Air pollution mixture exposure during pregnancy and postpartum psychological functioning: racial/ethnic- and fetal sex-specific associations

Abstract

Background: Prenatal air pollution (AP) exposure has been linked to postpartum psychological functioning, impacting health outcomes in both women and children. Extant studies primarily focused on individual pollutants.

Objective: To assess the association between prenatal exposure to a mixture of seven AP components and postpartum psychological functioning using daily exposure data and data-driven statistical methods.

Methods: Analyses included 981 women recruited at 24.0 ± 9.9 weeks gestation and followed longitudinally. We estimated prenatal daily exposure levels for constituents of fine particles [elemental carbon (EC), organic carbon (OC), nitrate (NO₃^-), sulfate (SO₄^2-), ammonium (NH₄⁺)], nitrogen dioxide (NO₂), and ozone (O₃) using validated global 3-D chemical-transport models and satellite-based hybrid models based on residential addresses. Edinburgh Postnatal Depression Scale (EPDS) was administered to participants to derive a total EPDS score and the subconstruct scores for anhedonia and depressive symptoms. A distributed lag model (DLM) was employed within Bayesian Kernel Machine Regression (BKMR) to develop time-weighted exposure profile for each pollutant. These exposures were then input into a Weighted Quantile Sum (WQS) regression to estimate an overall mixture effect, adjusted for maternal age, education, race/ethnicity, season of delivery, and delivery year. Effect modification by race/ethnicity and fetal sex was also examined.

Results: Women were primarily Hispanic (51%) and Black (32%) reporting ≤12 years of education (58%). Prenatal exposure to an AP mixture was significantly associated with increased anhedonia subscale z-scores, particularly in Hispanics (β = 0.07, 95%CI = 0.004-0.13, per unit increase in WQS index). It was also borderline associated with increased total EPDS (β = 0.11, 95%CI = 0.00-0.22) and depressive symptom subscale (β = 0.09, 95%CI = -0.02 to 0.19) z-scores, particularly among Hispanic women who gave birth to a male infant. Sulfate (SO₄^2-), O₃ and OC were major contributors to these associations.

Impact: This study utilizes an advanced data-driven approach to examine the temporally- and mixture-weighted effects of prenatal air pollution exposure on postpartum psychological functioning. We found that exposure to a prenatal air pollution mixture predicted poorer postpartum psychological functioning, particularly anhedonia symptoms in Hispanic women. Findings underscore the importance of considering both exposure mixtures as well as potential modifying factors to better help identify particular pollutants that drive effects and susceptible populations, which can inform more effective intervention strategies.

Keywords: Air pollution; Health disparities; Mixture; Postpartum depression; Prenatal exposure.

Figure 1.. Predicted exposure levels of each component of AP mixture averaged across pregnancy for the study participants

This figure demonstrates the predicted prenatal averaged exposure levels of the seven air pollutants (upper panel from left to right: EC, OC, SO₄²⁻, NO₃⁻; bottom panel from left to right: NH₄⁺, NO₂, O₃) for study participants. The exposure patterns were dependent on the mixture component.

Figure 2.. Race/ethnicity- and fetal sex-specific associations between the prenatal AP mixture and EPDS outcomes

Associations between prenatal exposure to AP mixture and postpartum EPDS outcomes using WQS regressions based on the exposure-window weighted AP mixture levels derived by BKMR-DLMs. Panel (A), Total EPDS Score; Panel (B), Anhedonia subscale; Panel (C), Depressive Symptom subscale. Models were adjusted for maternal age, education, season of birth, and year of birth. Race/ethnicity was adjusted in the models not stratified by race/ethnicity. Solid shaped-icons denote beta-estimate of change in z-score of EPDS measurements corresponding to per unit increase in WQS index, and error bars denote 95% confidence interval (95% CI).