Abstract
BACKGROUND: There is a growing evidence that exposure to ambient particulate air pollution during pregnancy is associated with adverse birth outcomes, including reduced birth weight (BW). The objective of this study was to quantify associations between BW and exposure to particulate matter (PM) and biomass burning during pregnancy in Thailand. METHODS: We collected hourly ambient air pollutant data from ground-based monitors (PM with diameter of <10 µm [PM(10)], Ozone [O(3)], and nitrogen dioxide [NO(2)]), biomass burning from satellite remote sensing data, and individual birth weight data during 2015-2018. We performed a semi-ecological analysis to evaluate the association between mean trimester exposure to air pollutants and biomass burning with BW and low-birth weight (LBW) (<2500 g), adjusting for gestation age, sex, previous pregnancies, mother's age, heat index, season, year, gaseous pollutant concentrations, and province. We examined potential effect modification of PM(10) and biomass burning exposures by sex. RESULTS: There were 83,931 eligible births with a mean pregnancy PM(10) exposure of 39.7 µg/m(3) (standard deviation [SD] = 7.7). The entire pregnancy exposure was associated with reduced BW both for PM(10) (-6.81 g per 10 µg/m(3) increase in PM(10) [95% CI = -12.52 to -1.10]) and biomass burning (-6.34 g per 1 SD increase in fires/km(2) [95% CI = -11.35 to -1.34]) only after adjustment for NO(2). In contrast with these findings, a reduced odds ratio (OR) of LBW was associated with PM(10) exposure only in trimesters one and two, with no relationship across the entire pregnancy period. Associations with biomass burning were limited to increased ORs of LBW with exposure in trimester three, but only for male births. CONCLUSION: Based on our results, we encourage further investigation of air pollution, biomass burning and BW in Thailand and other low-income and middle-income countries.