Air pollution from incinerators and reproductive outcomes: a multisite study
Silvia Candela1, Andrea Ranzi, Laura Bonvicini
1From the aEpidemiology Unit, Local Health Authority, Reggio Emilia, Italy; bRegional Reference Centre on Environment and Health, ARPA Emilia-Romagna, Modena, Italy; cPublic Health Service, Emilia-Romagna Region, Italy; and dDepartment of Epidemiology, Lazio Region, Italy.
Background:
The few studies that have investigated the relationship between emissions from municipal solid-waste incinerators and adverse pregnancy outcomes have had conflicting results. We conducted a study to assess the effects of air emissions from the eight incinerators currently in operation in the Emilia-Romagna Region of Italy on reproductive outcomes (sex ratio, multiple births, preterm births, and small for gestational age [SGA] births).
Methods:
We considered all births (n = 21,517) to women residing within a 4-km radius of an incinerator at the time of delivery during the period 2003-2010 who were successfully linked to the Delivery Certificate database. This source also provided information on maternal characteristics and deliveries. Each newborn was georeferenced and characterized by a specific level of exposure to incinerator emissions, categorized in quintiles of PM10, and other sources of pollution (NOx quartiles), evaluated by means of ADMS-Urban system dispersion models. We ran logistic regression models for each outcome, adjusting for exposure to other pollution sources and maternal covariates.
Results:
Incinerator pollution was not associated with sex ratio, multiple births, or frequency of SGA. Preterm delivery increased with increasing exposure (test for trend, P < 0.001); for the highest versus the lowest quintile exposure, the odds ratio was 1.30 (95% confidence interval = 1.08-1.57). A similar trend was observed for very preterm babies. Several sensitivity analyses did not alter these results.
Conclusions:
Maternal exposure to incinerator emissions, even at very low levels, was associated with preterm delivery.
