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Environmental Exposures in Pregnancy

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Women's Health".

Deadline for manuscript submissions: closed (31 July 2022) | Viewed by 30304

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Special Issue Editors

Dr. Amy M. Padula

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Guest Editor

Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
Interests: environmental epidemiology; perinatal epidemiology; child health; health disparities; preterm birth; birth defects; environmental health; chemicals; PFAS; air pollution; wildfires; psychosocial stress

Dr. Kelly K. Ferguson

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Guest Editor

Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
Interests: environmental epidemiology; reproductive epidemiology; fetal growth; preterm birth; developmental origins of health and disease; chemical exposure assessment; biomarker; phthalates; non-persistent chemicals; environmental health; inflammation; oxidative stress; longitudinal modeling; chemical mixtures

Dr. Jeanette A. Stingone

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Guest Editor

Department of Epidemiology, Columbia University, New York, NY, USA
Interests: environmental epidemiology; health equity; perinatal and pediatric epidemiology; air pollution; birth defects; neurodevelopment; data science; environmental mixtures; the external exposome; community-driven research

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue on “Environmental Exposures in Pregnancy” in the International Journal of Environmental Research and Public Health. Pregnancy is a critical period for the mother and fetus, and environmental exposures during this window can have pronounced and lasting impacts on their health. In this Special Issue, we welcome contributions on environmental exposures during pregnancy including (though not limited to): persistent and non-persistent chemicals, endocrine-disrupting chemicals, metals, air pollution, water pollution, radiation, climate change, agricultural practices, noise, the built environment, as well as the broad physical, psychological, social and cultural environment. We are especially interested in studies investigating environmental justice, the role of the environment in maternal and child health inequities, combined chemical and non-chemical stressors, exposure mixtures, the exposome, biomarkers of exposure, biological mechanisms of action, and novel statistical methods to address the current challenges in this field.

Dr. Amy M. Padula
Dr. Kelly K. Ferguson
Dr. Jeanette A. Stingone
Guest Editors

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Keywords

pregnancy
chemicals
environment
pollution
birth
child
disparities
equity
epidemiology
perinatal
psychosocial stressor
mixtures

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Published Papers (9 papers)

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Research

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17 pages, 2280 KiB

Open AccessArticle

Perinatal Health Inequalities in the Industrial Region of Estonia: A Birth Registry-Based Study

by Usha Dahal, Triin Veber, Daniel Oudin Åström, Tanel Tamm, Leena Albreht, Erik Teinemaa, Kati Orru and Hans Orru

Int. J. Environ. Res. Public Health 2022, 19(18), 11559; https://doi.org/10.3390/ijerph191811559 - 14 Sep 2022

Cited by 2 | Viewed by 2173

Abstract

Despite the increasing number of studies on industrially contaminated sites (ICS) and their health effects, there are very few studies on perinatal health outcomes in ICSs. In the present study, we examined the perinatal health inequalities by comparing adverse birth outcomes (ABOs) in the oil shale industry region of Ida-Viru County in Estonia with national-level figures and investigated the effects of maternal environmental and sociodemographic factors. Based on the 208,313 birth records from 2004–2018, Ida-Viru ICS has a birth weight 124.5 g lower than the average of 3544 g in Estonia. A higher prevalence of preterm birth (4.3%) and low birth weight (4.8%) in Ida-Viru ICS is found compared to 3.3% on both indicators at the national level. Multiple logistic regression analysis shows the statistically significant association of ABOs with fine particle (PM_2.5) air pollution, mother’s ethnicity, and education throughout Estonia. However, in Ida-Viru ICS, the ABOs odds are remarkably higher in these characteristics except for the mother’s ethnicity. Furthermore, the ABOs are associated with the residential proximity to ICS. Thus, the Ida-Viru ICS has unequally higher odds of adverse perinatal health across the environmental and sociodemographic factors. In addition to reducing the air pollutants, policy actions on social disparities are vital to address the country’s unjustly higher perinatal health inequalities, especially in the Ida-Viru ICS. Full article

(This article belongs to the Special Issue Environmental Exposures in Pregnancy)

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14 pages, 864 KiB

Open AccessArticle

Quitting Smoking before and after Pregnancy: Study Methods and Baseline Data from a Prospective Cohort Study

by Erica Cruvinel, Kimber P. Richter, Kathryn I. Pollak, Edward Ellerbeck, Nicole L. Nollen, Byron Gajewski, Zoe Sullivan-Blum, Chuanwu Zhang, Elena Shergina and Taneisha S. Scheuermann

Int. J. Environ. Res. Public Health 2022, 19(16), 10170; https://doi.org/10.3390/ijerph191610170 - 17 Aug 2022

