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. 2019 Jan;30(1):4-10.
doi: 10.1097/EDE.0000000000000918.

Traffic-related Air Pollution and Pregnancy Loss

Marianthi-Anna Kioumourtzoglou  1 , Raanan Raz  2 , Ander Wilson  3 , Ronen Fluss  2 , Ronit Nirel  4 , David M Broday  5 , Yuval  5 , Michele R Hacker  6   7 , Thomas F McElrath  8 , Itamar Grotto  9   10 , Petros Koutrakis  11 , Marc G Weisskopf  7   11
Affiliations

Traffic-related Air Pollution and Pregnancy Loss

Marianthi-Anna Kioumourtzoglou et al. Epidemiology. 2019 Jan.

Abstract

Background: Traffic-related air pollution has been linked to multiple adverse pregnancy outcomes. However, few studies have examined pregnancy loss, targeting losses identified by hospital records, a large limitation as it does not capture events not reported to the medical system.

Methods: We used a novel variation of the time-series design to determine the association, and identify the critical window of vulnerability, between week-to-week traffic-related air pollution and conceptions resulting in live births, using nitrogen dioxide (NO2) as a traffic emissions tracer. We used information from all live births recorded at Beth Israel Deaconess Medical Center in Boston, MA (2000-2013) and all live births in Tel Aviv District, Israel (2010-2013).

Results: In Boston (68,969 live births), the strongest association was during the 15th week of gestation; for every 10 ppb of NO2 increase during that week, we observed a lower rate of live births (rate ratio [RR] = 0.87; 95% confidence interval [CI], 0.78, 0.97), using live birth-identified conceptions to infer pregnancy losses. In the Tel Aviv District (95,053 live births), the strongest estimate was during the 16th gestational week gestation (RR = 0.82; 95% CI, 0.76, 0.90 per 10 ppb of NO2).

Conclusions: Using weekly conceptions ending in live birth rather than identified pregnancy losses, we comprehensively analyzed the relationship between air pollution and all pregnancy loss throughout gestation. The observed results, with remarkable similarity in two independent locations, suggest that higher traffic-related air pollution levels are associated with pregnancy loss, with strongest estimates between the 10th and 20th gestational weeks.

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Conflict of interest statement

Conflict of interest:

Nothing to disclose.

Figures

Figure 1.
Figure 1.
An example of the study design (using simulated data). The top plot shows the daily number of births, i.e. the observable data. The middle plot shows the weekly counts of live-birth identified conceptions (LBIC), which are constructed by mapping the live births back to the conception week by subtracting gestational age from the date of birth. The bottom plot shows the weekly NO2 time-series. In gray, we highlight one example for the unit of analysis (weekly number of LBIC), from the daily births, to the NO2 exposure window of that LBIC (in gestational weeks).
Figure 2.
Figure 2.
Association between weekly NO2 levels over gestation and change in number of live births (solid black line for Boston and gray dashed line for Tel Aviv District). The shaded areas represent the 95% confidence intervals (striped black for Boston and solid gray for Tel Aviv District).
Figure 3.
Figure 3.
Sensitivity Analysis: Association between weekly NO2 levels over gestation and change in number of live births (solid black line for Boston and gray dashed line for Tel Aviv District). The shaded areas represent the 95% confidence intervals (striped black for Boston and solid gray for Tel Aviv). For Boston this analysis is restricted to births of women living within 20 km of BIDMC. For Tel Aviv District these are the same results as those presented in Figure 2.
See this image and copyright information in PMC

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