Environmental Science and Pollution Research

, Volume 26, Issue 3, pp 2397–2408 | Cite as

Outdoor air pollution pregnancy exposures are associated with behavioral problems in China’s preschoolers

  • Yunzhao Ren
  • Xing Yao
  • Yisi Liu
  • Suyang Liu
  • Xiao Li
  • Qing Huang
  • Feifei Liu
  • Na Li
  • Yuanan Lu
  • Zhanpeng Yuan
  • Shiyue LiEmail author
  • Hao XiangEmail author
Research Article


There are mounting evidences indicated that maternal exposure to outdoor air pollutants in pregnancy affects children’s neural development, but the researches on children’s behavioral difficulties are seldom. We explored the association between maternal exposure to outdoor air pollution during different trimesters of pregnancy and the prevalence of behavioral difficulties among 657 preschool children aged 3–4 from three kindergartens in Wuhan, China. This is a cross-sectional study. Children’s behavioral difficulties were assessed by the Strengths and Difficulties Questionnaire (SDQ) (reported by parents). Maternal exposure to outdoor air pollutants during pregnancy were estimated based on the daily average measured concentration levels from ground monitoring stations. Potential confounding factors including children-related, maternal, and socio-economic status (SES) were adjusted in the study. We calculated the prevalence of each type of behavioral difficulties and used binary logistic regression method to estimate the crude odds ratio (cOR), adjusted odds ratio (aOR), and corresponding 95% confidence intervals (95% CIs) for 1 μg/m3 increase in each air pollutant during every exposure window in single- and two-pollutant models. The prevalence of participants’ total behavioral difficulties was 9.6%. In single-pollutant models, during full gestation, positive associations were observed between exposure to NO2 (aOR = 1.204, 95% CI 1.042, 1.392), particle matter (PM)10 (aOR = 1.070, 95% CI 1.018, 1.125), PM2.5 (aOR = 1.095, 95% CI 1.021, 1.176) and total difficulties, exposure to PM10 (aOR = 1.040, 95% CI 1.001, 1.081), PM2.5 (aOR = 1.053, 95% CI 1.000, 1.109) and prosocial behavior, respectively. In the first trimester, exposure to SO2 (aOR = 1.047, 95% CI 1.009, 1.086), NO2 (aOR = 1.039, 95% CI 1.013, 1.066), PM10 (aOR = 1.013, 95% CI 1.004, 1.023), and PM2.5 (aOR = 1.016, 95% CI 1.004, 1.028) were all positively associated with total difficulties. The associations between second and third trimesters’ exposure to all pollutants and outcomes were not statistically significant. However, in the two-pollutant models, second trimester exposure to PM2.5 (aOR = 1.078, 95%CI 1.023, 1.137) was positively associated with total behavioral difficulties after adjusting for PM10. Exposure to outdoor air pollutants SO2, NO2, PM10, and PM2.5 during pregnancy may be associated with behavioral difficulties, especially in the first trimester.


Air pollution Behavioral difficulties Pregnancy China 



We gratefully thank all the children, their parents/guardians for their enthusiastic participation, and all the staff of kindergartens for their cooperation. The three kindergartens were Qingqing kindergarten, No.1 kindergarten of Qingshan District, and No.2 kindergarten of Hubei Provincial direct organ, respectively.


This study was funded by the Natural Science Fund of Hubei Province (grant number 2018CFB634).

Compliance with ethical standards

This study was conducted within an agreement of Wuhan University. All the parents recruited in the study signed informed consent letters before the survey.

Conflicts of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Yunzhao Ren
    • 1
  • Xing Yao
    • 1
  • Yisi Liu
    • 2
  • Suyang Liu
    • 1
    • 3
  • Xiao Li
    • 4
  • Qing Huang
    • 1
  • Feifei Liu
    • 1
  • Na Li
    • 1
  • Yuanan Lu
    • 5
  • Zhanpeng Yuan
    • 1
  • Shiyue Li
    • 1
    Email author
  • Hao Xiang
    • 1
    • 3
    Email author
  1. 1.School of Health SciencesWuhan UniversityWuhanChina
  2. 2.Department of Environmental and Occupational Health Sciences, School of Public HealthUniversity of WashingtonSeattleUSA
  3. 3.Global Health InstituteWuhan UniversityWuhanChina
  4. 4.Gilead Sciences IncFoster CityUSA
  5. 5.Environmental Health Laboratory, Department of Public Health SciencesUniversity of Hawaii at ManoaHonoluluUSA

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