Exposure to low concentrations of air pollutants and adverse birth outcomes in Brisbane, Australia, 2003–2013

Background It's unclear whether exposures to low-level air pollution have adverse effects on birth outcomes, and which trimester-specific pregnant exposure is sensitive. Objectives To investigate the effects of maternal exposure during each trimester and the whole pregnancy to particles with aerodynamic diameter < 2.5 μm (PM_2.5), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), and ozone (O₃) on preterm birth (PTB) and low birth weight (LBW). Methods Daily data on birth records, air quality, and weather conditions were collected in Brisbane, Australia during 2003–2013. Mean concentrations of air pollutants were calculated for each trimester of pregnancy. Cox proportional hazards models were used to examine the associations between air pollution and birth outcomes. Multi-pollutant models and stratified analyses by ambient temperature were performed. Results Exposures to PM_2.5, SO₂, NO₂, and O₃ during the whole pregnancy were associated with increased risk of PTB [IQR HRs (hazard ratios with an interquartile range increase in air pollutants) and 95% confidence intervals (CIs): 1.05 (1.02, 1.08), 1.12 (1.09, 1.16), 1.07 (1.01, 1.13), and 1.13 (1.10, 1.16), respectively] and LBW [IQR HRs and 95% CIs: 1.06 (1.02, 1.10), 1.12 (1.08, 1.16), 1.11 (1.03, 1.18), and 1.13 (1.09, 1.17), respectively]. Highest HRs were observed during trimester 3, and lowest in trimester 1. For each air pollutant, stronger effects on PTB and LBW were present for exposure to low and moderate temperatures than exposure to high ambient temperature. Conclusions Exposures to low-level air pollutants are related to adverse birth outcomes. More effective policies for air quality control could contribute to improving neonatal health.