Synergistic risks of ambient air particulate matter and ozone exposure on low birth weight: An 11-year longitudinal Chinese maternity cohort study
Observational epidemiological studies have demonstrated that maternal exposure to air pollution increases the risk of adverse pregnancy outcomes. However, interactions among multiple environmental exposures remain underexplored. In this study, we performed an epidemiological analysis on 147,979 preg...
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Elsevier
2025-08-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0160412025003915 |
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| author | Haitong Zhe Sun Han Chen Yijia Tian Zekun Wang Juan Zhou Lina Zhang Jing Fang Juan Gao Kim Robin van Daalen Lynette P. Shek Wei Jie Seow Yuming Guo Nick Watts Xiaoxia Bai |
| author_facet | Haitong Zhe Sun Han Chen Yijia Tian Zekun Wang Juan Zhou Lina Zhang Jing Fang Juan Gao Kim Robin van Daalen Lynette P. Shek Wei Jie Seow Yuming Guo Nick Watts Xiaoxia Bai |
| author_sort | Haitong Zhe Sun |
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| description | Observational epidemiological studies have demonstrated that maternal exposure to air pollution increases the risk of adverse pregnancy outcomes. However, interactions among multiple environmental exposures remain underexplored. In this study, we performed an epidemiological analysis on 147,979 pregnant women recruited from nine provinces in southeastern China between 2013 and 2023, focusing on the risk of low birth weight (LBW). We found that the critical exposure windows for PM2.5 and ozone (O3) extend from six months prior to conception through the end of second trimester, with hazard ratio of HR = 1.152 (95 % confidence interval [CI]: 1.128–1.177) per 10-μg/m3 incremental PM2.5 exposure and HR = 1.028 (95 % CI: 1.024–1.031) per 10-ppb increase in O3. Our estimates indicate that in 2021, approximately 47,500 (95 % uncertainty interval [UI]: 41,200–53,600) live-born LBW infants nationwide in China could be attributed to ambient air pollution, declining from 79,800 (95 % UI: 71,700–87,900) in 2002. We observed statistically significant synergistic risk effects, neglecting which could lead to an underestimation of 11,600 (95 % UI: 9,300–13,900) LBW cases. Although air pollution-associated LBW burden is decreasing, the rapidly rising LBW prevalence remains a significant public health concern, particularly as China is implementing the “three-child policy”. Therefore, our study offers precisely quantified, evidence-based policy guidance for safeguarding reproductive health. |
| format | Article |
| id | doaj-art-159c6e7ad3044e7681f6affe36e432c9 |
| institution | Matheson Library |
| issn | 0160-4120 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
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| series | Environment International |
| spelling | doaj-art-159c6e7ad3044e7681f6affe36e432c92025-07-02T04:49:24ZengElsevierEnvironment International0160-41202025-08-01202109640Synergistic risks of ambient air particulate matter and ozone exposure on low birth weight: An 11-year longitudinal Chinese maternity cohort studyHaitong Zhe Sun0Han Chen1Yijia Tian2Zekun Wang3Juan Zhou4Lina Zhang5Jing Fang6Juan Gao7Kim Robin van Daalen8Lynette P. Shek9Wei Jie Seow10Yuming Guo11Nick Watts12Xiaoxia Bai13Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China; Centre for Sustainable Medicine (CoSM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117549, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore; Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, United Kingdom; British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, United Kingdom; Corresponding authors at: Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China.Centre for Sustainable Medicine (CoSM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117549, SingaporeDepartment of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, ChinaDepartment of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, ChinaDepartment of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, ChinaDepartment of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, ChinaLanxi People’s Hospital, Jinhua, Zhejiang Province 321102, China; Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, ChinaCentre for Sustainable Medicine (CoSM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117549, SingaporeBritish Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, United