Full Text:   <769>

Summary:  <158>

Suppl. Mater.: 

CLC number: R173

On-line Access: 2019-03-01

Received: 2018-03-07

Revision Accepted: 2018-08-10

Crosschecked: 2019-01-10

Cited: 0

Clicked: 3644

Citations:  Bibtex RefMan EndNote GB/T7714


Le-qian Guo


-   Go to

Article info.
Open peer comments

Journal of Zhejiang University SCIENCE B 2019 Vol.20 No.3 P.238-252


Ambient air pollution and adverse birth outcomes: a systematic review and meta-analysis

Author(s):  Le-qian Guo, Yu Chen, Bai-bing Mi, Shao-nong Dang, Dou-dou Zhao, Rong Liu, Hong-li Wang, Hong Yan

Affiliation(s):  Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; more

Corresponding email(s):   yanhong1234@aliyun.com

Key Words:  Air pollution, Low birth weight, Preterm birth, Meta-analysis, Adverse birth outcome

Le-qian Guo, Yu Chen, Bai-bing Mi, Shao-nong Dang, Dou-dou Zhao, Rong Liu, Hong-li Wang, Hong Yan. Ambient air pollution and adverse birth outcomes: a systematic review and meta-analysis[J]. Journal of Zhejiang University Science B, 2019, 20(3): 238-252.

@article{title="Ambient air pollution and adverse birth outcomes: a systematic review and meta-analysis",
author="Le-qian Guo, Yu Chen, Bai-bing Mi, Shao-nong Dang, Dou-dou Zhao, Rong Liu, Hong-li Wang, Hong Yan",
journal="Journal of Zhejiang University Science B",
publisher="Zhejiang University Press & Springer",

%0 Journal Article
%T Ambient air pollution and adverse birth outcomes: a systematic review and meta-analysis
%A Le-qian Guo
%A Yu Chen
%A Bai-bing Mi
%A Shao-nong Dang
%A Dou-dou Zhao
%A Rong Liu
%A Hong-li Wang
%A Hong Yan
%J Journal of Zhejiang University SCIENCE B
%V 20
%N 3
%P 238-252
%@ 1673-1581
%D 2019
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1800122

T1 - Ambient air pollution and adverse birth outcomes: a systematic review and meta-analysis
A1 - Le-qian Guo
A1 - Yu Chen
A1 - Bai-bing Mi
A1 - Shao-nong Dang
A1 - Dou-dou Zhao
A1 - Rong Liu
A1 - Hong-li Wang
A1 - Hong Yan
J0 - Journal of Zhejiang University Science B
VL - 20
IS - 3
SP - 238
EP - 252
%@ 1673-1581
Y1 - 2019
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1800122

Several reviews have assessed the relationship between exposure to ambient air pollution and adverse birth outcomes during pregnancy, but the results remain controversial. The objective of this study was to assess this correlation quantitatively and to explore sources of heterogeneity. We included all published case-control or cohort studies that evaluated the correlation between ambient air pollution and low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA). Analytical methods and inclusion criteria were provided on the PROSPERO website (CRD42018085816). We evaluated pooled effects and heterogeneity. Subgroup analyses (grouped by exposure period, study settings, study design, exposure types, data source, Newcastle-Ottawa quality score (NOS), and adjustment for smoking or meteorological factors) were also conducted and publication bias was examined. The risk of bias in systematic reviews (ROBIS) tool was used to evaluate the overall risk of bias in this review. Forty studies met the inclusion criteria. We observed pooled odds ratios (ORs) of 1.03–1.21 for LBW and 0.97–1.06 for PTB when mothers were exposed to CO, NO2, NOx, O3, PM2.5, PM10, or SO2 throughout their pregnancy. For SGA, the pooled estimate was 1.02 in relation to NO2 concentrations. Subgroup analysis and sensitivity analysis decreased the heterogeneity to some extent, such as the subgroups of continuous measures (OR=0.98 (0.97–0.99), I2=0.0%) and NOS>7 (OR=0.98 (0.97–0.99), I2=0.0%) in evaluating the association between PTB and NO2. This review was completed with a low risk of bias. High concentrations of air pollution were significantly related to the higher risk of adverse birth outcomes. However, the sources of heterogeneity among studies should be further explored.




Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article


[1]Araban M, Kariman N, Tavafian SS, et al., 2012. Air pollution and low birth weight: a historical cohort study from Tehran. East Mediterr Health J, 18(6):556-560.


[3]Behrman RE, Butler AS, 2007. Preterm Birth: Causes, Consequences, and Prevention. National Academies Press, Washington, DC, USA.

[4]Berrocal VJ, Gelfand AE, Holland DM, et al., 2011. On the use of a PM2.5 exposure simulator to explain birthweight. Environmetrics, 22(4):553-571.

[5]Bibby E, Stewart A, 2004. The epidemiology of preterm birth. Neuro Endocrinol Lett, 25(S1):43-47.

[6]Bosetti C, Nieuwenhuijsen MJ, Gallus S, et al., 2010. Ambient particulate matter and preterm birth or birth weight: a review of the literature. Arch Toxicol, 84(6):447-460.

[7]Brauer M, Lencar C, Tamburic L, et al., 2008. A cohort study of traffic-related air pollution impacts on birth outcomes. Environ Health Perspect, 116(5):680-686.

[8]Dadvand P, Parker J, Bell ML, et al., 2013. Maternal exposure to particulate air pollution and term birth weight: a multi-country evaluation of effect and heterogeneity. Environ Health Perspect, 121(3):267-373.

[9]Du MK, Ge LY, Zhou ML, et al., 2017. Effects of pre-pregnancy body mass index and gestational weight gain on neonatal birth weight. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 18(3):263-271.

[10]Dugandzic R, Dodds L, Stieb D, et al., 2006. The association between low level exposures to ambient air pollution and term low birth weight: a retrospective cohort study. Environ Health, 5(1):3.

[11]Ghosh JKC, Wilhelm M, Su J, et al., 2012. Assessing the influence of traffic-related air pollution on risk of term low birth weight on the basis of land-use-based regression models and measures of air toxics. Am J Epidemiol, 175(12):1262-1274.

[12]Giorgis-Allemand L, Pedersen M, Bernard C, et al., 2017. The influence of meteorological factors and atmospheric pollutants on the risk of preterm birth. Am J Epidemiol, 185(4):247-258.

[13]Habermann M, Gouveia N, 2014. Socioeconomic position and low birth weight among mothers exposed to traffic-related air pollution. PLoS ONE, 9(11):e113900.

[14]Hannam K, McNamee R, Baker P, et al., 2014. Air pollution exposure and adverse pregnancy outcomes in a large UK birth cohort: use of a novel spatio-temporal modelling technique. Scand J Work Environ Health, 40(5):518-530.

[15]Hansen C, Neller A, Williams G, et al., 2006. Maternal exposure to low levels of ambient air pollution and preterm birth in Brisbane, Australia. BJOG, 113(8):935-941.

[16]Harbord RM, Higgins J, 2008. Meta-regression in Stata. Stata J, 8(4):493-519.

[17]Higgins JP, Green S, 2011. Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0. The Cochrane Collaboration. http://handbook.cochrane.org [Accessed on Mar. 19, 2018].

[18]Higgins JP, Thompson SG, Deeks JJ, et al., 2003. Measuring inconsistency in meta-analyses. Br Med J, 327(7414):557-560.

[19]Huynh M, Woodruff TJ, Parker JD, et al., 2006. Relationships between air pollution and preterm birth in California. Paediatr Perinat Epidemiol, 20(6):454-461.

[20]Jalaludin B, Mannes T, Morgan G, et al., 2007. Impact of ambient air pollution on gestational age is modified by season in Sydney, Australia. Environ Health, 6(1):16.

[21]Kim OJ, Ha EH, Kim BM, et al., 2007. PM10 and pregnancy outcomes: a hospital-based cohort study of pregnant women in Seoul. J Occup Environ Med, 49(12):1394-1402.

[22]Laden F, Neas LM, Dockery DW, et al., 2000. Association of fine particulate matter from different sources with daily mortality in six U.S. cities. Environ Health Perspect, 108(10):941-947.

[23]Lai HK, Tsang H, Wong CM, 2013. Meta-analysis of adverse health effects due to air pollution in Chinese populations. BMC Public Health, 13:360.