Cited by 1 | Viewed by 1855

Abstract

Smoking during pregnancy and postpartum remains an important public health problem. No known prior study has prospectively examined mutual changes in risk factors and women’s smoking trajectory across pregnancy and postpartum. The objective of this study was to report methods used to implement a prospective cohort (Msgs4Moms), present participant baseline characteristics, and compare our sample characteristics to pregnant women from national birth record data. The cohort study was designed to investigate smoking patterns, variables related to tobacco use and abstinence, and tobacco treatment quality across pregnancy through 1-year postpartum. Current smokers or recent quitters were recruited from obstetrics clinics. Analyses included Chi-square and independent sample t-tests using Cohen’s d. A total of 62 participants (41 smokers and 21 quitters) were enrolled. Participants were Black (45.2%), White (35.5%), and multiracial (19.3%); 46.8% had post-secondary education; and most were Medicaid-insured (64.5%). Compared with quitters, fewer smokers were employed (65.9 vs 90.5%, Cohen’s d = 0.88) and more reported financial strain (61.1% vs 28.6%; Cohen’s d = 0.75). Women who continue to smoke during pregnancy cope with multiple social determinants of health. Longitudinal data from this cohort provide intensive data to identify treatment gaps, critical time points, and potential psychosocial variables warranting intervention. Full article

(This article belongs to the Special Issue Environmental Exposures in Pregnancy)

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14 pages, 366 KiB

Open AccessArticle

Association between Water Fluoride Levels and Low Birth Weight: National Health and Nutrition Examination Survey (NHANES) 2013–2016

by Aaditya Krishna Arun, Luis Rustveld and Ajeesh Sunny

Int. J. Environ. Res. Public Health 2022, 19(15), 8956; https://doi.org/10.3390/ijerph19158956 - 23 Jul 2022

Cited by 7 | Viewed by 3045

Abstract

Background: Excessive fluoride consumption affects reproductive and child health. We examined the association between levels of fluoride in drinking water and birth weight, in the National Health and Nutrition Examination Survey 2013–2016, after adjusting for known risk factors Low Birth Weight (LBW) including age, smoking, and socio-demographic variables including education, food security, health care access, and health status. Methods: The study included 7147 and 6858 women with complete birth weight and water fluoride data, respectively. Linear regression models evaluated the association between water fluoride and birth weight across racial/ethnic groups. The odds of delivering an LBW infant (<2500 g) compared to an infant weighing ≥ 2500 g, as well as the odds of delivering a Very Low Birth Weight (VLBW, <1500 g) infant compared to an LBW infant were explored in separate logistic regression models. Results: Women with LBW infants were exposed to significantly higher levels of water fluoride compared to those with normal birth weight infants. Our findings suggest a significant association between excess water fluoride exposure (>0.7 ppm) and LBW weight in Hispanic women, independent of established LBW risk factors. In logistic regression models, Hispanic women exposed to increased levels of water fluoride were 1.5 times more likely to give birth to an LBW infant and 3.5 more likely to give birth to a VLBW infant. Conclusion: Taken together, these findings can inform public health education strategies that highlight water fluoride as a potential risk factor during pregnancy in Hispanic women. More research is needed to confirm these findings. Full article

(This article belongs to the Special Issue Environmental Exposures in Pregnancy)

12 pages, 1117 KiB

Open AccessArticle

Risk Assessment for Birth Defects in Offspring of Chinese Pregnant Women

by Pengfei Qu, Doudou Zhao, Mingxin Yan, Danmeng Liu, Leilei Pei, Lingxia Zeng, Hong Yan and Shaonong Dang

Int. J. Environ. Res. Public Health 2022, 19(14), 8584; https://doi.org/10.3390/ijerph19148584 - 14 Jul 2022

Cited by 3 | Viewed by 1878

Abstract

Objective: This study aimed to develop a nomogram for the risk assessment of any type of birth defect in offspring using a large birth-defect database in Northwest China. Methods: This study was based on a birth-defect survey, which included 29,204 eligible women who were pregnant between 2010 and 2013 in the Shaanxi province of Northwest China. The participants from central Shaanxi province were assigned to the training group, while the subjects from the south and north of Shaanxi province were assigned to the external validation group. The primary outcome was the occurrence of any type of birth defect in the offspring. A multivariate logistic regression model was used to establish a prediction nomogram, while the discrimination and calibration were evaluated by external validation. Results: The multivariate analyses revealed that household registration, history of miscarriages, family history of birth defects, infection, taking medicine, pesticide exposure, folic acid supplementation, and single/twin pregnancy were significant factors in the occurrence of birth defects. The area under the receiver operating characteristic curve (AUC) in the prediction model was 0.682 (95% CI 0.653 to 0.710) in the training set. The validation set showed moderate discrimination, with an AUC of 0.651 (95% CI 0.614 to 0.689). Additionally, the prediction model had a good calibration (HL χ² = 8.106, p= 0.323). Conclusions: We developed a nomogram risk model for any type of birth defect in a Chinese population based on important modifying factors in pregnant women. This risk-prediction model could be a tool for clinicians to assess the risk of birth defects and promote health education. Full article

