Evidence of interactive effects of late-pregnancy exposure to air pollution and extreme temperature on preterm birth in China: A nationwide study

Xiang Xiao, Ruixia Liu, Yunjiang Yu, Zheng Zhang, Luke D. Knibbs, Bin Jalaludin, Lidia Morawska, Shyamali C. Dharmage, Joachim Heinrich, Stefania Papatheodorou, Yuming Guo, Yangyang Xu, Ling Jin, Yike Guo, Wentao Yue, Jilong Yao, Yue Zhang, Chengrong Wang, Shen Gao, Enjie ZhangShaofei Su, Tong Zhu, Guang Hui Dong, Meng Gao, Chenghong Yin

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Perinatal exposure to heat and air pollution has been shown to affect the risk of preterm birth (PTB). However, limited evidence exists regarding their joint effects, particularly in heavily polluted regions like China. This study utilized data from the ongoing China Birth Cohort Study, including 103 040 birth records up to December 2020, and hourly measurements of air pollution (PM2.5, NO2, and O3) and temperature. We assessed the nonlinear associations between air pollution and temperature extereme exposures and PTB by employing generalized additive models with restricted cubic slines. Air pollution and temperature thresholds (corresponding to minimum PTB risks) were determined by the lowest Akaike Information Criterion. We found that maternal exposures to PM2.5, NO2, O3, and both low and high temperature during the third trimester of pregnancy were independently associated with increased risk of PTB. The adjusted risk ratios for PTB of PM2.5, O3, NO2, and temperature at the 95th percentile against thresholds were 1.32 (95% CI: 1.23, 1.42), 1.33 (95% CI: 1.18, 1.50), 1.44 (95% CI: 1.33, 1.56) and 1.70 (95% CI: 1.56, 1.85), respectively. Positive additive interactions [relative excess risk due to interaction (RERI) > 0] of PM2.5-high temperature (HT), O3-HT, O3-low temperature (LT) are identified, but the interactive effects of PM2.5 and LT were negative (RERI < 0). These observed independent effects of air pollution and temperature, along with their potential joint effects, have important implications for future studies and the development of public health policies aimed at improving perinatal health outcomes.

Original languageEnglish
Article number094017
Number of pages10
JournalEnvironmental Research Letters
Issue number9
Publication statusPublished - 1 Sept 2023


  • air pollution
  • birth outcomes
  • preterm birth
  • temperature extremes
  • threshold effect

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