Ambient air pollution has been linked to small for gestational age (SGA); however, the relationship with large for gestational age (LGA) is unclear and very few studies have investigated seasonal effects on the association between air pollution and SGA or LGA. Using birth registry data of 506,000 singleton live births from 11 districts in Guangzhou, China between January 2015 and July 2017, we examined associations between ambient air pollutants (PM2.5, PM10, NO2, SO2, and O3) and SGA/LGA, and further assessed the modification effect of season. Daily concentrations of air pollutants from 11 monitoring stations were used to estimate district-specific exposures for each participant based on their district of residence during pregnancy. Two-level binary logistic regression models were used to evaluate associations between air pollution and SGA/LGA. Stratified analyses by season and a Cochran Q test were performed to assess the modification of season. Exposure to PM2.5, NO2, SO2, and O3 was significantly associated with increased risk of SGA, especially for exposure during the second and third trimester. For an interquartile range (IQR) increase in PM2.5 (6.5 μg/m3), NO2 (12.7 μg/m3), SO2 (2.8 μg/m3) and O3 (20.8 μg/m3) during the entire pregnancy, SGA risk increased by 2% (OR = 1.02, 95% CI: 1.00-1.04), 8% (OR = 1.08, 95% CI: 1.04-1.12), 2% (OR = 1.02, 95% CI: 1.01-1.03), and 14% (1.14, 1.11-1.17), respectively. A decreased risk of LGA was found for PM2.5, PM10, SO2, and O3 during the first trimester or entire pregnancy. When examined by season, significant associations between air pollutants and SGA were observed for women who conceived during summer or fall, and the patterns were consistent for all pollutants. Our study suggests that conception during different seasons might modify the association between ambient air pollution and SGA.
Keywords: Air pollution; Effect modification; Large for gestational age; Season; Small for gestational age.
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