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Cited by 120Air Quality and Health ImpactsEnvironmental Justice and Health DisparitiesIndoor Air Quality and Microbial Exposure

Air pollution and stillbirth risk: exposure to airborne particulate matter during pregnancy is associated with fetal death

Open access
DeFranco, Emily, Hall, Eric, Hossain, Monir, Chen, Aimin, Haynes, Erin N., Jones, David, Ren, Sheng, Lu, Long +1 more·2015·PLOS ONE
DOI 10.1371/journal.pone.0120594PMC PMC4368103
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Abstract

OBJECTIVE: To test the hypothesis that exposure to fine particulate air pollution (PM2.5) is associated with stillbirth. STUDY DESIGN: Geo-spatial population-based cohort study using Ohio birth records (2006-2010) and local measures of PM2.5, recorded by the EPA (2005-2010) via 57 monitoring stations across Ohio. Geographic coordinates of the mother's residence for each birth were linked to the nearest PM2.5 monitoring station and monthly exposure averages calculated. The association between stillbirth and increased PM2.5 levels was estimated, with adjustment for maternal age, race, education level, quantity of prenatal care, smoking, and season of conception. RESULTS: There were 349,188 live births and 1,848 stillbirths of non-anomalous singletons (20-42 weeks) with residence ≤10 km of a monitor station in Ohio during the study period. The mean PM2.5 level in Ohio was 13.3 μg/m3 [±1.8 SD, IQR(Q1: 12.1, Q3: 14.4, IQR: 2.3)], higher than the current EPA standard of 12 μg/m3. High average PM2.5 exposure through pregnancy was not associated with a significant increase in stillbirth risk, adjOR 1.21(95% CI 0.96,1.53), nor was it increased with high exposure in the 1st or 2nd trimester. However, exposure to high levels of PM2.5 in the third trimester of pregnancy was associated with 42% increased stillbirth risk, adjOR 1.42(1.06,1.91). CONCLUSIONS: Exposure to high levels of fine particulate air pollution in the third trimester of pregnancy is associated with increased stillbirth risk. Although the risk increase associated with high PM2.5 levels is modest, the potential impact on overall stillbirth rates could be robust as all pregnant women are potentially at risk.

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  • In an Ohio cohort, high PM2.5 exposure during the third trimester was associated with 42% increased stillbirth risk, but high PM2.5 exposure was not associated with increase in stillbirth risk through pregnancy, first or second trimester.

    “Similarly, in an Ohio cohort, “high” PM2.5 exposure, defined as greater than or equal to the mean PM2.5 level during the study period (13.3 μg/m3) plus the IQR for the specific time period measured for each birth) was not associated with increase in stillbirth risk through pregnancy, first or second trimester; however, high PM2.5 exposure during the third trimester was associated with 42% increase”

    From Air pollution and children’s health—a review of adverse effects associated with prenatal exposure from fine to ultrafine particulate matter (2021) · cites this paper as [18]

    The Abstract Results and Study Design confirm the Ohio cohort finding: high PM2.5 exposure in the third trimester was associated with 42% higher stillbirth risk, while high exposure across pregnancy or in the first or second trimester was not associated with a significant increase. The citing sentence's threshold definition is imprecise: the Results define high exposure using each period’s own mean plus its IQR, not the overall mean of 13.3 μg/m3 plus each period’s IQR. (LLM, conf=0.86)

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  • High stress is associated with miscarriage risk (aOR 1.46; 95% CI 1.16-1.77).

    “Our review of the evidence also found that high stress is associated with miscarriage risk (aOR 1·46; 95% CI 1·161·77; Table 6) 66,71,73-77”

    From Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss (2021) · cites this paper as [77]

    The Methods (Outcome; page unavailable) define the study outcome as stillbirth at 20 weeks or later. The Discussion (Interpretation; page unavailable) mentions miscarriage only as a hypothetical consequence of early particulate-matter exposure. Searches for high stress and the reported aOR found no passage addressing a stress–miscarriage association. (LLM, conf=0.76)

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Authors
DeFranco, E., Hall, E., Hossain, M., Chen, A., Haynes, E. N., Jones, D., Ren, S., Lu, L., & Muglia, L.
Affiliations
  • Cincinnati Children's Hospital Medical Center (US)
  • University of Cincinnati (US)
Corresponding author
DeFranco, Emily
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2015-03-20
Volume
10
Issue
3
Pages
e0120594
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0120594
PMC
PMC4368103
OpenAlex
W2042390942
Cited by
120
References
26
Citations by year
2026: 8 · 2025: 13 · 2024: 8 · 2023: 11 · 2022: 10 · 2021: 17 · 2020: 7 · 2019: 13 · 2018: 12 · 2017: 11 · 2016: 8 · 2014: 1
FWCI
6.47
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • March of Dimes Foundation (22-FY13-543)
  • Cincinnati Children's Hospital Medical Center
Topics
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
  • Social Sciences › Sociology and Political Science › Environmental Justice and Health Disparities
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
Keywords
air pollution, PM2.5, stillbirth, fetal death, pregnancy, trimester-specific exposure, maternal exposure, birth outcomes, Ohio
MeSH terms
Adult, Air Pollutants, Air Pollution, Female, Humans, Infant, Newborn, Middle Aged, Ohio, Pregnancy, Risk Factors, Stillbirth, Particulate Matter

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