Effect of Air Pollution On Maternal Outcome In

Upper Egypt by

DR/ Ahmed Ali M. NasrAssistant Professor Of Obstetrics & Gynecology,

Faculty Of Medicine, Al–Azhar University

حيم حمن الر بسم هللا الر

كم رى هللا عمل و قل اعملوا فسي

و رسوله والمؤمن و

ملعظيصدق هللا ا

INTRODUCTION

Magnitude of the problem

Mortality: Air pollution is

estimated to cause approximately

two million premature deaths

worldwide per year

(ENVIRONMENTAL PERFORMANCE INDEX,

2012)

Morbidity:

• Air pollution has been shown to

elevate risks of cardiovascular and

respiratory diseases (Eder et al. 2009).

• Air pollution during pregnancy

induces placental and fetal

hypoxia, inflammation, and

oxidative stress which may induce

adverse pregnancy outcomes

(Kannan et al.2006).

Facts:

• As many processes in the body are mediated

by sex steroids, toxic response is modulated

in a sex–specific way (Keitt et al., 2008).

• In fact female gender is more vulnerable to

toxicants than men as proved by higher

bioavailability of some drugs in women, (Van

der Pol et al., 2008).

WHY

Explanations

1. Down regulation of plasma

proteins by sex steroids (Morris et

al., 2007)

2. The larger relative fat mass that

allows larger distribution for fat–

soluble substances, as most

environmental chemicals are

highly lipophilic (Kauppinen et al.,

2007).

TOXICOLOGICALLY SPEAKING

Female Gender

Is More

Vulnerable To

Toxicants Than

Male

(Van der Pol et al., 2008).

According To

Egypt State Of The Environment Report; 2012

Kom- Ombo district of Aswan is one of the most

polluted areas in Upper Egypt caused by sugar factory.

the concentrations of pollutants were several times

over the maximum allowed of The Executive

Regulation Of Environmental Low No.4 Of 1994.

• Sulpher Dioxide (SO2) • Nitrogen Dioxide (NO2)

• Ozone (O3) • Carbon Monoxide (CO)

• Black Smoke • Particulate Matter (PM10)

These pollutants are

Aim of the study

This is a case – control study conducted by

Azhar Assiut Obs. & Gyn. Department

in collaboration with

The Egyptian Ministry Of Health

to investigate the effect of Kom–Ombo Cane

Sugar Factory pollutants on maternal outcome

Subjects and Methods

600 pregnant women

Group A

(300 patients)Living within the polluted area

Group B

(300 controls)Living away from polluted area

Results

Average concentrations of pollutants (ug/m3)in Kom-

Ombo in relation to the maximum allowed limits

Pollutants

Concentration in

Kom-Ombo

Maximum

allowed limitsRatio

CO 30 10 3

SO2 89 60 1.5

NO2 43 40 1.1

PM10 278 70 4.1

Black smoke 144 60 2.4

(Egypt state of the environment report; 2012)

Maternal Outcome

Maternal

outcome

group A

(Patients)

group B

(Controls)X2 P

no. % no. %

Anemia 148 49.3% 83 27.67% 29.74 0.000

PIH 83 27.7% 22 7.3% 42.96 0.0000

UTI 155 51.7% 114 38 % 11.3 0.0008

CD 80 26.7% 31 10.3% 26.5 0.0000

PROM 77 25.7% 47 15.7% 9.15 0.0024

PTL 96 32 % 52 17.3% 17.4 0.0000

How air pollution

affects

Maternal outcome?

The prevalence of anemia in polluted

area is attributed to toxic materials which

lead to significant damage of red blood

cells, reduced hemoglobin concentrations,

number of erythrocytes and hematocrit.

(Nikolić et al., 2008).

The prevalence of UTI in polluted area

could be due to impaired immunity caused

by inhalation of PM10

(Williams; 2011).

The prevalence of PIH

could be caused by

mechanisms similar to that

of atherosclerotic cardio–

vascular disease as

inflammation, oxidative

stress and endothelial

dysfunction (Brook et al., 2008).

The biological effect of air pollution

on respiratory diseases was explained

by pro inflammatory pathways and

the generation of reactive oxygen

species that lead to pulmonary

inflammation, airway obstruction,

and increased susceptibility to

infection and sensitivity to allergens

(Simkhovich et al., 2008).

The prevalence of PTL and PROM

could be attributed to CO, SO2 and

PM10 exposure in early and late

pregnancy. The mechanism may be

due to several pathways including

placental hypoxia, fetal hypoxia,

inflammation and oxidative stress

(Knnan et al. 2006)

CONCLUSIONS

&

RECOMMENDATIONS

This study concluded the presence of

considerable evidence for some adverse

maternal outcomes related to cane sugar

factory pollutants in Kom- Ombo, but was

inconclusive in identifying the most

harmful pollutants and the most

susceptible periods during gestation.

Further investigations should be conducted:

• To identify the most vulnerable period of

exposure in pregnancy,

• To specify the contribution of different

pollutants in the adverse outcomes,

• To clarify the biologic pathways involved in

the adverse outcomes, and

• To study the adverse fetal outcomes.

THANK YOU

VERY MUCH