[24]Lamichhane DK, Leem JH, Lee JY, et al., 2015. A meta-analysis of exposure to particulate matter and adverse birth outcomes. Environ Health Toxicol, 30:e2015011.

[25]Lawn JE, Gravett MG, Nunes TM, et al., 2010. Global report on preterm birth and stillbirth (1 of 7):definitions, description of the burden and opportunities to improve data. BMC Pregnancy Childbirth, 10(Suppl 1):S1.

[26]Lee PC, Roberts JM, Catov JM, et al., 2013. First trimester exposure to ambient air pollution, pregnancy complications and adverse birth outcomes in Allegheny county, PA. Matern Child Health J, 17(3):545-555.

[27]Leem JH, Kaplan BM, Shim YK, et al., 2006. Exposures to air pollutants during pregnancy and preterm delivery. Environ Health Perspect, 114(6):905-910.

[28]Lin CC, Santolaya-Forgas J, 1998. Current concepts of fetal growth restriction: part I. Causes, classification, and pathophysiology. Obstetr Gynecol, 92(6):1044-1055.

[29]Lin CM, Li CY, Yang GY, et al., 2004. Association between maternal exposure to elevated ambient sulfur dioxide during pregnancy and term low birth weight. Environ Res, 96(1):41-50.

[30]Llop S, Ballester F, Estarlich M, et al., 2010. Preterm birth and exposure to air pollutants during pregnancy. Environ Res, 110(8):778-785.

[31]Madsen C, Gehring U, Walker SE, et al., 2010. Ambient air pollution exposure, residential mobility and term birth weight in Oslo, Norway. Environ Res, 110(4):363-371.

[32]Nieuwenhuijsen MJ, Dadvand P, Grellier J, et al., 2013. Environmental risk factors of pregnancy outcomes: a summary of recent meta-analyses of epidemiological studies. Environ Health, 12(1):6.

[33]Pedersen M, Giorgis-Allemand L, Bernard C, et al., 2013. Ambient air pollution and low birthweight: a European cohort study (ESCAPE). Lancet Respir Med, 1(9):695-704.

[34]Poirier A, Dodds L, Dummer T, et al., 2015. Maternal exposure to air pollution and adverse birth outcomes in Halifax, Nova Scotia. J Occup Environ Med, 57(12):1291-1298.

[35]Qian ZM, Liang SW, Yang SP, et al., 2016. Ambient air pollution and preterm birth: a prospective birth cohort study in Wuhan, China. Int J Hyg Environ Health, 219(2):195-203.

[36]Ritz B, Wilhelm M, Hoggatt KJ, et al., 2007. Ambient air pollution and preterm birth in the environment and pregnancy outcomes study at the University of California, Los Angeles. Am J Epidemiol, 166(9):1045-1052.

[37]Romão R, Pereira LAA, Saldiva PHN, et al., 2013. The relationship between low birth weight and exposure to inhalable particulate matter. Cad Saúde Pública, 29(6):1101-1108.

[38]Saigal S, Doyle LW, 2008. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet, 371(9608):261-269.

[39]Salam MT, Millstein J, Li YF, et al., 2005. Birth outcomes and prenatal exposure to ozone, carbon monoxide, and particulate matter: results from the children’s health study. Environ Health Perspect, 113(11):1638-1644.

[40]Salihu HM, Ghaji N, Mbah AK, et al., 2012. Particulate pollutants and racial/ethnic disparity in feto-infant morbidity outcomes. Matern Child Health J, 16(8):1679-1687.

[41]Samoli E, Peng R, Ramsay T, et al., 2008. Acute effects of ambient particulate matter on mortality in Europe and North America: results from the APHENA study. Environ Health Perspect, 116(11):1480-1486.

[42]Sapkota A, Chelikowsky AP, Nachman KE, et al., 2012. Exposure to particulate matter and adverse birth outcomes: a comprehensive review and meta-analysis. Air Qual, Atmos Health, 5(4):369-381.

[43]Shah PS, Balkhair T, on behalf of Knowledge Synthesis Group on Determinants of Preterm/LBW Births, 2011. Air pollution and birth outcomes: a systematic review. Environ Int, 37(2):498-516.

[44]Šrám RJ, Binková B, Rössner P, et al., 1999. Adverse reproductive outcomes from exposure to environmental mutagens. Mutat Res, 428(1-2):203-215.

