Abstract
Accumulating evidence suggested that the risk of preterm births (PTBs) following prenatal exposure to air pollution was inconclusive. The aim of this study is to investigate the relationship between air pollution exposure in the days before delivery and PTB and assess the threshold effect of short-term prenatal exposure to air pollution on PTB. This study collected data including meteorological factors, air pollutants, and information in Birth Certificate System from 9 districts during 2015-2020 in Chongqing, China. Generalized additive models (GAMs) with the distributed lag non-linear models were conducted to assess the acute impact of air pollutants on the daily counts of PTB, after controlling for potential confounding factors. We observed that PM(2.5) was related to increased occurrence of PTB on lag 0-3 and lag 10-21 days, with the strongest on the first day (RR = 1.017, 95%CI: 1.000-1.034) and then decreasing. The thresholds of PM(2.5) for lag 1-7 and 1-30 days were 100 μg/m(3) and 50 μg/m(3), respectively. The lag effect of PM(10) on PTB was very similar to that of PM(2.5). In addition, the lagged and cumulative exposure of SO(2) and NO(2) was also associated with the increased risk of PTB. The lag relative risk and cumulative relative risk of CO exposure were the strongest, with a maximum RR at lag 0 (RR = 1.044, 95%CI: 1.018, 1.069). Importantly, the exposure-response curve of CO showed that RR increased rapidly when the concentration exceeded 1000 μg/m(3). This study indicated significant associations between air pollution and PTB. The relative risk decreases with day lag, while the cumulative effect increases. Thus, pregnant women should understand the risk of air pollution and try to avoid high concentration exposure.