Air Quality, Atmosphere & Health

, Volume 5, Issue 4, pp 369–381 | Cite as

Exposure to particulate matter and adverse birth outcomes: a comprehensive review and meta-analysis

  • Amir SapkotaEmail author
  • Adam P. Chelikowsky
  • Keeve E. Nachman
  • Aaron J. Cohen
  • Beate Ritz


Increasing number of studies have investigated the impact of maternal exposure to air pollution during pregnancy and adverse birth outcomes, particularly low birth weight (LBW, <2,500 g at birth) and preterm birth (PTB, <37 completed weeks of gestation). We performed a comprehensive review of the peer-reviewed literature and a meta-analysis to quantify the association between maternal exposure to particulate matter with aerodynamic diameter 2.5 and 10 μm (PM2.5 and PM10) during pregnancy and the risk of LBW and PTB. We identified 20 peer-reviewed articles providing quantitative estimate of exposure and outcome that met our selection criteria. There was significant heterogeneity between studies, particularly for findings related to PM10 exposure (LBW, I-squared 54%, p = 0.01; PTB, I-squared = 73%, p < 0.01). Results from random-effect meta-analysis suggested a 9% increase in risk of LBW associated with a 10-μg/m3 increase in PM2.5 (combined odds ratios (OR), 1.09; 95% confidence interval (CI), 0.90–1.32), but our 95% CI included the null value. We estimated a 15% increase in risk of PTB for each 10-μg/m3 increase in PM2.5 (combined OR, 1.15; CI, 1.14–1.16). The magnitude of risk associated with PM10 exposure was smaller (2% per 10-μg/m3 increase) and similar in size for both LBW and PTB, neither reaching formal statistical significance. We observed no significant publication bias, with p > 0.05 based on both Begg's and Egger's bias tests. Our results suggest that maternal exposure to PM, particularly PM2.5 may have adverse effect on birth outcomes. Additional mechanistic studies are needed to understand the underlying mechanisms for this association.


Adverse birth outcome Low birth weight (LBW) Preterm birth (PTB) Air pollution Particulate matter Maternal exposure 



The views expressed in this paper are those of the authors and do not necessarily reflect the views of the Health Effects Institute or its sponsors.

The work was partially supported by a grant for CHERG to the US Fund for UNICEF and for the Global Burden of Diseases, Injuries, and Risk Factors Study. Both grants were from the Bill & Melinda Gates Foundation.


