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● Data from multiple continents show risks of negative gestational outcomes in mothers exposed to air pollution.

● Six Criteria Air Pollutants associated with Preterm Birth and Low Birth Weight (US and China)

● Low Birth Weight (LBW): <2500 grams (5.5 pounds) [7]● Preterm Birth (PTB): < 37 weeks gestation [7]● Although, the exact mechanism of how air pollution effects the fetus is still unknown,

some researchers hypothesize that oxidative stress, inflammation, and hemodynamic changes associated with air pollutants can impair the oxygen and nutrient transportation to the fetus [7].

INTRODUCTION

METHODS

Figure 1

Figure 1 displays a world map of the air quality indexes [10].

Table 1

Table 2

Tables 1 and 2 display a comparison of studies between the US and China regarding the outcomes of health under study (PTB and LBW). Pollutants are categorized by each type and outcomes under study are listed.

GLOBAL AIR POLLUTIONTable 3

Table 3 provides the Air Quality Index rates (AQI) in different locations based on the months of April to May; as, the colors are respective to Figure

1 [10].

Table 4

Table 4 displays the AQI ranges from 0-300 respectively, good to hazardous, according to the World Quality Index (2008), respective to

Figure 1 [10].

China’s Domestic Trans-Boundary Impacts● Premature mortalities are ranked as the top cause of deaths in China

[3].● 870,000 premature mortalities in China are caused by PM2.5 per year

[3].● 160,000 or 18% of the premature mortalities in China are caused by

trans-boundary pollution per year [3].● Trans-boundary pollution: Pollution that starts in one country and

crosses borders into another country causing damage to the environment through air or water [9].

● Gu’s study focuses on domestic trans-boundary impacts in China.

Table 3

RESULTS RESULTS

● Low significant findings were seen in almost every study, indicating a potential association between certain air pollutant markers and birth outcomes such as PTB and LBW.

● Non-significant findings include Hao et al’s association with ozone and PTB, Coker et al’s NO2 and FTBW, and Wu et al’s association with term LBW and SO2 and NO2 markers.

● Many confounding factors may have skewed outcomes of interest in this analysis.

● Only results for the 6 criteria air pollutants were accounted for in relation to preterm birth and low birth weight.

DISCUSSION

Although, this review found associations between pollutant markers such as PM, SO2, and NO2, we must conclude that our analysis is confounded by many factors. These include but are not limited to age, race, income level, gestation period, combination of pollutants, and others. It is seen that higher rates of pollution in China may lead to stronger negative outcomes in expectant mothers. In the United States, pollution levels remain relatively low in comparison to China. The United States and China both suffer from many social constructs which may skew associations when comparing these rates. Although, research shows significant associations between air pollution, preterm birth, and low birth weight, we must conclude that more research is needed to make sound associations.

[1] Coker, Eric, et al. (2016). Multi-Pollutant Exposure Profiles Associated with Term Low Birth Weight in Los Angeles County. Environment International, vol. 91, 1–13.

[2] Ebisu, Keita, and Michelle L. Bell. (2012). Airborne PM2.5 Chemical Components and Low Birth Weight in the Northeastern and Mid-Atlantic Regions of the United States. Environmental Health Perspectives.

[3] Gu, Y., & Yim, S. (2016). The air quality and health impacts of domestic trans-boundary pollution in various regions of China. Environment International, 97, 117-124. doi:10.1016/j.envint.2016.08.004

[4] Ha, S., Hu, H., Roussos-Ross, D., Haidong, K., Roth, J., & Xu, X. (2014). Ambient Air Pollution and Adverse Birth Outcomes. Environmental Research,134, 198-204. doi:10.1111/j.1742-7843.2007.00161.x

[5] Han, Yingying, et al. (2018). Effects of Particulate Matter Exposure during Pregnancy on Birth Weight: A Retrospective Cohort Study in Suzhou, China. Science of the Total Environment, 615, 369-374.

[6] Hao, Hua, et al. “Air Pollution and Preterm Birth in the U.S. State of Georgia (2002–2006): Associations with Concentrations of 11 Ambient Air Pollutants Estimated by Combining Community Multiscale Air Quality Model

(CMAQ) Simulations with Stationary Monitor Measurements.” Environmental Health Perspectives, vol. 124, no. 6, 2015, doi:10.1289/ehp.1409651.

[7] Huang, Cheng & Nichols, Catherine & Liu, Yang & Zhang, Yunping & Liu, Xiaohong & Gao, Suhong & Li, Zhiwen & Ren, Aiguo. (2015). Ambient air pollution and adverse birth outcomes: A natural experiment study. Population

health metrics.13. 17. 10.1186/s12963-015-0050-4.

[8] Hyder, Ayaz et al. (2014). “PM2.5 Exposure and Birth Outcomes: Use of Satellite- and Monitor-Based Data.” Epidemiology (Cambridge, Mass.) 25.1, 58–67. PMC.

[9] Transboundary Pollution. (n.d.). Retrieved June 2, 2018, from https://www.safewater.org/fact-sheets-1/2017/1/23/transboundary-pollution

[10] World Air Quality. (2008). Air Pollution in World: Real-time Air Quality Index Visual Map. Retrieved March 19, 2018.

