Published online July 3, 2006
PEDIATRICS Vol. 118 No. 1 July 2006, pp. 156-164 (doi:10.1542/peds.2005-2432)
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Air Pollution and Very Low Birth Weight Infants: A Target Population?

J. Felix Rogers, PhD, MPHa and Anne L. Dunlop, MD, MPHb

a National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia
b Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia

OBJECTIVE. The goal was to examine systematically the association between maternal exposure to particulate matter of <10 µm and very low birth weight (<1500 g) delivery for evidence of an effect on duration of gestation and/or intrauterine growth restriction.

METHODS. This case-control study took place between April 1, 1986, and March 30, 1988, in Georgia Health Care District 9 and included 128 mothers of very low birth weight infants, all of whom were preterm and were classified as either small for gestational age or appropriate for gestational age, and 197 mothers of term, appropriate-for-gestational-age infants weighing ≥2500 g. Maternal exposure to particulate matter of <10 µm was estimated with 2 exposure measures, namely, a county-level measure based on residence in a county with an industrial point source and an environmental transport model based on the geographic location of the birth home.

RESULTS. Considering preterm/appropriate-for-gestational-age infants as cases and term/appropriate-for-gestational-age infants as controls, adjusted odds ratios for maternal exposure to particulate matter of <10 µm were statistically significant (adjusted odds ratio for county-level model: 4.31; adjusted odds ratio for environmental transport model: 3.68). Although elevated, no statistically significant association was found between maternal exposure and preterm/appropriate-for-gestational-age delivery when compared to preterm/small-for-gestational-age delivery.

CONCLUSIONS. There are increased odds of maternal exposure to ambient particulate matter of <10 µm for very low birth weight preterm/appropriate-for-gestational-age delivery, compared with term/appropriate-for-gestational-age delivery, which suggests that the observed association between maternal exposure to air pollution and low infant birth weight (particularly <1500 g) is at least partially attributable to an effect on duration of gestation.

Key Words: air pollution • birth weight • preterm • environmental factors • fetal growth restriction

Abbreviations: AGA—appropriate for gestational age • IUGR—intrauterine growth restriction • LBW—low birth weight • PM10—particulate matter of <10 µm • SGA—small for gestational age • VLBW—very low birth weight • CI—confidence interval • GHCD9—Georgia Health Care District 9 • OR—odds ratio • aOR—adjusted odds ratio

Accepted Feb 10, 2006.