(This article belongs to the Special Issue Environmental Exposures in Pregnancy)

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13 pages, 595 KiB

Open AccessArticle

First- and Third-Trimester Urinary Phthalate Metabolites in the Development of Hypertensive Diseases of Pregnancy

by Sabrina M. Bedell, Grace R. Lyden, Sheela Sathyanarayana, Emily S. Barrett, Kelly K. Ferguson, Ashley Santilli, Nicole R. Bush, Shanna H. Swan, Thomas F. McElrath and Ruby H.N. Nguyen

Int. J. Environ. Res. Public Health 2021, 18(20), 10627; https://doi.org/10.3390/ijerph182010627 - 11 Oct 2021

Cited by 20 | Viewed by 2572

Abstract

The purpose of this study was to determine whether maternal urinary phthalate metabolite concentrations are associated with the development of higher blood pressure or pregnancy-induced hypertension (PIH). Participants were women without chronic hypertension who enrolled in The Infant Development and the Environment Study, a prospective pregnancy cohort conducted at four U.S. academic medical centers from 2010–2012. Prenatal records were reviewed to obtain blood pressure measurements and diagnoses of PIH (gestational hypertension, preeclampsia, eclampsia, and HELLP syndrome, defined as hemolysis, elevated liver enzymes, and low platelet count). Complete-case analyses used multivariable linear and logistic regression for analysis of blood pressure measurements and PIH diagnoses, respectively. In the final dataset (N = 668), higher concentrations of first-trimester monoethyl phthalate (MEP) and mono-3-carboxypropyl phthalate (MCPP) and third-trimester mono-isobutyl phthalate (MiBP) were significantly associated with a medical chart diagnosis of PIH. First-trimester mono-n-butyl phthalate (MBP) and MEP along with the sum of di-(2-ethylhexyl) phthalate metabolites (∑DEHP) were each associated with increased systolic blood pressure across pregnancy. In conclusion, several phthalate metabolite concentrations were significantly associated with PIH and greater increases in systolic blood pressure across pregnancy. Full article

(This article belongs to the Special Issue Environmental Exposures in Pregnancy)

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9 pages, 859 KiB

Open AccessArticle

Does the Summer Season Affect the Amniotic Fluid Volume during Pregnancy?

by Ah-Young Choi, Jun-Yi Lee, In-Sook Sohn, Han-Sung Kwon, Yong-Soo Seo, Myoung-Hwan Kim, Seung-Woo Yang and Han-Sung Hwang

Int. J. Environ. Res. Public Health 2021, 18(18), 9483; https://doi.org/10.3390/ijerph18189483 - 8 Sep 2021

Cited by 2 | Viewed by 4911

Abstract

Amniotic fluid is crucial for the well-being of the fetus. Recent studies suggest that dehydration in a pregnant woman leads to oligohydramnios. We assessed the variation in the amniotic fluid index (AFI) during the summer and non-summer seasons and evaluated neonatal outcomes. We retrospectively reviewed electrical medical records of pregnant women who visited the Konkuk University Medical Center for antenatal care, between July 2005 and July 2019. A total of 19,724 cases from 6438 singleton pregnant women were included after excluding unsuitable cases. All AFI values were classified as 2nd and 3rd trimester values. Additionally, borderline oligohydramnios (AFI, 5–8) and normal AFI (AFI, 8–24) were assessed according to the seasons. The average AFI between the summer and non-summer season was statistically different only in the 3rd trimester; but the results were not clinically significant. In the 3rd trimester, the summer season influenced the increased incidence of borderline oligohydramnios. The borderline oligohydramnios group showed an increased small-for-gestational-age (SGA) rate and NICU admission rate. In the summer season, the incidence of borderline oligohydramnios was seen to increase. This result would be significant for both physicians and pregnant women. Full article

(This article belongs to the Special Issue Environmental Exposures in Pregnancy)

