Prenatal ozone exposure and child lung function: Exploring effect modification by oxidative balance score

Affiliations

¹ Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA. Electronic address: dearbl@uw.edu.
² Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA.
³ Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, DE, USA.
⁴ Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA.
⁵ Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.
⁶ Division of Epidemiology and Biostatistics, School of Public Health, College of Health and Human Services, San Diego State University, San Diego, CA, USA.
⁷ Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁸ Division of Pulmonary and Critical Care Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
⁹ Department of Psychiatry and Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
¹⁰ Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
¹¹ Department of Pediatrics, School of Medicine, Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA.
¹² Department of Pediatrics, Department of Environmental Medicine & Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

PMID: 39671893
PMCID: PMC11788037 (available on 2026-03-01)
DOI: 10.1016/j.ijheh.2024.114491

Prenatal ozone exposure and child lung function: Exploring effect modification by oxidative balance score

Logan C Dearborn et al. Int J Hyg Environ Health. 2025 Mar.

. 2025 Mar:264:114491.

doi: 10.1016/j.ijheh.2024.114491. Epub 2024 Dec 12.

Authors

Affiliations

¹ Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA. Electronic address: dearbl@uw.edu.
² Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA.
³ Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, DE, USA.
⁴ Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA.
⁵ Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.
⁶ Division of Epidemiology and Biostatistics, School of Public Health, College of Health and Human Services, San Diego State University, San Diego, CA, USA.
⁷ Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁸ Division of Pulmonary and Critical Care Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
⁹ Department of Psychiatry and Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
¹⁰ Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
¹¹ Department of Pediatrics, School of Medicine, Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA.
¹² Department of Pediatrics, Department of Environmental Medicine & Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

PMID: 39671893
PMCID: PMC11788037 (available on 2026-03-01)
DOI: 10.1016/j.ijheh.2024.114491

Abstract

Background: Prenatal exposures to ozone (O₃) may impact child lung function, including through oxidative stress pathways, contributing to lifelong morbidity. Diet, reflected in oxidative balance scores (OBS), may modify these pathways and is a potential target for interventions to mitigate O₃ effects.

Methods: We examined associations between prenatal exposure to O₃ and child lung function at age 8-9 years via spirometry in the CANDLE cohort within the ECHO-PATHWAYS Consortium. O₃ was estimated using a point-based spatiotemporal model and averaged over fetal morphological lung development phases: pseudoglandular, canalicular, and saccular. Lung function z-scores were calculated for FEV₁, FVC, FEV₁/FVC, and FEF_25-75. OBS during pregnancy was derived using maternal diet and lifestyle factors. Linear regression models adjusted for child, maternal, and neighborhood characteristics and exposure in other prenatal windows. Using two and three-way multiplicative interaction terms, we explored effect modification by OBS and maternal race.

Results: Women (N = 661) self-identified as Black (61%), White (33%), or another race (6%); 40.7% attended some college/technical school. Mean O₃ concentrations ranged from 26.1 to 29.5 ppb across exposure windows. No associations between prenatal O₃ exposure and lung function were observed in primary models, although there was a suggestive adverse association of 10 ppb higher O₃ in the saccular window (24-35 weeks) with lower z-scores for FEV₁/FVC (-0.23, 95% CI: -0.52, 0.05) and FEF_25-75 (-0.17, 95% CI: -0.43, 0.09). No effect modification by OBS or maternal race was found in two-way models. In three-way interaction models, higher O₃ was associated with lower child FEV₁ among Black women with lower OBS and among White women with higher OBS although data was sparse for those with the highest OBS.

Conclusions: In a large, well-characterized pregnancy cohort, we did not find robust evidence of an effect of prenatal O₃ on lung function. There was suggestion of enhanced vulnerability for some subgroups in exploratory analyses.

Keywords: Diet; FEV(1); Maternal exposure; Oxidative stress; Ozone; Spirometry.

Published by Elsevier GmbH.

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References

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Prenatal ozone exposure and child lung function: Exploring effect modification by oxidative balance score

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Prenatal ozone exposure and child lung function: Exploring effect modification by oxidative balance score

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