Effects of air pollution on neonatal prematurity in Guangzhou of China

Qingguo Zhao et al. Environmental Health 2011, 102

Background

Air pollution affects the health of children as well as the elderly, and it has been increasingly noticed and also studied in the recent years as a new public health challenge. Some studies have already shown that air pollution is associated with an increased risk rate of adverse pregnancy outcomes [1, 2]. International survey data showed a 7-10% premature rate [3] in the industrialized countries, and 9-12% in United States in recent years, displaying an upward trend [4]. A survey in China indicated a 5-15% preterm rate increasing [5].

Fifteen percent of preterm babies die in neonatal period. In addition to fatal malformations, 70% of neonatal deaths and 75% of neonatal complications are associated with premature births [6]. Complications include respiratory diseases, intracerebral hemorrhage, infections and dysplasia. Compared with full-term babies, premature babies suffer greater exposure to cerebral palsy, amblyopia, deafness and mental retardation [7]. It has been shown that prematurity was not only a major cause in neonatal deaths, but also a substantial contributor to diabetes mellitus, coronary heart disease and hypertension in adulthood [8,9]. Hence, seeking the causes and the risk factors of preterm birth is of vital importance to public health.

By the end of the twentieth century, researches on possible risk factors of premature birth were mainly focused on the socio-economics level, educational achievements, smoking status and drinking behavior during pregnancy, intrauterine infections, multiple births, parity history including abortions, still births and preterm births, genital abnormality, pregnancy-induced hypertension, risky sexual behavior, etc [10-15]. During the last decade, an increasing number of researchers have noticed the possible causality between air pollutants and the occurrence of prematurity, which lead to a large number of studies in America, Canada, Australia, Lithuania and China concerning this topic.

The results suggested that exposure to air pollutants such as NO2, PM10 and SO2 during pregnancy were possibly related to premature births [16-19]. Meanwhile, cities in China such as Beijing, Taiyuan and Taibei have also conducted such studies revealing that the increased concentration of air pollutants such as NO2, PM10 and SO2 presents as a risk attributing to premature births [20-22].

In this study we applied the Generalized Additive Model (GAM) extended Poisson regression model to quantitatively evaluate the effects of ambient air pollutants, NO2, PM10 and SO2, on the preterm birth by analyzing the time-series data of air pollution, meteorological factors, and preterm births in Guangdong Province in 2007.

Results

Despite the limitations of research data, the result of this study indicated positive effects of the NO2, PM10 and SO2 on preterm birth risk. Although the absolute increase of risk is relatively small, we still need to take into accounts that the air pollution is a long term public health challenge, as everyday and everyone is being exposed to it, especially the pregnant women, thousands of pregnant women could have been exposed to high levels of air pollution in a long-term period. Therefore, the public health significance can not be ignored.

Conclusions
In summary, this paper has examined that the concentrations of the NO2, PM10 and SO2 of air pollutants contributed to occurrence of preterm birth in Guangzhou city, and has shown that the three air pollutants have dose-response reactions in terms of neonatal prematurity, through analyzing a single air pollutant model and a multiple air pollutants GAM model.

Although there were limitations in this study, it provided the fact that air pollution plays a non-neglectable role in prematurity. Thus, it highlights the importance of policy-makers making decisions to control air pollution and decrease rate of preterm birth.

The complete article and references are available as a provisional PDF

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