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4 pages, 267 KiB

Open AccessCommunication

Pregnant Women Who Smoke May Be at Greater Risk of Adverse Effects from Bushfires

by Ratika Kumar, Parivash Eftekhari and Gillian Sandra Gould

Int. J. Environ. Res. Public Health 2021, 18(12), 6223; https://doi.org/10.3390/ijerph18126223 - 8 Jun 2021

Cited by 1 | Viewed by 2733

Abstract

Bushfires substantially increase the environmental health risks for people living in affected areas, especially the disadvantaged (e.g., those experiencing health inequities due to their socio-economic status, racial/ethnic backgrounds, geographic location and/or sexual orientation) and those with pre-existing health conditions. Pregnant women exposed to bushfire smoke are at a greater risk of adverse pregnancy and foetal outcomes, especially if they smoke tobacco, which may compound the toxic impacts. Bushfires may also exacerbate mental stress, leading to an increase in smoking. There are gaps in the evidence and more research is required on the combined effect of bushfire smoke and tobacco smoke on pregnant populations. Full article

(This article belongs to the Special Issue Environmental Exposures in Pregnancy)

15 pages, 903 KiB

Open AccessArticle

Polybrominated Diphenyl Ether Serum Concentrations and Depressive Symptomatology in Pregnant African American Women

by Abby D. Mutic, Dana Boyd Barr, Vicki S. Hertzberg, Patricia A. Brennan, Anne L. Dunlop and Linda A. McCauley

Int. J. Environ. Res. Public Health 2021, 18(7), 3614; https://doi.org/10.3390/ijerph18073614 - 31 Mar 2021

Cited by 13 | Viewed by 3185

Abstract

(1) Polybrominated diphenyl ethers (PBDEs) were widely produced in the United States until 2004 but remain highly persistent in the environment. The potential for PBDEs to disrupt normal neuroendocrine pathways resulting in depression and other neurological symptoms is largely understudied. This study examined whether PBDE exposure in pregnant women was associated with antenatal depressive symptomatology. (2) Data were collected from 193 African American pregnant women at 8–14 weeks gestation. Serum PBDEs and depressive symptoms were analyzed and a mixture effect was calculated. (3) Urban pregnant African American women in the Southeastern United States had a high risk of depression (27%) compared to the National average. Increased levels of PBDEs were found. BDE-47 and -99 exposures are significantly associated with depressive symptomatology in the pregnant cohort. The weighted body burden estimate of the PBDE mixture was associated with a higher risk of mild to moderate depression using an Edinburgh Depression Scale cutoff score of ≥10 (OR = 2.93; CI 1.18, 7.82). (4) Since antenatal depression may worsen in postpartum, reducing PBDE exposure may have significant clinical implications. Full article

(This article belongs to the Special Issue Environmental Exposures in Pregnancy)

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Review

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29 pages, 2168 KiB

Open AccessReview

Wildfire Smoke Exposure during Pregnancy: A Review of Potential Mechanisms of Placental Toxicity, Impact on Obstetric Outcomes, and Strategies to Reduce Exposure

by Emilia Basilio, Rebecca Chen, Anna Claire Fernandez, Amy M. Padula, Joshua F. Robinson and Stephanie L. Gaw

Int. J. Environ. Res. Public Health 2022, 19(21), 13727; https://doi.org/10.3390/ijerph192113727 - 22 Oct 2022

Cited by 19 | Viewed by 6228

Abstract

Climate change is accelerating the intensity and frequency of wildfires globally. Understanding how wildfire smoke (WS) may lead to adverse pregnancy outcomes and alterations in placental function via biological mechanisms is critical to mitigate the harms of exposure. We aim to review the literature surrounding WS, placental biology, biological mechanisms underlying adverse pregnancy outcomes as well as interventions and strategies to avoid WS exposure in pregnancy. This review includes epidemiologic and experimental laboratory-based studies of WS, air pollution, particulate matter (PM), and other chemicals related to combustion in relation to obstetric outcomes and placental biology. We summarized the available clinical, animal, and placental studies with WS and other combustion products such as tobacco, diesel, and wood smoke. Additionally, we reviewed current recommendations for prevention of WS exposure. We found that there is limited data specific to WS; however, studies on air pollution and other combustion sources suggest a link to inflammation, oxidative stress, endocrine disruption, DNA damage, telomere shortening, epigenetic changes, as well as metabolic, vascular, and endothelial dysregulation in the maternal-fetal unit. These alterations in placental biology contribute to adverse obstetric outcomes that disproportionally affect the most vulnerable. Limiting time outdoors, wearing N95 respirator face masks and using high quality indoor air filters during wildfire events reduces exposure to related environmental exposures and may mitigate morbidities attributable to WS. Full article

(This article belongs to the Special Issue Environmental Exposures in Pregnancy)

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