  1. Aguilera I, Guxens M, Garcia-Esteban R, Corbella T, Nieuwenhuijsen MJ, Foradada CM, Sunyer J (2009) Association between GIS-based exposure to urban air pollution during pregnancy and birth weight in the INMA Sabadell cohort. Environ Health Perspect 117:1322–1327Google Scholar
  2. Alderman BW, Baron AE, Savitz DA (1987) Maternal exposure to neighborhood carbon-monoxide and risk of low infant birth-weight. Public Health Rep 102:410–414Google Scholar
  3. Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101CrossRefGoogle Scholar
  4. Bell ML, Ebisu K, Belanger K (2007) Ambient air pollution and low birth weight in Connecticut and Massachusetts. Environ Health Perspect 115:1118–1124CrossRefGoogle Scholar
  5. Bobak M (2000) Outdoor air pollution, low birth weight, and prematurity. Environ Health Perspect 108:173–176CrossRefGoogle Scholar
  6. Bobak M, Leon DA (1999a) Pregnancy outcomes and outdoor air pollution: an ecological study in districts of the Czech Republic 1986–8. Occup Environ Med 56:539–543CrossRefGoogle Scholar
  7. Bobak M, Leon DA (1999b) The effect of air pollution on infant mortality appears specific for respiratory causes in the postneonatal period. Epidemiology 10:666–670CrossRefGoogle Scholar
  8. Brauer M, Lencar C, Tamburic L, Koehoorn M, Demers P, Karr C (2008) A cohort study of traffic-related air pollution impacts on birth outcomes. Environ Health Perspect 116:680–686CrossRefGoogle Scholar
  9. Chen L, Yang W, Jennison BL, Goodrich A, Omaye ST (2002) Air pollution and birth weight in northern Nevada, 1991–1999. Inhal Toxicol 14:141–157CrossRefGoogle Scholar
  10. Choi H, Rauh V, Garfinkel R, Tu YS, Perera FP (2008) Prenatal exposure to airborne polycyclic aromatic hydrocarbons and risk of intrauterine growth restriction. Environ Health Perspect 116:658–665CrossRefGoogle Scholar
  11. Crider KS, Whitehead N, Buus RM (2005) Genetic variation associated with preterm birth: a huge review. Genet Med 7:593–604CrossRefGoogle Scholar
  12. Currie J, Walker R (2009) Traffic congestion and infant health: evidence from E-ZPass. 15413. NBER Working Paper Series. Report. National Bureau of Economic Research, Cambridge, MAGoogle Scholar
  13. Dejmek J, Selevan SG, Benes I, Solansky I, Sram RJ (1999) Fetal growth and maternal exposure to particulate matter during pregnancy. Environ Health Perspect 107:475–480CrossRefGoogle Scholar
  14. Dejmek J, Solansky I, Benes I, Lenicek J, Sram RJ (2000) The impact of polycyclic aromatic hydrocarbons and fine particles on pregnancy outcome. Environ Health Perspect 108:1159–1164CrossRefGoogle Scholar
  15. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188CrossRefGoogle Scholar
  16. Dietz PM, England LJ, Callaghan WM, Pearl M, Wier ML, Kharrazi M (2007) A comparison of LMP-based and ultrasound-based estimates of gestational age using linked California livebirth and prenatal screening records. Paediatr Perinat Epidemiol 21:62–71CrossRefGoogle Scholar
  17. Egger M, Davey SG, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634CrossRefGoogle Scholar
  18. Engel SAM, Erichsen HC, Savitz DA, Thorp J, Chanock SJ, Olshan AF (2005) Risk of spontaneous preterm birth is associated with common proinflammatory cytokine polymorphisms. Epidemiology 16:469–477CrossRefGoogle Scholar
  19. Fell DB, Dodds L, King WD (2004) Residential mobility during pregnancy. Paediatr Perinat Epidemiol 18:408–414CrossRefGoogle Scholar
  20. Ghosh R, Rankin J, Pless-Mulloli T, Glinianaia S (2007) Does the effect of air pollution on pregnancy outcomes differ by gender? A systematic review. Environ Res 105:400–408CrossRefGoogle Scholar
  21. Gilboa SM, Mendola P, Olshan AF, Langlois PH, Savitz DA, Loomis D, Herring AH, Fixler DE (2005) Relation between ambient air quality and selected birth defects, seven county study, Texas, 1997–2000. Am J Epidemiol 162:238–252CrossRefGoogle Scholar
  22. Glinianaia SV, Rankin J, Bell R, Pless-Mulloli T, Howel D (2004) Particulate air pollution and fetal health a systematic review of the epidemiologic evidence. Epidemiology 15:36–45CrossRefGoogle Scholar
  23. Goldenberg RL, Culhane JF, Iams JD, Romero R (2008) Preterm birth 1—epidemiology and causes of preterm birth. Lancet 371:75–84CrossRefGoogle Scholar
  24. Gouveia N, Bremner SA, Novaes HMD (2004) Association between ambient air pollution and birth weight in Sao Paulo, Brazil. J Epidemiol Community Health 58:11–17CrossRefGoogle Scholar
  25. Ha EH, Hong YC, Lee BE, Woo BH, Schwartz J, Christiani DC (2001) Is air pollution a risk factor for low birth weight in Seoul? Epidemiology 12:643–648CrossRefGoogle Scholar
  26. Heinrich J, Slama R (2007) Fine particles, a major threat to children. Int J Hyg Environ Health 210:617–622CrossRefGoogle Scholar
  27. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558CrossRefGoogle Scholar