Kingdom; Heart and Lung Research Institute, University of Cambridge, Cambridge CB2 0BD, United Kingdom; Barcelona Supercomputing Centre, Department of Earth Sciences, Barcelona 08034, SpainCentre for Sustainable Medicine (CoSM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117549, SingaporeSaw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, SingaporeSchool of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, AustraliaCentre for Sustainable Medicine (CoSM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, SingaporeDepartment of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China; Traditional Chinese Medicine for Reproductive Health Key Laboratory of Zhejiang Province, Hangzhou 310006 Zhejiang Province, China; Zhejiang Provincial Clinical Research Centre for Obstetrics and Gynaecology, Hangzhou 310006 Zhejiang Province, China; Women’s Reproductive Health Laboratory of Zhejiang University, Hangzhou 310006 Zhejiang Province, China; Corresponding authors at: Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China.Observational epidemiological studies have demonstrated that maternal exposure to air pollution increases the risk of adverse pregnancy outcomes. However, interactions among multiple environmental exposures remain underexplored. In this study, we performed an epidemiological analysis on 147,979 pregnant women recruited from nine provinces in southeastern China between 2013 and 2023, focusing on the risk of low birth weight (LBW). We found that the critical exposure windows for PM2.5 and ozone (O3) extend from six months prior to conception through the end of second trimester, with hazard ratio of HR = 1.152 (95 % confidence interval [CI]: 1.128–1.177) per 10-μg/m3 incremental PM2.5 exposure and HR = 1.028 (95 % CI: 1.024–1.031) per 10-ppb increase in O3. Our estimates indicate that in 2021, approximately 47,500 (95 % uncertainty interval [UI]: 41,200–53,600) live-born LBW infants nationwide in China could be attributed to ambient air pollution, declining from 79,800 (95 % UI: 71,700–87,900) in 2002. We observed statistically significant synergistic risk effects, neglecting which could lead to an underestimation of 11,600 (95 % UI: 9,300–13,900) LBW cases. Although air pollution-associated LBW burden is decreasing, the rapidly rising LBW prevalence remains a significant public health concern, particularly as China is implementing the “three-child policy”. Therefore, our study offers precisely quantified, evidence-based policy guidance for safeguarding reproductive health.http://www.sciencedirect.com/science/article/pii/S0160412025003915Low birth weightEnvironmental epidemiologyMaternity cohortAir pollutionSynergistic riskSurvival analysis |
| spellingShingle | Haitong Zhe Sun Han Chen Yijia Tian Zekun Wang Juan Zhou Lina Zhang Jing Fang Juan Gao Kim Robin van Daalen Lynette P. Shek Wei Jie Seow Yuming Guo Nick Watts Xiaoxia Bai Synergistic risks of ambient air particulate matter and ozone exposure on low birth weight: An 11-year longitudinal Chinese maternity cohort study Environment International Low birth weight Environmental epidemiology Maternity cohort Air pollution Synergistic risk Survival analysis |
| title | Synergistic risks of ambient air particulate matter and ozone exposure on low birth weight: An 11-year longitudinal Chinese maternity cohort study |
| title_full | Synergistic risks of ambient air particulate matter and ozone exposure on low birth weight: An 11-year longitudinal Chinese maternity cohort study |
| title_fullStr | Synergistic risks of ambient air particulate matter and ozone exposure on low birth weight: An 11-year longitudinal Chinese maternity cohort study |
| title_full_unstemmed | Synergistic risks of ambient air particulate matter and ozone exposure on low birth weight: An 11-year longitudinal Chinese maternity cohort study |
| title_short | Synergistic risks of ambient air particulate matter and ozone exposure on low birth weight: An 11-year longitudinal Chinese maternity cohort study |
| title_sort | synergistic risks of ambient air particulate matter and ozone exposure on low birth weight an 11 year longitudinal chinese maternity cohort study |
| topic | Low birth weight Environmental epidemiology Maternity cohort Air pollution Synergistic risk Survival analysis |
| url | http://www.sciencedirect.com/science/article/pii/S0160412025003915 |
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