Road Traffic Noise Exposure and Birth Outcomes: An Updated Systematic Review and Meta-Analysis

Unlike the other WHO evidence reviews, the systematic review on birth outcomes could not provide a quantitative estimate of the effect of environmental noise. With that in mind, we aimed to update it with additional studies published through to 12 May, 2019 to allow for a formal meta-analysis of the association of residential road traffic noise with birth weight, low birth weight (LBW), small for gestational age (SGA), and preterm birth (PTB). The quality effects and random effects estimators were used for meta-analysis and the robustness of findings was tested in several sensitivity analyses. Nine studies were included in the qualitative synthesis, from which we extracted seven estimates for birth weight (n = 718,136 births) and LBW (n = 620,221), and five for SGA (n = 547,256) and PTB (n = 74,609). We found -8.26 g (95% CI: -20.61 g, 4.10 g) (I = 87%) lower birth weight associated with a 10 dB(A) increase in day-evening-night noise level (L_den), and this effect became significant in sensitivity analyses. No evidence of significant effects was found for LBW (OR = 1.06; 95% CI: 0.91, 1.23) (I = 49%), SGA (OR = 1.02; 95% CI: 0.86, 1.21) (I = 90%), or PTB (OR = 1.00; 95% CI: 0.79, 1.27) (I = 69%). The quality of evidence for continuous birth weight was graded as "moderate", while for the other outcomes it was deemed "very low". Finally, we discuss limitations of the risk of bias assessment criteria employed by Nieuwenhuijsen et al.