[45]Šrám RJ, Binková B, Dejmek J, et al., 2005. Ambient air pollution and pregnancy outcomes: a review of the literature. Environ Health Perspect, 113(4):375-382.

[46]Sterne JA, Harbord RM, 2004. Funnel plots in meta-analysis. Stata J, 4(2):127-141.

[47]Stieb DM, Chen L, Eshoul M, et al., 2012. Ambient air pollution, birth weight and preterm birth: a systematic review and meta-analysis. Environ Res, 117:100-111.

[48]Stieb DM, Chen L, Hystad P, et al., 2016. A national study of the association between traffic-related air pollution and adverse pregnancy outcomes in Canada, 1999-2008. Environ Res, 148:513-526.

[49]Sun XL, Luo XP, Zhao CM, et al., 2015. The association between fine particulate matter exposure during pregnancy and preterm birth: a meta-analysis. BMC Pregnancy Childbirth, 15:300.

[50]Vadillo-Ortega F, Osornio-Vargas A, Buxton MA, et al., 2014. Air pollution, inflammation and preterm birth: a potential mechanistic link. Med Hypoth, 82(2):219-224.

[51]van Lieshout RJ, Boyle MH, Saigal S, et al., 2015. Mental health of extremely low birth weight survivors in their 30s. Pediatrics, 135(3):452-459.

[52]Wardlaw TM, 2004. Low Birthweight: Country, Regional and Global Estimates. WHO, Geneva, Switzerland.

[53]Wells GA, Shea B, O'Connell D, et al., 2018. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses. The Ottawa Hospital Research Institute. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp [Accessed on Mar. 19, 2018].

[54]Whiting P, Savović J, Higgins JPT, et al., 2016. ROBIS: a new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol, 69:225-234.

[55]Wilcox AJ, 2001. On the importance—and the unimportance— of birthweight. Int J Epidemiol, 30(6):1233-1241.

[56]Wilhelm M, Ritz B, 2005. Local variations in CO and particulate air pollution and adverse birth outcomes in Los Angeles County, California, USA. Environ Health Perspect, 113(9):1212-1221.

[57]Wilhelm M, Ghosh JK, Su J, et al., 2011. Traffic-related air toxics and preterm birth: a population-based case-control study in Los Angeles County, California. Environ Health, 10(1):89.

[58]Wilhelm M, Ghosh JK, Su J, et al., 2012. Traffic-related air toxics and term low birth weight in Los Angeles County, California. Environ Health Perspect, 120(1):132-138.

[59]Wu J, Wilhelm M, Chung J, et al., 2011. Comparing exposure assessment methods for traffic-related air pollution in an adverse pregnancy outcome study. Environ Res, 111(5):685-692.

[60]Xu XH, Sharma RK, Talbott EO, et al., 2011. PM10 air pollution exposure during pregnancy and term low birth weight in Allegheny County, PA, 1994–2000. Int Arch Occup Environ Health, 84(3):251-257.

[61]Yorifuji T, Kashima S, Doi H, 2015. Outdoor air pollution and term low birth weight in Japan. Environ Int, 74:106-111.

[62]Zhang J, Yu K, 1998. What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA, 280(19):1690-1691.

[63]Zhao N, Qiu J, Zhang YQ, et al., 2015. Ambient air pollutant PM10 and risk of preterm birth in Lanzhou, China. Environ Int, 76:71-77.

[64]Zhu X, Liu Y, Chen Y, et al., 2015. Maternal exposure to fine particulate matter (PM2.5) and pregnancy outcomes: a meta-analysis. Environ Sci Pollut Res, 22(5):3383-3396.

[65]List of electronic supplementary materials

[66]Table S1 PRISMA 2009 checklist

[67]Table S2 Characteristics of primary studies

[68]Table S3 Questions in ROBIS

Open peer comments: Debate/Discuss/Question/Opinion


Please provide your name, email address and a comment

Journal of Zhejiang University-SCIENCE, 38 Zheda Road, Hangzhou 310027, China
Tel: +86-571-87952783; E-mail: cjzhang@zju.edu.cn
Copyright © 2000 - Journal of Zhejiang University-SCIENCE