Air Pollution and Pregnancy Outcomes

Abstract

Children born with low birth weight, preterm, or with fetal growth restriction may suffer from significant short and long term morbidity and mortality, making adverse pregnancy outcomes a major public health concern with significant health, social, and economic consequences for families, communities, and the nation. Despite aggressive public heath campaigns, racial and geographic disparities in pregnancy outcomes persist. Disproportionate exposure to environmental hazards may partially account for such disparities. In this chapter, we synthesize the existing literature connecting air pollution exposures and pregnancy outcomes. We begin by providing readers with background on adverse pregnancy outcomes, including their consequences and documented disparities. Next, we summarize existing research on air pollution and pregnancy outcomes with a systematic literature review, describing the state of knowledge regarding associations between each outcome and key pollutants. While the scientific literature clearly points to a detrimental association between maternal air pollution exposure and pregnancy outcomes, the literature does not yet provide a consensus understanding of the details of this association. Thus, we describe key methodological barriers and inconsistencies that make interpretation across studies challenging, noting why these issues arise, how they impact results, and how they may be addressed. Acknowledging these challenges and the need for additional research, this chapter highlights clear evidence of a negative association between air pollution and pregnancy outcomes. Future work addressing methodological issues and, perhaps most importantly, identifying causal pathways, is critical to establishing appropriate regulatory policy and protecting maternal and infant health.