Maternal exposure to ambient air pollution mixture and premature rupture of membranes: Evidence from a large cohort in Southern California (2008-2018)

Anqi Jiao; Yi Sun; Chantal Avila; Vicki Chiu; John Molitor; Jeff Slezak; David A Sacks; Jiu-Chiuan Chen; Tarik Benmarhnia; Darios Getahun; Jun Wu

doi:10.1016/j.envint.2023.108030

Maternal exposure to ambient air pollution mixture and premature rupture of membranes: Evidence from a large cohort in Southern California (2008-2018)

Environ Int. 2023 Jul:177:108030. doi: 10.1016/j.envint.2023.108030. Epub 2023 Jun 11.

Authors

Anqi Jiao¹, Yi Sun², Chantal Avila³, Vicki Chiu³, John Molitor⁴, Jeff Slezak³, David A Sacks⁵, Jiu-Chiuan Chen⁶, Tarik Benmarhnia⁷, Darios Getahun⁸, Jun Wu⁹

Affiliations

¹ Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA.
² Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA; Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³ Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
⁴ College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA.
⁵ Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
⁶ Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
⁷ Scripps Institution of Oceanography, University of California, San Diego, CA, USA.
⁸ Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA. Electronic address: Darios.T.Getahun@kp.org.
⁹ Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA. Electronic address: junwu@hs.uci.edu.

Abstract

Background: There is minimal evidence of relationships between maternal air pollution exposure and spontaneous premature rupture of membranes (SPROM), a critical obstetrical problem that can significantly increase maternal and fetal mortality and morbidity. No prior study has explored the PROM risk related to specific components of particulate matter with aerodynamic diameters of ≤ 2.5 µm (PM_2.5). We examined associations between maternal exposure to nitrogen dioxide (NO₂), ozone (O₃), PM_2.5, PM₁₀, and PM_2.5 constituents and SPROM.

Methods: A large retrospective cohort study was conducted and included 427,870 singleton live births from Kaiser Permanente Southern California during 2008-2018. Monthly averages of NO₂, O₃ (8-h daily maximum), PM_2.5, and PM₁₀ were measured using empirical Bayesian kriging based on measurements from monitoring stations. Data on PM_2.5 sulfate, nitrate, ammonium, organic matter, and black carbon were obtained from a fine-resolution model. A discrete time approach with pooled logistic regressions was used to estimate associations throughout the pregnancy and based on trimesters and gestational months. The quantile-based g-computation models were fitted to examine the effects of 1) the air pollution mixture of four pollutants of interest and 2) the mixture of PM_2.5 components.

Results: There were 37,857 SPROM cases (8.8%) in our study population. We observed relationships between SPROM and maternal exposure to NO₂, O₃, and PM_2.5. PM_2.5 sulfate, nitrate, ammonium, and organic matter were associated with higher SPROM risks in the single-pollutant model. Mixture analyses demonstrated that the overall effects of the air pollution mixture and PM_2.5 mixture in this study were mainly driven by O₃ and PM_2.5 nitrate, respectively. Underweight mothers had a significantly higher risk of SPROM associated with NO₂.

Conclusion: Our findings add to the literature on associations between air pollution exposure and SPROM. This is the first study reporting the impact of PM_2.5 constituents on SPROM.

Keywords: Air pollution; Maternal exposure; Ozone; Particulate matter; Pregnancy outcome; Premature rupture of membranes.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Air Pollutants* / adverse effects
Air Pollutants* / analysis
Air Pollution* / adverse effects
Air Pollution* / analysis
Bayes Theorem
Environmental Exposure / analysis
Environmental Pollutants*
Female
Humans
Maternal Exposure / adverse effects
Nitrates
Nitrogen Dioxide / adverse effects
Nitrogen Dioxide / analysis
Particulate Matter / adverse effects
Particulate Matter / analysis
Pregnancy
Premature Birth*
Retrospective Studies

Substances

Air Pollutants
Nitrogen Dioxide
Nitrates
Particulate Matter
Environmental Pollutants

Grants and funding

R01 ES030353/ES/NIEHS NIH HHS/United States