Health Impacts of Air Pollution Exposure During Pregnancy

Air pollution is now the world’s largest single environmental health risk. WHO reports that air pollution exposure caused deaths of 7 million people 2012, or one in eight of total global deaths. Deaths among pregnant women, children and adolescents account for more than one third of the global burden of premature mortality. Children in developing countries are eight times more likely to die before they reach the age of five. Air pollution exposure causes health impacts that significantly differ across different population groups, among which pregnant women and infant might be the most vulnerable population.  

Worldwide, air pollution-related disease and death are distributed unequally. The huge burden of disease affects mainly low- and middle-income countries in South-East Asia and Western Pacific Regions, with a total of 3.3 million deaths linked to indoor air pollution and 2.6 million deaths related to outdoor air pollution. Most of the low- and middle-income countries have urgent needs related to depressed economies, dense populations, heavy traffic, less access to clean energy, as well as little investment in pollution control and weak environmental legislation. These factors combined create high air pollution levels in under-resourced countries. China is one country with dense population and heavy air pollution. In 2015, none of 366 air monitored cities in China met the WHO standard (yearly average PM2.5: 10ug/m3). Beijing had 45 days with an average PM2.5 concentration higher than 150ug/m3 in 2014.

This cohort study is designed to characterize the burden of pregnant women’s air pollution exposure and explore how it might affect miscarriage, gestational complication, birth outcomes and infant health. Intrauterine exposure to air pollution has been hypothesized to impart multiple-level health threats. First, airborne insults may cause pregnancy complications which are closely related to maternal and neonatal mortality. Second, airborne insults can interfere fetus development, lead to loss of pregnancy and affect birth outcome. Third, intrauterine exposure may also influence neonatal survival, infant development as well as the potential of developing diseases in adulthood. The proposed study aims to address environmental inequity in this vulnerable population.

The study enrolled 200 pregnant women within the first 10-weeks of gestation and followed them through pregnancy to collect data on air pollution exposure at each trimester and at birth. Current outcomes include pregnancy complications and birth outcomes. We have found that air pollution exposure during the first few weeks after conception might increase the risk of miscarriage and mother's pesticide exposure affect birth weight. 

Our study will follow the children up to 1 year of age, collecting participants’ medical record, data on health status and development. We seek to link external chemical exposure to the physiological markers that are potentially associated with health outcomes. We will use the collected biospecimens to measure telomere length and assay hundreds of metabolites using metabolomics platforms, to understand which of these measures may reflect early response to perinatal exposure to environmental pollutants. 

Air pollution exposure during pregnancy and spontaneous abortion and stillbirth
Alexandra Grippo, Jun Zhang, Li Chu, Lihua Qiao, Jun Zhang, Ajay A. Myneni, Lina Mu
Published in Reviews on Environmental Health, July 2018

Biomarkers used in studying air pollution exposure during pregnancy and perinatal outcomes: a review
Desai, G., L. Chu, Y. J. Guo, A. A. Myneni, and L. N. Mu
Biomarkers, 2017

Investigators from UB

• Lina Mu, MD, PhD, PI, Associate Professor, Department of Epidemiology and Environmental Health (Role: design and conduct the overall study)
• Wenyao Xu, PhD, Co-I, Assistant Professor, Department of Computer Science and Engineering (Role: design air sensor and supervise its application)
• Vanessa Barnabei, MD, PhD, Co-I, Chair and professor, Department of Obstetrics and Gynecology (Role: supervise data collection on maternal health and birth outcome)
• Jayasree Nair, MD, Co-I, Department of Pediatrics. (Role: Oversee evaluation on neonatal health)
• Matthew Bonner, PhD, Co-I, Associate Professor, Department of Epidemiology and Environmental Health (Role: oversee epidemiological study design)
• Jo Freudenheim, PhD, Co-I, Professor, Department of Epidemiology and Environmental Health (Role: oversee epidemiological study design )
• Richard Browne, PhD, Co-I, Associate Professor, Department of Biotechnical and Clinical Laboratory Sciences (Role: oversee biospecimen collection and laboratory assay)
• Lili Tian, PhD, Co-I, Professor, Department of Biostatistics (Role: Biostatisticians)

Investigators from NICHD

• Pauline Mendola, PhD, Co-I, Investigator, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (Role: Oversee the overall study design)

Partner Organizations from China

• Tsinghua University
  • Yanping Zhang, PhD, Professor, Department of Environmental Engineering (Local air pollution)
  • Jun Zhang, PhD, Center of Public Health (Rile: oversight field work)

Participating Hospitals

• Consultants from participating Hospitals in Beijing:
  • Jun Zhang, MD, An Zhen Hospital
  • Li Chu, MD, MS, An Zhen Hospital]
  • Yunping Zhang, MD, Haidian Children and Women’s Hospital
  • Xiaomei Jia, MD, Haidian Children and Women’s Hospital
  • Yanjun Guo, MD, PhD, HangTian General Hospital
  • Meixia Liu, MD, MPH, Wuzhou Women’s Hospital