Effects of prenatal exposure to air pollution on preeclampsia in Shenzhen, China

Abstract

The impact of ambient air pollution on pregnant women is a concern in China. However, little is known about the association between air pollution and preeclampsia and the potential modifying effects of meteorological conditions have not been assessed. This study aimed to assess the effects of prenatal exposure to air pollution on preeclampsia, and to explore whether temperature and humidity modify the effects. We performed a retrospective cohort study based on 1.21 million singleton births from the birth registration system in Shenzhen, China, between 2005 and 2012. Daily average measurements of particulate matter <10 μm (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), air temperature (T), and dew point (T_d) were collected. Logistic regression models were performed to estimate associations between air pollution and preeclampsia during the first and second trimesters, and during the entire pregnancy. In each time window, we observed a positive gradient of increasing preeclampsia risk with increasing quartiles of PM₁₀ and SO₂ exposure. When stratified by T and T_d in three categories (<5th, 5th -95th, and >95th percentile), we found a significant interaction between PM₁₀ and T_d on preeclampsia; the adverse effects of PM₁₀ increased with T_d. During the entire pregnancy, there was a null association between PM₁₀ and preeclampsia under T_d < 5th percentile. Preeclampsia risk increased by 23% (95% CI: 19-26%) when 5th < T_d < 95th percentile, and by 34% (16-55%) when T_d > 95th percentile. We also found that air pollution effects on preeclampsia in autumn/winter seasons were stronger than those in the spring/summer. This is the first study to address modifying effects of meteorological factors on the association between air pollution and preeclampsia. Findings indicate that prenatal exposure to PM₁₀ and SO₂ increase preeclampsia risk in Shenzhen, China, and the effects could be modified by humidity. Pregnant women should limit air pollution exposure, particularly during humid periods.

Keywords: Air pollution; Humidity; Modification; Preeclampsia; Temperature.