Baltimore, Maryland.Department of Maternal and Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing.Department of Maternal and Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing.Department of Maternal and Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing.Department of Maternal and Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing.National Research Institute for Family Planning, Beijing, China.National Research Institute for Family Planning, Beijing, China.Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.National Research Institute for Family Planning, Beijing, China.National Research Institute for Family Planning, Beijing, China.National Research Institute for Family Planning, Beijing, China.National Research Institute for Family Planning, Beijing, China.National Research Institute for Family Planning, Beijing, China.National Research Institute for Family Planning, Beijing, China.Environmental and Spatial Epidemiology Research Center, National Human Genetic Resources Center, Beijing, China. Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China.Environmental and Spatial Epidemiology Research Center, National Human Genetic Resources Center, Beijing, China. National Research Institute for Family Planning, Beijing, China.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29297052

Citation

Wang, Yuan-Yuan, et al. "Association of Long-term Exposure to Airborne Particulate Matter of 1 Μm or Less With Preterm Birth in China." JAMA Pediatrics, vol. 172, no. 3, 2018, pp. e174872.
Wang YY, Li Q, Guo Y, et al. Association of Long-term Exposure to Airborne Particulate Matter of 1 μm or Less With Preterm Birth in China. JAMA Pediatr. 2018;172(3):e174872.
Wang, Y. Y., Li, Q., Guo, Y., Zhou, H., Wang, X., Wang, Q., Shen, H., Zhang, Y., Yan, D., Zhang, Y., Zhang, H., Li, S., Chen, G., Zhao, J., He, Y., Yang, Y., Xu, J., Wang, Y., Peng, Z., ... Ma, X. (2018). Association of Long-term Exposure to Airborne Particulate Matter of 1 μm or Less With Preterm Birth in China. JAMA Pediatrics, 172(3), e174872. https://doi.org/10.1001/jamapediatrics.2017.4872
Wang YY, et al. Association of Long-term Exposure to Airborne Particulate Matter of 1 Μm or Less With Preterm Birth in China. JAMA Pediatr. 2018 03 5;172(3):e174872. PubMed PMID: 29297052.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Long-term Exposure to Airborne Particulate Matter of 1 μm or Less With Preterm Birth in China. AU - Wang,Yuan-Yuan, AU - Li,Qin, AU - Guo,Yuming, AU - Zhou,Hong, AU - Wang,Xiaobin, AU - Wang,Qiaomei, AU - Shen,Haiping, AU - Zhang,Yiping, AU - Yan,Donghai, AU - Zhang,Ya, AU - Zhang,Hongguang, AU - Li,Shanshan, AU - Chen,Gongbo, AU - Zhao,Jun, AU - He,Yuan, AU - Yang,Ying, AU - Xu,Jihong, AU - Wang,Yan, AU - Peng,Zuoqi, AU - Wang,Hai-Jun, AU - Ma,Xu, Y1 - 2018/03/05/ PY - 2018/1/4/pubmed PY - 2019/9/7/medline PY - 2018/1/4/entrez SP - e174872 EP - e174872 JF - JAMA pediatrics JO - JAMA Pediatr VL - 172 IS - 3 N2 - Importance: Airborne particulate matter pollution has been associated with preterm birth (PTB) in some studies. However, most of these studies assessed only populations living near monitoring stations, and the association of airborne particulate matter having a median diameter of 1 μm or less (PM1) with PTB has not been studied. Objective: To evaluate whether PM1 concentrations are associated with the risk of PTB. Design, Setting, and Participants: This national cohort study used National Free Preconception Health Examination Project data collected in 324 of 344 prefecture-level cities from 30 provinces of mainland China. In total, 1 300 342 healthy singleton pregnancies were included from women who were in labor from December 1, 2013, through November 30, 2014. Data analysis was conducted between December 1, 2016, and April 1, 2017. Exposures: Predicted weekly PM1 concentration data collected using satellite remote sensing, meteorologic, and land use information matched with the home addresses of pregnant women. Main Outcomes and Measures: Preterm birth (<37 gestational weeks). Gestational age was assessed using the time since the first day of the last menstrual period. Cox proportional hazards regression analysis was used to examine the associations between trimester-specific PM1 concentrations and PTB after controlling for temperature, seasonality, spatial variation, and individual covariates. Results: Of the 1 300 342 singleton live births at the gestational age of 20 to 45 weeks included in this study, 104 585 (8.0%) were preterm. In fully adjusted models, a PM1 concentration increase of 10 μg/m3 over the entire pregnancy was significantly associated with increased risk of PTB (hazard ratio [HR], 1.09; 95% CI, 1.09-1.10), very PTB as defined as gestational age from 28 through 31 weeks (HR, 1.20; 95% CI, 1.18-1.23), and extremely PTB as defined as 20 through 27 weeks' gestation (HR, 1.29; 95% CI, 1.25-1.34). Pregnant women who were older (30-50 years) at conception (HR, 1.13; 95% CI, 1.11-1.14), were overweight before pregnancy (HR, 1.13; 95% CI, 1.11-1.15), had a rural household registration (HR, 1.09; 95% CI, 1.09-1.10), worked as farmers (HR, 1.10; 95% CI, 1.09-1.11), and conceived in autumn (HR, 1.48; 95% CI, 1.46-1.50) appeared to be more sensitive to PM1 exposure than their counterparts. Conclusions and Relevance: Results from this national cohort study examining more than 1.3 million births indicated that exposure to PM1 air pollution was associated with an increased risk of PTB in China. These findings will provide evidence to inform future research studies, public health interventions, and environmental policies. SN - 2168-6211 UR - https://www.unboundmedicine.com/medline/citation/29297052/Association_of_Long_term_Exposure_to_Airborne_Particulate_Matter_of_1_μm_or_Less_With_Preterm_Birth_in_China_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2017.4872 DB - PRIME DP - Unbound Medicine ER -