Acute and chronic maternal exposure to fine particulate matter and prelabor rupture of the fetal membranes: A nation-wide survey in China

Cuiping Wang; Guoqi Yu; Ramkumar Menon; Nanbert Zhong; Chong Qiao; Jing Cai; Weidong Wang; Huijuan Zhang; Ming Liu; Kang Sun; Haidong Kan; Jun Zhang

doi:10.1016/j.envint.2022.107561

Acute and chronic maternal exposure to fine particulate matter and prelabor rupture of the fetal membranes: A nation-wide survey in China

Environ Int. 2022 Dec:170:107561. doi: 10.1016/j.envint.2022.107561. Epub 2022 Oct 3.

Authors

Cuiping Wang¹, Guoqi Yu¹, Ramkumar Menon², Nanbert Zhong³, Chong Qiao⁴, Jing Cai⁵, Weidong Wang⁵, Huijuan Zhang⁶, Ming Liu⁷, Kang Sun⁸, Haidong Kan⁹, Jun Zhang¹⁰

Affiliations

¹ Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Department of Obstetrics and Gynecology/Cell Biology at the University Texas Medical Branch at Galveston, TX, U.S.A.
³ The New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY, U.S.A.
⁴ Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
⁵ School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China.
⁶ Department of Pathology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁷ Department of Obstetrics, Shanghai Oriental Hospital, Tongji University, Shanghai, China.
⁸ Center for Reproductive Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁹ School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China; Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, China. Electronic address: kanh@fudan.edu.cn.
¹⁰ Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: junjimzhang@sina.com.

PMID: 36209598
DOI: 10.1016/j.envint.2022.107561

Abstract

Background: Prelabor rupture of the fetal membranes (PROM) is a major contributor to adverse perinatal outcomes. Some epidemiologic studies explored the association between maternal PM_2.5 exposure and PROM but failed to treat the labor induction and prelabor cesarean section as censored observations.

Objective: We aimed to evaluated whether acute and chronic maternal ambient PM_2.5 exposure may increase the risk of PROM in China.

Methods: This study was based on the China Labor and Delivery Survey, a nationwide multicenter investigation. Included in the current analysis were 45,879 singleton spontaneous births in 96 hospitals in mainland China from 2015 to 2017. Outcomes were PROM, preterm PROM (<37 weeks' gestation) and term PROM (≥37 weeks' gestation). Daily concentration of PM_2.5 at 1 km spatial resolution was estimated by gap-filling model. Generalized linear mixed model and mixed effects Cox model were applied to assess the associations of acute (from 0 to 4 days before delivery) and chronic (average gestational and trimester-specific) ambient PM_2.5 exposure with outcomes, respectively.

Results: Significant associations were found between acute PM_2.5 exposures (per interquartile range increase) and the risk of preterm PROM (OR = 1.11; 95 % CI: 1.03, 1.19 for PM_2.5 on delivery day; OR = 1.10; 95 % CI: 1.02, 1.18 for PM_2.5 1 day before delivery) but not for term PROM. An interquartile range increase in PM_2.5 during the second trimester was associated with elevated risks of PROM (HR = 1.14; 95 % CI: 1.07, 1.22), preterm PROM (HR = 1.22; 95 % CI: 1.02, 1.45) and term PROM (HR = 1.13; 95 % CI: 1.06, 1.22), respectively. Women who were less educated, obese, or gave birth in a cold season appeared to be more sensitive to ambient PM_2.5 exposure.

Conclusion: Our findings suggest that both acute and chronic maternal exposures to ambient PM_2.5 during pregnancy are risk factors for PROM.

Keywords: Fine particulate matter; Maternal exposure; Nationwide multicenter investigation; Preterm prelabor rupture of the fetal membrane; Term prelabor rupture of the fetal membrane.

Publication types

Multicenter Study

MeSH terms

Cesarean Section
China / epidemiology
Extraembryonic Membranes
Female
Humans
Infant, Newborn
Maternal Exposure* / adverse effects
Particulate Matter* / adverse effects
Pregnancy

Substances

Particulate Matter