  28. Huynh M, Woodruff TJ, Parker JD, Schoendorf KC (2006) Relationships between air pollution and preterm birth in California. Paediatr Perinat Epidemiol 20:454–461CrossRefGoogle Scholar
  29. Jalaludin B, Mannes T, Morgan G, Lincoln D, Sheppeard V, Corbett S (2007) Impact of ambient air pollution on gestational age is modified by season in Sydney. Australia, Environmental Health, 6Google Scholar
  30. Kannan S, Misra DP, Dvonch JT, Krishnakumar A (2006) Exposures to airborne particulate matter and adverse perinatal outcomes: a biologically plausible mechanistic framework for exploring potential effect modification by nutrition. Environ Health Perspect 114:1636–1642Google Scholar
  31. Keelan JA, Blumenstein M, Helliwell RJA, Sato TA, Marvin KW, Mitchell MD (2003) Cytokines, prostaglandins and parturition—a review. Placenta 24:S33–S46CrossRefGoogle Scholar
  32. Kharrazi M, DeLorenze GN, Kaufman FL, Eskenazi B, Bernert JT, Graham S, Pearl M, Pirkle J (2004) Environmental tobacco smoke and pregnancy outcome. Epidemiology 15:660–670CrossRefGoogle Scholar
  33. Landgren O (1996) Environmental pollution and delivery outcome in southern Sweden: a study with central registries. Acta Paediatr 85:1361–1364CrossRefGoogle Scholar
  34. Lee BE, Ha EH, Park HS, Kim YJ, Hong YC, Kim H, Lee JT (2003) Exposure to air pollution during different gestational phases contributes to risks of low birth weight. Hum Reprod 18:638–643CrossRefGoogle Scholar
  35. Leem JH, Kaplan BM, Shim YK, Pohl HR, Gotway CA, Bullard SM, Rogers JF, Smith MM, Tylenda CA (2006) Exposures to air pollutants during pregnancy and preterm delivery. Environ Health Perspect 114:905–910CrossRefGoogle Scholar
  36. Leonardi-Bee J, Smyth A, Britton J, Coleman T (2008) Environmental tobacco smoke and fetal health: systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 93:F351–F361CrossRefGoogle Scholar
  37. Lin CM, Li CY, Mao IF (2004a) Increased risks of term low-birth-weight infants in a petrochemical industrial city with high air pollution levels. Arch Environ Health 59:663–668CrossRefGoogle Scholar
  38. Lin CM, Li CY, Yang GY, Mao IF (2004b) Association between maternal exposure to elevated ambient sulfur dioxide during pregnancy and term low birth weight. Environ Res 96:41–50CrossRefGoogle Scholar
  39. Lynch CD, Zhang J (2007) The research implications of the selection of a gestational age estimation method. Paediatr Perinat Epidemiol 21:86–96CrossRefGoogle Scholar
  40. Maisonet M, Bush TJ, Correa A, Jaakkola JJK (2001) Relation between ambient air pollution and low birth weight in the northeastern United States. Environ Health Perspect 109:351–356Google Scholar
  41. Maisonet M, Correa A, Misra D, Jaakkola JJ (2004) A review of the literature on the effects of ambient air pollution on fetal growth. Environ Res 95:106–115CrossRefGoogle Scholar
  42. Medeiros A, Gouveia N (2005) Relationship between low birthweight and air pollution in the city of Sao Paulo, Brazil. Rev Saúde Pública 39:965–972CrossRefGoogle Scholar
  43. Mills NL, Donaldson K, Hadoke PW, Boon NA, MacNee W, Cassee FR, Sandstrom T, Blomberg A, Newby DE (2009) Adverse cardiovascular effects of air pollution. Nat Clin Pract Cardiovasc Med 6:36–44CrossRefGoogle Scholar
  44. Olsen J (2005) The Danish national birth cohort—a data source for studying preterm birth. Acta Obstet Gynecol Scand 84:539–540Google Scholar
  45. Olsen J, Basso O (2005) Reproductive epidemiology. In: Ahrens W, Pigeot I (eds) Handbook of epidemiology. Springer, Berlin, pp 1043–1109CrossRefGoogle Scholar
  46. Osmond C, Barker DJP (2000) Fetal, infant, and childhood growth are predictors of coronary heart disease, diabetes, and hypertension in adult men and women. Environ Health Perspect 108:545–553Google Scholar
  47. Parker JD, Woodruff TJ (2008) Influences of study design and location on the relationship between particulate matter air pollution and birthweight. Paediatr Perinat Epidemiol 22:214–227CrossRefGoogle Scholar
  48. Parker JD, Mendola P, Woodruff TJ (2008) Preterm birth after the Utah Valley steel mill closure a natural experiment. Epidemiology 19:820–823CrossRefGoogle Scholar
  49. Petitti DB (2001) Approaches to heterogeneity in meta-analysis. Stat Med 20:3625–3633CrossRefGoogle Scholar
  50. Pope CA (1996) Particulate pollution and health: a review of the Utah Valley experience. J Expo Anal Environ Epidemiol 6:23–34Google Scholar
  51. Ricciardi C, Guastadisegni C (2003) Environmental inequities and low birth weight. Ann Ist Super Sanità 39:229–234Google Scholar
  52. Ritz B, Yu F (1999) The effect of ambient carbon monoxide on low birth weight among children born in southern California between 1989 and 1993. Environ Health Perspect 107:17–25CrossRefGoogle Scholar
  53. Ritz B, Yu F, Chapa G, Fruin S (2000) Effect of air pollution on preterm birth among children born in Southern California between 1989 and 1993. Epidemiology 11:502–511CrossRefGoogle Scholar
