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Maternal exposure to outdoor air pollution and congenital limb deficiencies in the National Birth Defects Prevention Study.
Environ Res. 2019 12; 179(Pt A):108716.ER

Abstract

BACKGROUND

Congenital limb deficiencies (CLDs) are a relatively common group of birth defects whose etiology is mostly unknown. Recent studies suggest maternal air pollution exposure as a potential risk factor.

AIM

To investigate the relationship between ambient air pollution exposure during early pregnancy and offspring CLDs.

METHODS

The study population was identified from the National Birth Defects Prevention Study, a population-based multi-center case-control study, and consisted of 615 CLD cases and 5,701 controls with due dates during 1997 through 2006. Daily averages and/or maxima of six criteria air pollutants (particulate matter <2.5 μm [PM2.5], particulate matter <10 μm [PM10], nitrogen dioxide [NO2], sulfur dioxide [SO2], carbon monoxide [CO], and ozone [O3]) were averaged over gestational weeks 2-8, as well as for individual weeks during this period, using data from EPA air monitors nearest to the maternal address. Logistic regression was used to estimate odds ratios (aORs) and 95% confidence intervals (CIs) adjusted for maternal age, race/ethnicity, education, and study center. We estimated aORs for any CLD and CLD subtypes (i.e., transverse, longitudinal, and preaxial). Potential confounding by co-pollutant was assessed by adjusting for one additional air pollutant. Using the single pollutant model, we further investigated effect measure modification by body mass index, cigarette smoking, and folic acid use. Sensitivity analyses were conducted restricting to those with a residence closer to an air monitor.

RESULTS

We observed near-null aORs for CLDs per interquartile range (IQR) increase in PM10, PM2.5, and O3. However, weekly averages of the daily average NO2 and SO2, and daily max NO2, SO2, and CO concentrations were associated with increased odds of CLDs. The crude ORs ranged from 1.03 to 1.12 per IQR increase in these air pollution concentrations, and consistently elevated aORs were observed for CO. Stronger associations were observed for SO2 and O3 in subtype analysis (preaxial). In co-pollutant adjusted models, associations with CO remained elevated (aORs: 1.02-1.30); but aORs for SO2 and NO2 became near-null. The aORs for CO remained elevated among mothers who lived within 20 km of an air monitor. The aORs varied by maternal BMI, smoking status, and folic acid use.

CONCLUSION

We observed modest associations between CLDs and air pollution exposures during pregnancy, including CO, SO2, and NO2, though replication through further epidemiologic research is warranted.

Authors+Show Affiliations

Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States. Electronic address: giehae.choi@unc.edu.Department of Epidemiology, Columbia University, New York, NY, United States.Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States.Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States.Department of Epidemiology, Fay Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States.Stanford School of Medicine, Stanford, CA, United States.National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States; Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States.Department of Epidemiology, The University of Iowa, Iowa City, IA, United States.Massachusetts Department of Health, Boston, MA, United States.New York State Department of Health, Albany, NY, United States.Texas Department of State Health Services, Austin, TX, United States.Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.Office of Research and Development, U.S. Environmental Protection Agency, RTP, NC, United States.No affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

