Correlation between exposure to fine particulate matter and hypertensive disorders of pregnancy in Shanghai, China

Association between fine particulate matter (PM_2.5) and hypertensive disorders of pregnancy (HDP) is inconsistent and appears to change in each trimester. We aim to investigate the association of exposure to ambient PM_2.5 in early pregnancy with HDP.

A retrospective cohort study was performed among 8776 women with singleton pregnancy who attended the antenatal clinic before 20 gestational weeks in a tertiary women's hospital during 2014-2015. Land use regression models were used to predict individual levels of PM_2.5 exposure.

The average PM_2.5 concentration during the first 20 gestational weeks ranged from 28.6 to 74.8 μg m^- 3 [median, 51.4 μg m^- 3; interquartile range, 47.3-57.8 μg m^- 3]. A total of 440 (5.0%) women was diagnosed with HDP. The restricted cubic spline showed a positive exposure-response relationship between the PM_2.5 concentration and risk of HDP. We observed an association between PM_2.5 exposure during the first trimester with HDP (RR = 3.89 per 10 μg m^- 3, 95% CI: 1.45-10.43), but not during the second trimester (RR = 0.71 per 10 μg m^- 3, 95% CI: 0.40-1.27). Compared with their counterparts, nulliparous women who were exposed to high levels of PM_2.5 in the index pregnancy had a higher risk of developing HDP [the relative excess risk due to interaction was 0.92 (0.46-1.38)].

Our findings suggest that PM_2.5 exposure during the first trimester is associated with the development of HDP. The effect estimate is more obvious for nulliparous women than multiparous women.