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Associations of Pre- and Postnatal Air Pollution Exposures with Child Blood Pressure and Modification by Maternal

Yu Ni¹, Adam A Szpiro², Michael T Young³

¹Department of Epidemiology, School of Public Health, University of Washington (UW), Seattle, Washington, USA.

Environmental Health Perspectives

|April 2, 2021

Insights

Exposure to nitrogen dioxide during pregnancy is linked to higher blood pressure in young children. This association may be influenced by maternal folate levels, highlighting potential environmental impacts on early cardiovascular health.

Area of Science:

Environmental health
Pediatric health
Cardiovascular disease epidemiology

Background:

Limited evidence suggests air pollution contributes to pediatric high blood pressure (HBP).
Pediatric HBP is a predictor of adult cardiovascular diseases.

Purpose of the Study:

To investigate the association between prenatal air pollution exposure and early childhood blood pressure.
To explore potential effect modification by maternal nutrition, child sex, and maternal race.

Main Methods:

The Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study included 822 mother-child dyads.
Air pollutant estimates (nitrogen dioxide [NO2] and particulate matter [PM2.5]) were obtained for pre- and postnatal windows.
Multivariate regressions were used to assess associations between air pollutants and blood pressure percentiles (SBP, DBP).

Main Results:

Higher second-trimester NO2 exposure was associated with increased SBP percentile (14.6 per 1 ppb increase) and DBP percentile (8.7 per 1 ppb increase).
Prenatal NO2 exposure was significantly associated with higher DBP percentiles.
Associations were stronger in children with lower maternal folate concentrations and in female children.

Conclusions:

Higher prenatal NO2 exposure, especially in the second trimester, is associated with elevated early childhood blood pressure.
Maternal folate concentrations may modify this adverse association.
Further research is needed to understand the impact of air pollution on pediatric cardiovascular health.

Read full analysis

Abstract

Background:

Limited data suggest air pollution exposures may contribute to pediatric high blood pressure (HBP), a known predictor of adult cardiovascular diseases.

Methods:

We investigated this association in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study, a sociodemographically diverse pregnancy cohort in the southern United States with participants enrolled from 2006 to 2011. We included 822 mother-child dyads with available address histories and a valid child blood pressure measurement at 4-6 y. Systolic (SBP) and diastolic blood pressures (DBP) were converted to age-, sex-, and height-specific percentiles for normal-weight U.S. children. HBP was classified based on SBP or DBP percentile. Nitrogen dioxide () and particulate matter in aerodynamic diameter () estimates in both pre- and postnatal windows were obtained from annual national models and spatiotemporal models, respectively. We fit multivariate Linear and Poisson regressions and explored multiplicative joint effects with maternal nutrition, child sex, and maternal race using interaction terms.

Results:

Mean and in the prenatal period were 10.8 [standard deviation (SD): 0.9] and 10.0 (SD: 2.4) ppb, respectively, and 9.9 (SD: 0.6) and 8.8 (SD: 1.9) ppb from birth to the 4-y-old birthday. On average, SBP percentile increased by 14.6 (95% CI: 4.6, 24.6), and DBP percentile increased by 8.7 (95% CI: 1.4, 15.9) with each increase in second-trimester . averaged over the prenatal period was only significantly associated with higher DBP percentiles [ 11.6 (95% CI: 2.9, 20.2)]. Positive associations of second-trimester with SBP and DBP percentiles were stronger in children with maternal folate concentrations in the lowest quartile ( 0.05 and 0.07, respectively) and associations with DBP percentiles were stronger in female children ( 0.05). We did not detect significant association of , road proximity, and postnatal with any outcomes.

Conclusions:

The findings suggest that higher prenatal exposure, particularly in the second trimester, is associated with elevated early childhood blood pressure. This adverse association could be modified by pregnancy folate concentrations. https://doi.org/10.1289/EHP7486.

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