AMBIENT AIR POLLUTION, FETAL AMBIENT AIR POLLUTION, FETAL GROWTH AND PREMATURE GROWTH AND PREMATURE BIRTHS IN POLISH URBAN BIRTHS IN POLISH URBAN

POPULATIONPOPULATION

Bogdan WojtyniakBogdan Wojtyniak

Jakub StokwiszewskiJakub Stokwiszewski

Daniel RabczenkoDaniel Rabczenko

National Institute of Hygiene, WarsawNational Institute of Hygiene, Warsaw

POZNAN

LODZ

WROCLAW

CRACOW

GERMANY

CZECH REPUBLIC

BELARUS

LITHUANIA

RUSSIA

SLOVAKIA

UKRAINEN

EW

S

Polish cities included in the analysis

The purpose of the study was to examine if exposure to outdoor air pollution during pregnancy is associated

with increased risk of adverse birth outcomes in Polish urban population

Air pollutants

• Black smoke (BS)

• Sulphur dioxide (SO2)

• Nitrogen dioxide (NO2)

Birth outcomes

• Low birth weight (<2500g)

• Prematurity (<37 weeks)

• Intrauterine growth retardation

• Birth weight

Cracow Lodz Poznan Wroclaw

No. of births 5905 6106 4621 4753

LBW (% / n) 2.6 / 154 3.4 / 207 2.3 / 104 2.5 / 120

Prematurity (% / n) 4.4 / 271 5.3 / 345 5.9 / 292 4.8 / 241

IUGR (% / n) 8.1 / 476 11.3 / 688 7.2 / 332 8.7 / 413

Mean (SD) BW (g) 3356 (449) 3272 (443) 3379 (463) 3359 (449)

Analysed birth outcomes in four Polish cities, 1995-1996

Cracow Lodz Poznan Wroclaw

Infants genderMale 51.8 52.1 50.6 51.6

Female 48.2 47.9 49.4 48.4

Maternal age (years)<20 12.5 14.2 13.0 15.4

20-24 45.9 47.3 46.4 45.625-29 29.2 27.8 29.6 28.1

30+ 12.4 10.7 11.0 10.9

Maternal educationprimary 9.4 14.5 10.6 13.0

vocational 24.3 23.6 25.8 21.4secondary 45.4 44.6 43.3 42.8

college+univ. 20.9 17.3 20.3 22.8

Single mother 17.4 18.0 16.6 19.0Conception season

spring 23.7 23.7 23.2 24.1summer 26.8 26.3 26.1 24.9autumn 27.2 26.7 27.4 26.6

winter 22.3 23.3 23.3 24.4

Characteristic of study groups (percentages)

Cracow Lodz Poznan Wroclaw

BS 44.5 30.2 24.5 26.7

SO2 41.5 21.3 23.0 20.1

NO2 57.7 36.6 52.5 26.7

Threemonths means of air pollution during study

period (μg/m3)

BS Cracow Lodz Poznan Wroclaw Mean weight Cracow Lodz Poznan WroclawCracow 1.00 Cracow 1.00

Lodz 0.90 1.00 Lodz -0.06 1.00Poznan 0.84 0.95 1.00 Poznan -0.03 -0.37 1.00Wroclaw 0.84 0.92 0.96 1.00 Wroclaw 0.21 0.09 0.14 1.00

SO2 Cracow Lodz Poznan Wroclaw IUGR Cracow Lodz Poznan WroclawCracow 1.00 Cracow 1.00

Lodz 0.96 1.00 Lodz -0.10 1.00Poznan 0.91 0.96 1.00 Poznan 0.10 0.18 1.00Wroclaw 0.93 0.95 0.93 1.00 Wroclaw 0.02 0.06 0.34 1.00

NO2 Cracow Lodz Poznan Wroclaw Prematurity Cracow Lodz Poznan WroclawCracow 1.00 Cracow 1.00

Lodz 0.01 1.00 Lodz 0.03 1.00Poznan 0.33 0.10 1.00 Poznan 0.21 0.03 1.00Wroclaw 0.33 0.04 0.62 1.00 Wroclaw -0.38 0.03 0.06 1.00

Correlation coefficients between the cities monthly values of a) air pollution b) birth outcomes

a) Air pollution b) Birth outcomes

Birth outcomes by the variables included in the models

Category

Females(-160.4 ; -138.1) (1.50 ; 2.11) (0.95 ; 1.15) (0.77 ; 0.97)

Birth Year 1996(19.1 ; 41.4) (0.77 ; 1.08) (0.75 ; 0.90) (0.85 ; 1.07)

(-76.1 ; -49.6) (1.48 ; 2.18) (1.39 ; 1.72) (0.99 ; 1.31)

