妊娠中の緑地、大気汚染、気温への曝露と早産児の予後

Alice Aveline¹, Nicole Bando², Mohammad Noaeen^3,4

¹Neonatal Medicine Research Group, Imperial College London, London, United Kingdom.

JAMA network open

|February 26, 2026

要旨

Importance:

Existing evidence shows that the environment is a risk factor in preterm birth. However, more evidence is needed about the association between environmental exposures and outcomes of preterm birth.

Objective:

To examine the association of antepartum exposure to individual and combined indices of greenness, air pollution, and extreme temperatures with outcomes of preterm infants.

Design, Setting, And Participants:

This cohort study used linked national databases of the Canadian Neonatal Network and Canadian Urban Environmental Health Research Consortium. The cohort consisted of infants born at 22 to 28 weeks plus 6 days' gestation between January 1, 2010, and December 31, 2020, and treated in tertiary neonatal intensive care units (NICUs) across Canada. Data were analyzed between May 1 and September 15, 2024.

Exposure:

Indices summarizing levels of greenness, air pollutants, and ambient temperature at mothers' residential postal code at birth.

Main Outcome And Measure:

Infant survival without major morbidity (SWMM) assessed at death or discharge from the NICU. Logistic regression models estimated associations between individual and combination of indices with SWMM.

Results:

A total of 14 748 infants (7965 males [54.0%]; mean [SD] gestational age, 26.1 [1.6] weeks; median [IQR] birth weight, 890 [720-1090] g) were included. The rate of SWMM was 32.1% (4737 of 14 748). Infants born to mothers who were exposed to high ozone levels had lower odds of SWMM vs infants with mothers exposed to low ozone levels (adjusted odds ratio [AOR], 0.83; 95% CI, 0.74-0.95). Infants with antepartum exposure to low temperature combined with either high levels of ozone (AOR, 0.76; 95% CI, 0.60-0.95) or low levels of greenness (AOR, 0.77; 95% CI, 0.60-0.99) or both low levels of greenness and high levels of ozone (AOR, 0.58; 95% CI, 0.43-0.77) had lower odds of SWMM than infants with mothers who were not exposed to these risk factors.

Conclusions And Relevance:

In this cohort study, antepartum exposure to high ozone and combined low temperatures and low levels of greenness or high ozone were associated with lower odds of SWMM in preterm infants. These findings suggest that the health outcomes of antepartum environmental exposure extend to neonatal outcomes of preterm infants.

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