  54. Ritz B, Yu F, Fruin S, Chapa G, Shaw GM, Harris JA (2002) Ambient air pollution and risk of birth defects in southern California. Am J Epidemiol 155:17–25CrossRefGoogle Scholar
  55. Ritz B, Wilhelm M, Hoggatt KJ, Ghosh JKC (2007) Ambient air pollution and preterm birth in the environment and pregnancy outcomes study at the University of California, Los Angeles. Am J Epidemiol 166:1045–1052CrossRefGoogle Scholar
  56. Rogers JF, Dunlop AL (2006) Air pollution and very low birth weight infants: a target population? Pediatrics 118:156–164CrossRefGoogle Scholar
  57. Rubes J, Selevan SG, Evenson DP, Zudova D, Vozdova M, Zudova Z, Robbins WA, Perreault SD (2005) Episodic air pollution is associated with increased DNA fragmentation in human sperm without other changes in semen quality. Hum Reprod 20:2776–2783CrossRefGoogle Scholar
  58. Rudra CB, Williams MA, Frederick IO, Luthy DA (2006) Maternal asthma and risk of preeclampsia—a case-control study. J Reprod Med 51:94–100Google Scholar
  59. Sagiv SK, Mendola P, Loomis D, Herring AH, Neas LM, Savitz DA, Poole C (2005) A time-series analysis of air pollution and preterm birth in Pennsylvania, 1997–2001. Environ Health Perspect 113:602–606CrossRefGoogle Scholar
  60. Salam MT, Millstein J, Li YF, Lurmann FW, Margolis HG, Gilliland FD (2005) Birth outcomes and prenatal exposure to ozone, carbon monoxide, and particulate matter: results from the children's health study. Environ Health Perspect 113:1638–1644CrossRefGoogle Scholar
  61. Selevan SG, Kimmel CA, Mendola P (2000) Identifying critical windows of exposure for children's health. Environ Health Perspect 108:451–455Google Scholar
  62. Slama R, Morgenstern V, Cyrys J, Zutavern A, Herbarth O, Wichmann HE, Heinrich J, LISA Study Group (2007) Traffic-related atmospheric pollutants levels during pregnancy and offspring's term birth weight: a study relying on a land-use regression exposure model. Environ Health Perspect 115:1283–1292CrossRefGoogle Scholar
  63. Slama R, Thiebaugeorges O, Goua V, Aussel L, Sacco P, Bohet A, Forhan A, Ducot B, Nnesi-Maesano I, Heinrich J, Magnin G, Schweitzer M, Kaminski M, Charles MA (2009) Maternal personal exposure to airborne benzene and intrauterine growth. Environ Health Perspect 117:1313–1321Google Scholar
  64. Sram RJ, Binkova B, Dejmek J, Bobak M (2005) Ambient air pollution and pregnancy outcomes: a review of the literature. Environ Health Perspect 113:375–382CrossRefGoogle Scholar
  65. Stillerman KP, Mattison DR, Giudice LC, Woodruff TJ (2008) Environmental exposures and adverse pregnancy outcomes: a review of the science. Reprod Sci 15:631–650CrossRefGoogle Scholar
  66. Suh YJ, Ha EH, Park H, Kim YJ, Kim H, Hong YC (2008) GSTM1 polymorphism along with PM10 exposure contributes to the risk of preterm delivery. Mutat Res, Genet Toxicol Environ Mutagen 656:62–67CrossRefGoogle Scholar
  67. Suh YJ, Kim H, Seo JH, Park H, Kim YJ, Hong YC, Ha EH (2009) Different effects of PM10 exposure on preterm birth by gestational period estimated from time-dependent survival analyses. Int Arch Occup Environ Health 82:613–621CrossRefGoogle Scholar
  68. Wang XB, Ding H, Ryan L, Xu XP (1997) Association between air pollution and low birth weight: a community-based study. Environ Health Perspect 105:514–520CrossRefGoogle Scholar
  69. Wilcox AJ (2001) On the importance—and the unimportance—of birthweight. Int J Epidemiol 30:1233–1241CrossRefGoogle Scholar
  70. Wilhelm M, Ritz B (2005) Local variations in CO and particulate air pollution and adverse birth outcomes in Los Angeles County, California, USA. Environ Health Perspect 113:1212–1221CrossRefGoogle Scholar
  71. Wu J, Ren C, Delfino R, Chung J, Wilhelm M, Ritz B (2009) Association between local traffic-generated air pollution and preeclampsia and preterm delivery in the South Coast air basin of California. Environ Health Perspect 117:1773–1779CrossRefGoogle Scholar
  72. Xu XP, Ding H, Wang XB (1995) Acute effects of total suspended particles and sulfur dioxides on preterm delivery: a community-based cohort study. Arch Environ Health 50:407–415CrossRefGoogle Scholar
  73. Zeger SL, Thomas D, Dominici F, Samet JM, Schwarz J, Dockery D, Cohen A (2001) Exposure measurement error in time-series studies of air pollution: concepts and consequences. Environ Health Perspect 109:A517 (Vol. 108, p 419, 2000)Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Amir Sapkota
    • 1
    Email author
  • Adam P. Chelikowsky
    • 1
  • Keeve E. Nachman
    • 2
  • Aaron J. Cohen
    • 3
  • Beate Ritz
    • 4
  1. 1.Maryland Institute for Applied Environmental HealthUniversity of Maryland College Park School of Public HealthCollege ParkUSA
  2. 2.Centre for Livable FutureJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Health Effects InstituteBostonUSA
  4. 4.Department of EpidemiologyUCLA School of Public HealthLos AngelesUSA

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