[11] Wu, Han, et al. (2018). Associations between Maternal Weekly Air Pollutant Exposures and Low Birth Weight: a Distributed Lag Non-Linear Model. Environmental Research Letters, 13 (2), 024023.,

doi:10.1088/1748-9326/aaa346.

[12] Xiao, Q., Chen, H., Strickland, M. J., Kan, H., Chang, H. H., Klein, M., . . . Liu, Y. (2018). Associations between birth outcomes and maternal PM 2.5 exposure in Shanghai: A comparison of three exposure assessment approaches.

Environment International,117, 226-236. doi:10.1016/j.envint.2018.04.050

Key Search Terms:● United States● China● Air pollution● Health● Low birth weight

Search Engines:● PubMed● Academic Search Complete● CINAHL

Participants and Recruitment: ● No recruitment of human subjects● Literature review of pre-existing studies and data● Samples of pregnant women of all ages and newborn children under the age of 5 years

Exclusion/Inclusion Criteria: Exclusion:● Children > 5 years of age● Studies with locations outside of the US or China● Studies that do not focus on preterm births or low birth weights● Men

Inclusion:● Pregnant or non-pregnant women● Children < 5 years of age● Locations within the US or China

Data ManagementLiterature review of women in the US and China:

● Started with 25 studies, and narrowed it down to nine studies● Low birth weight and preterm birth focus● Compare outcomes of global pollution with six criteria air pollutants: SO2, O3, CO,

NO2, PM2.5/10

Statistical Analysis: ● Hypothesis: Global air pollution has an impact on low birth weight and preterm birth ● Outcomes of interest: 1) Low Birth Weight 2) Preterm Birth● Locations: US and China● Six Criteria Air pollutants: SO2, O3, CO, NO2, PM2.5/10● For specific values, please refer to Tables 1 and 2.

IRB approvalAfter being reviewed by the IRB chair, the project has been exempt from IRB Review

under 45 CFR 46.101(b) category 2, according to the Director of UCSD’s Human Research Protections Program.

○ SO2○ PM2.5○ PM10

○ CO○ NO ○ O3

● Birth weight● Maternal health● Mothers● Children● Air Quality Index

● Particulate matter or PM2.5● Nitrogen oxide or NO● Ozone or O3● Sulphur Dioxide or SO2

[10]

[10][10]

● Google Scholar● Web of Science● EMBASE

● Family and Society

OBJECTIVE

● Complete a literature review of studies to compare rates of air pollution and maternal health outcomes such as low birth weight and preterm birth in the United States and China.

USAStudies

Health Outcome

SO2 O3 PM10 PM2.5 CO NO2 Location # of Births

Hao et al. [6]

PretermBirth

p-values < 0.0001

1.59 ppbOR=1.009(95% CI: 1.002,1.015)

6.43 ppbnot sig

3.96 ug/m3not sig

2.01 ug/m3not sig

.06 ppmOR=1.005(95% CI:1.001,1.009)

1.81 ppbOR=1.009(95% CI:1.005,1.013)

GA 511,658

Ebisu et al. [2]

Change in BW per IQR p < 0.001

–0.9 gOR= 1.003(95% CI0.961 to 1.046)

–8.2 gOR=1.027(95% CI: 0.991 to 1.064)

–14.7 gOR=1.054(95% CI:1.022 to 1.087

–16.2 gOR=1.028(95% CI: 0.983 to 1.074)

-8.9 gOR=1.027(95% CI: 1.002 to 1.051)

CN 1,207,600

Coker et al. [1]

TermLBW

16.94 μg/m32.07% TLBW(95% CI: 2.04, 2.11)

22.49 ppbNot sig

Los Angeles, CA

804,726

Hyder et al. [8]

Preterm Birth

11.91ug/m3OR=1.0(95% CI: .99 to 1.02)

MASS 628,131

Change in BW per IQR 2.41μg/m

-6.2g (95% CI: -8 to -5)

MASS 628,131

Ha et al. [4]

TermLBW

37.4 ppbOR=.97(95% CI: .92 to 1.03)

1.7 ug/m3OR=1.050(95% CI: 1.024,1.076)

FL 423,719

CHINAStudies

Health Outcome

SO2 O3 PM10 PM2.5 CO NO2 Location # of Births

Wu et al. [11]

Term LBWper 10 μg/m3

63.1μg/m3Not sig

88μg/m3(OR: 1.03, 95% CI: 0.98, 1.09)

54.6μg/m3Not sig

Taiwan,China

1845

Han et al.[5]

Term LBW per 10 μg/m3

88.23 ug/m3-.548gp-value= .406(95% CI= -.018, .044)

62.34 μg/m3-.536g p-value= .809 (95% CI= -.030, 0.038)

Suzhou,China

10,915

Xiao et al. [12]

Preterm Birth 60 μg/m3(OR 1.27, 95% CI: 1.20, 1.36)

Shanghai 132,783

Term LBW per 10 μg/m3

60 μg/m3-12.85g (95% CI: -18.44, -7.27)