Maternal air pollution exposure and preterm birth in Wuxi, China: Effect modification by maternal age

Numerous studies have investigated prenatal air pollution and shown that air pollutants have adverse effect on birth outcomes. However, which trimester was the most sensitive and whether the effect was related to maternal age is still ambiguous.

This study aims to explore the association between maternal air pollution exposure during pregnancy and preterm birth, and if this relationship is modified by maternal age.

In this retrospective cohort study, we examine the causal relationship of prenatal exposure to air pollutants including particulate matters, which are less than 10 µm (PM₁₀), and ozone (O₃), which is one of the gaseous pollutants, on preterm birth by gestational age. A total of 6693 pregnant women were recruited from Wuxi Maternal and Child Health Care Hospital. The participants were dichotomized into child-bearing age group (< 35 years old) and advanced age group (> = 35 years old) in order to analyze the effect modification by maternal age. Logistic and linear regression models were performed to assess the risk for preterm birth (gestational age < 37 weeks) caused by prenatal air pollution exposure.

With adjustment for covariates, the highest level of PM₁₀ exposure significantly increased the risk of preterm birth by 1.42-fold (95% CI: 1.10, 1.85) compared those with the lowest level in the second trimester. Trimester-specific PM₁₀ exposure was positively associated with gestational age, whereas O₃ exposure was associated with gestational age in the early pregnancy. When stratified by maternal age, PM₁₀ exposure was significantly associated with an increased risk of preterm birth only in the advanced age group during pregnancy (OR:2.15, 95% CI: 1.13, 4.07). The results suggested that PM₁₀ exposure associated with preterm birth was modified by advanced maternal age (OR _interaction = 2.00, 95% CI: 1.02, 3.91, P_interaction = 0.032).

Prenatal air pollution exposure would increase risk of preterm birth and reduced gestational age. Thus, more attention should be paid to the effects of ambient air pollution exposure on preterm birth especially in pregnant women with advanced maternal age.