Abstract
BACKGROUND: Previous studies observed associations between prenatal exposure to fine particulate matter (≤ 2.5 μm; PM(2.5)) and small-for-gestational-age (SGA) birth and lower birthweight percentile for gestational age. Few, if any, studies examine prenatal air pollution exposure and these pregnancy outcomes in neonates born to the same women. Here, we assess whether prenatal exposure to ambient fine particulate matter (PM(2.5)) is associated with small-for-gestational-age (SGA) birth or birthweight percentile for gestational age in a longitudinal setting. METHODS: Detailed birth record data were used to identify women who had singleton live births at least twice in North Carolina during 2002-2006 (n = 53,414 women, n = 109,929 births). Prenatal PM(2.5) exposures were calculated using daily concentration estimates obtained from the US EPA Fused Air Quality Surface using Downscaling data archive. Associations between PM(2.5) exposure and birthweight percentile and odds of SGA birth were calculated using linear and generalized mixed models, comparing successive pregnancies to the same woman. Odds ratios and associations were also estimated in models that did not account for siblings born to the same mother. RESULTS: Among NHW women, pregnancy-long PM(2.5) exposure was associated with SGA (OR: 1.11 [1.06, 1.18]) and lower birthweight percentile (- 0.46 [- 0.74, - 0.17]). Trimester-specific PM(2.5) was also associated with SGA and lower birthweight percentile. Among NHB women, statistically significant within-woman associations between PM(2.5), SGA, and birthweight percentile were not observed. However, in models that did not account for births to the same mother, statistically significant associations were observed between some PM(2.5) exposure windows and higher odds of SGA and lower birthweight percentile among NHB women. CONCLUSIONS: Findings suggest that a woman is at greater risk of delivering an SGA or low birthweight percentile neonate when she has been exposed to higher PM(2.5) levels. The within-woman comparison implemented here better controls for factors that may differ between women and potentially confound the relationship between PM(2.5) exposure and pregnancy outcomes. This adds to the evidence that PM(2.5) exposure may be causally related to SGA and birthweight percentile, even at concentrations close to or below National Ambient Air Quality Standards.