Modification effects of ambient temperature on associations of ambient ozone exposure before and during pregnancy with adverse birth outcomes: A multicity study in China

Juan Chen; Liqiong Guo; Huimeng Liu; Lei Jin; Wenying Meng; Junkai Fang; Lei Zhao; Xiao-Wen Zeng; Bo-Yi Yang; Qi Wang; Xinbiao Guo; Furong Deng; Guang-Hui Dong; Xuejun Shang; Shaowei Wu

doi:10.1016/j.envint.2023.107791

Modification effects of ambient temperature on associations of ambient ozone exposure before and during pregnancy with adverse birth outcomes: A multicity study in China

Environ Int. 2023 Feb:172:107791. doi: 10.1016/j.envint.2023.107791. Epub 2023 Jan 31.

Authors

Juan Chen¹, Liqiong Guo², Huimeng Liu³, Lei Jin⁴, Wenying Meng⁵, Junkai Fang⁶, Lei Zhao², Xiao-Wen Zeng⁷, Bo-Yi Yang⁷, Qi Wang⁸, Xinbiao Guo⁹, Furong Deng⁹, Guang-Hui Dong⁷, Xuejun Shang¹⁰, Shaowei Wu¹¹

Affiliations

¹ Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China; Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China; Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.
² Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China; Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China.
³ Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.
⁴ Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
⁵ Tongzhou Maternal and Child Health Care Hospital, Beijing, China.
⁶ Tianjin Healthcare Affair Center, Tianjin, China.
⁷ Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China.
⁸ Department of Toxicology, School of Public Health, Peking University, Beijing, China.
⁹ Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China.
¹⁰ Department of Andrology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China. Electronic address: shangxj98@163.com.
¹¹ Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China; Key Laboratory of Trace Elements and Endemic Diseases in Ministry of Health, Xi'an, Shaanxi, China. Electronic address: shaowei_wu@xjtu.edu.cn.

PMID: 36739855
DOI: 10.1016/j.envint.2023.107791

Abstract

Background: Epidemiological studies suggest that both ambient ozone (O₃) and temperature were associated with increased risks of adverse birth outcomes. However, very few studies explored their interaction effects, especially for small for gestational age (SGA) and large for gestational age (LGA).

Objectives: To estimate the modification effects of ambient temperature on associations of ambient O₃ exposure before and during pregnancy with preterm birth (PTB), low birth weight (LBW), SGA and LGA based on multicity birth cohorts.

Methods: A total of 56,905 singleton pregnant women from three birth cohorts conducted in Tianjin, Beijing and Maoming, China, were included in the study. Maximum daily 8-h average O₃ concentrations of each pregnant woman from the preconception period to delivery for every day were estimated by matching their home addresses with the Tracking Air Pollution in China (TAP) datasets. We first applied the Cox proportional-hazards regression model to evaluate the city-specific effects of O₃ exposure before and during pregnancy on adverse birth outcomes at different temperature levels with adjustment for potential confounders, and then a meta-analysis across three birth cohorts was conducted to calculate the pooled associations.

Results: In pooled analysis, significant modification effects of ambient temperature on associations of ambient O₃ with PTB, LBW and LGA were observed (P_interaction < 0.05). For a 10 μg/m³ increase in ambient O₃ exposure at high temperature level (> 75^th percentile), the risk of LBW increased by 28 % (HR: 1.28, 95% CI: 1.13-1.46) during the second trimester and the risk of LGA increased by 116% (HR: 2.16, 95%CI: 1.16-4.00) during the entire pregnancy, while the null or weaker association was observed at corresponding low (≤ 25^th percentile) and medium (> 25^th and ≤ 75^th percentile) temperature levels.

Conclusion: This multicity study added new evidence that ambient high temperature may enhance the potential effects of ambient O₃ on adverse birth outcomes.

Keywords: Adverse birth outcomes; Ambient ozone; Ambient temperature; Large for gestational age; Modification effects.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Air Pollutants* / analysis
Air Pollution* / adverse effects
Air Pollution* / analysis
China / epidemiology
Female
Fetal Growth Retardation / chemically induced
Humans
Infant, Newborn
Maternal Exposure / adverse effects
Ozone* / analysis
Particulate Matter / analysis
Pregnancy
Pregnancy Complications* / chemically induced
Premature Birth* / chemically induced
Premature Birth* / epidemiology
Temperature

Substances

Air Pollutants
Ozone
Particulate Matter