31546130

Citation

Choi, Giehae, et al. "Maternal Exposure to Outdoor Air Pollution and Congenital Limb Deficiencies in the National Birth Defects Prevention Study." Environmental Research, vol. 179, no. Pt A, 2019, p. 108716.
Choi G, Stingone JA, Desrosiers TA, et al. Maternal exposure to outdoor air pollution and congenital limb deficiencies in the National Birth Defects Prevention Study. Environ Res. 2019;179(Pt A):108716.
Choi, G., Stingone, J. A., Desrosiers, T. A., Olshan, A. F., Nembhard, W. N., Shaw, G. M., Pruitt, S., Romitti, P. A., Yazdy, M. M., Browne, M. L., Langlois, P. H., Botto, L., & Luben, T. J. (2019). Maternal exposure to outdoor air pollution and congenital limb deficiencies in the National Birth Defects Prevention Study. Environmental Research, 179(Pt A), 108716. https://doi.org/10.1016/j.envres.2019.108716
Choi G, et al. Maternal Exposure to Outdoor Air Pollution and Congenital Limb Deficiencies in the National Birth Defects Prevention Study. Environ Res. 2019;179(Pt A):108716. PubMed PMID: 31546130.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maternal exposure to outdoor air pollution and congenital limb deficiencies in the National Birth Defects Prevention Study. AU - Choi,Giehae, AU - Stingone,Jeanette A, AU - Desrosiers,Tania A, AU - Olshan,Andrew F, AU - Nembhard,Wendy N, AU - Shaw,Gary M, AU - Pruitt,Shannon, AU - Romitti,Paul A, AU - Yazdy,Mahsa M, AU - Browne,Marilyn L, AU - Langlois,Peter H, AU - Botto,Lorenzo, AU - Luben,Thomas J, AU - ,, Y1 - 2019/09/10/ PY - 2019/04/01/received PY - 2019/07/28/revised PY - 2019/09/01/accepted PY - 2019/9/24/pubmed PY - 2020/5/1/medline PY - 2019/9/24/entrez KW - Air pollution KW - Carbon monoxide KW - Congenital limb deficiencies KW - Nitrogen dioxide KW - Sulfur dioxide SP - 108716 EP - 108716 JF - Environmental research JO - Environ. Res. VL - 179 IS - Pt A N2 - BACKGROUND: Congenital limb deficiencies (CLDs) are a relatively common group of birth defects whose etiology is mostly unknown. Recent studies suggest maternal air pollution exposure as a potential risk factor. AIM: To investigate the relationship between ambient air pollution exposure during early pregnancy and offspring CLDs. METHODS: The study population was identified from the National Birth Defects Prevention Study, a population-based multi-center case-control study, and consisted of 615 CLD cases and 5,701 controls with due dates during 1997 through 2006. Daily averages and/or maxima of six criteria air pollutants (particulate matter <2.5 μm [PM2.5], particulate matter <10 μm [PM10], nitrogen dioxide [NO2], sulfur dioxide [SO2], carbon monoxide [CO], and ozone [O3]) were averaged over gestational weeks 2-8, as well as for individual weeks during this period, using data from EPA air monitors nearest to the maternal address. Logistic regression was used to estimate odds ratios (aORs) and 95% confidence intervals (CIs) adjusted for maternal age, race/ethnicity, education, and study center. We estimated aORs for any CLD and CLD subtypes (i.e., transverse, longitudinal, and preaxial). Potential confounding by co-pollutant was assessed by adjusting for one additional air pollutant. Using the single pollutant model, we further investigated effect measure modification by body mass index, cigarette smoking, and folic acid use. Sensitivity analyses were conducted restricting to those with a residence closer to an air monitor. RESULTS: We observed near-null aORs for CLDs per interquartile range (IQR) increase in PM10, PM2.5, and O3. However, weekly averages of the daily average NO2 and SO2, and daily max NO2, SO2, and CO concentrations were associated with increased odds of CLDs. The crude ORs ranged from 1.03 to 1.12 per IQR increase in these air pollution concentrations, and consistently elevated aORs were observed for CO. Stronger associations were observed for SO2 and O3 in subtype analysis (preaxial). In co-pollutant adjusted models, associations with CO remained elevated (aORs: 1.02-1.30); but aORs for SO2 and NO2 became near-null. The aORs for CO remained elevated among mothers who lived within 20 km of an air monitor. The aORs varied by maternal BMI, smoking status, and folic acid use. CONCLUSION: We observed modest associations between CLDs and air pollution exposures during pregnancy, including CO, SO2, and NO2, though replication through further epidemiologic research is warranted. SN - 1096-0953 UR - https://www.unboundmedicine.com/medline/citation/31546130/Maternal_exposure_to_outdoor_air_pollution_and_congenital_limb_deficiencies_in_the_National_Birth_Defects_Prevention_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0013-9351(19)30513-4 DB - PRIME DP - Unbound Medicine ER -