(-18.0 ; 19.7) (0.54 ; 0.91) (0.73 ; 0.98) (1.04 ; 1.49)

Maternal age 25 - 29(-2.9 ; 25.3) (0.91 ; 1.42) (0.84 ; 1.08) (1.06 ; 1.44)

(7.8 ; 45.8) (1.10 ; 1.86) (0.79 ; 1.10) (1.63 ; 2.32)

Not married(-77.4 ; -44.9) (1.33 ; 2.03) (1.27 ; 1.62) (1.62 ; 2.18)

(13.4 ; 40.0) (0.63 ; 0.97) (0.75 ; 0.95) (0.78 ; 1.05)

11.2 1.13 0.95

26.7 0.78 0.84

26.8 1.43 0.93

-61.2 1.64 1.43

1.55

0.9 0.70 0.85

1.24

-149.2 1.77 1.05 0.87

30.2 0.91 0.82

-62.9 1.80

1.94

1.88

0.90

Weight LBW IUGR Prematurity

0.96

1.14

1.24

Education below secondary

Maternal age 30 and more

Married above 10 years

Maternal age below 20

Category

Birth season :

Spring(-5.2 ; 27.1) (0.87 ; 1.40) (0.81 ; 1.06) (0.91 ; 1.26)

Summer(-6.1 ; 25.8) (0.76 ; 1.24) (0.83 ; 1.09) (0.85 ; 1.18)

Autumn(-15.4 ; 16.1) (0.76 ; 1.24) (0.87 ; 1.14) (0.74 ; 1.03)

City of birth vs. Cracow:

Lodz(-68.5 ; -38.5) (0.95 ; 1.46) (1.23 ; 1.57) (1.05 ; 1.44)

Poznan(-21.5 ; 10.3) (0.80 ; 1.31) (0.93 ; 1.23) (1.18 ; 1.64)

Wroclaw(39.3 ; 71.3) (0.55 ; 0.91) (0.74 ; 0.99) (0.92 ; 1.30)

Weight LBW IUGR Prematurity

11.0 1.10 0.93 1.07

9.9 0.97 0.95 1.00

0.3 0.97 0.99 0.87

-53.5 1.17 1.39 1.23

-5.6 1.02 1.07 1.39

55.3 0.71 0.85 1.10

Birth outcomes by the variables included in the models

Dose response curves for association between mean birth weight and BS during 1st trimester of pregnancy

Dose response curves for association between risk of low birth weight and SO2 and BS during 1st and 3rd trimester of

pregnancy in Lodz

Dose response curves for association between risk of IUGR and SO2 and BS during 1st and 3rd trimester of pregnancy in

Lodz

Dose response curves for association between mean birth weight and SO2 and BS during 1st and 3rd trimester of

pregnancy in Lodz

Dose response curves for association between risk of premature birth and SO2 during 1st trimester of pregnancy

Dose response curves for association between risk of premature birth and SO2 during 3rd trimester of pregnancy

Risk of premature birth associated with 10mg/m3 increase in ambient SO2 concentration during 3rd trimester of

pregnancy

City

SO2

range

(g/m3)

OR

Cracow 0-40 0.904 0.717 1.13940+ 0.952 0.862 1.052

Lodz 0-40 0.867 0.763 0.98540+ 1.069 0.981 1.166

Poznan 0-40 0.924 0.802 1.06440+ 1.035 0.947 1.130

Wroclaw 0-40 0.819 0.703 0.95440+ 1.174 1.072 1.284

Meta 0-40 0.875 0.811 0.94440+ * 1.056 0.974 1.146

95% C.I.

* Random effect model

Dose response curves for association between risk of premature birth and BS during 1st trimester of pregnancy

Dose response curves for association between risk of premature birth and BS during 3rd trimester of pregnancy

Risk of premature birth associated with 10g/m3 increase in ambient BS concentration during 3rd

trimester of pregnancy

CityBS range

(g/m3)OR

Cracow 0-50 1.073 0.933 1.23350+ 1.022 0.960 1.088

Lodz 0-50 1.058 0.948 1.18050+ 1.104 1.021 1.194

Poznan 0-50 1.008 0.896 1.13350+ 1.074 1.007 1.146

Wroclaw 0-50 1.074 0.932 1.23650+ 1.148 1.055 1.249

Meta 0-50 1.049 0.986 1.11750+ 1.076 1.038 1.115

95% C.I.

CONCLUSIONSCONCLUSIONS

In Polish urban population:In Polish urban population:

• Ambient air pollution was not found Ambient air pollution was not found a a significant risk factor of fetal significant risk factor of fetal

growthgrowth

• Air pollution with black Air pollution with black smoke was smoke was found a significant risk found a significant risk factor of factor of

premature birthpremature birth