The Association between Preterm Birth and Ambient Air Pollution Exposure in Shiyan, China, 2015-2017

Shortening of the gestational duration has been found associated with ambient air pollution exposure. However, the critical exposure windows of ambient air pollution for gestational duration remain inconsistent, and the association between ambient air pollution and early term births (ETB, 37 to 38 weeks) has rarely been studied relative to preterm births (PTB, 28-37 weeks). A time-series study was conducted in Shiyan, a medium-sized city in China. Birth information was collected from the Shiyan Maternity and Child Health Hospital, and 13,111 pregnant women who gave birth between 2015 and 2017 were included. Data of the concentrations of air pollutants, including PM₁₀, PM_2.5, NO₂, and SO₂ and meteorological data, were collected in the corresponding gestational period. The Cox regression analysis was performed to estimate the relationship between ambient air pollution exposure and the risk of preterm birth after controlling the confounders, including maternal age, education, Gravidity, parity, fetal gender, and delivery mode. Very preterm birth (VPTB, 28-32 weeks) as a subtype of PTB was also incorporated in this study. The risk of VPTB and ETB was positively associated with maternal ambient air pollution exposure, and the correlation of gaseous pollutants was stronger than particulate matter. With respect to exposure windows, the critical trimester of air pollutants for different adverse pregnancy outcomes was different. The exposure windows of PM₁₀, PM_2.5, and SO₂ for ETB were found in the third trimester, with HRs (hazard ratios) of 1.06 (95%CI: 1.04, 1.09), 1.07 (95%CI: 1.04, 1.11), and 1.28 (95%CI: 1.20, 1.35), respectively. However, for NO₂, the second and third trimesters exhibited similar results, the HRs reaching 1.10 (95%CI: 1.03, 6.17) and 1.09 (95%CI: 1.03,1.15), respectively. This study extends and strengthen the evidence for a significant correlation between the ambient air pollution exposure during pregnancy and the risk of not only PTB but, also, ETB. Moreover, our findings suggest that the exposure windows during pregnancy vary with different air pollutants and pregnancy outcomes.