Center for Environment and Public Health Studies, School of Public Policy and Government, Fundação Getúlio Vargas, Brasília, Distrito Federal, Brazil.
Demography Department, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
Chemosphere. 2024 Oct;366:143469. doi: 10.1016/j.chemosphere.2024.143469. Epub 2024 Oct 8.
Low birth weight (LBW) is a global health concern. While it is commonly associated with maternal health and behavior, exposure to ambient air pollution, can also play a role in contributing to LBW. In Brazil, where diverse environmental conditions and regional disparities exist, assessing the impact of ambient air pollution on LBW becomes particularly pertinent. To our knowledge, there is a gap in the existing literature, as no previous study has specifically investigated the relationship between ambient air pollution and LBW nationwide in Brazil. This study aims to fill this gap by examining the association between ambient air pollution and LBW in each trimester of pregnancy across the Brazilian states. In this work, birth data from January 1, 2001, to December 31, 2018 has been used. We utilized logistic regression models to estimate the odds ratio (OR) for low birth weight (LBW) associated with ambient air pollution (PM, NO, and O) during each trimester of pregnancy (1st to 3rd trimester) across all 27 Brazilian states in our nationwide case-control study. We adjusted our model for several variables, including ambient temperature, relative humidity, and socioeconomic status (SES) variables at the individual level. We also conducted effect modification analyses by infant sex, mother's age, and the number of prenatal visits. Our study comprises over 10,213,144 birth records nationwide. Of these, 479,204 (4.92%) infants were included as cases of LBW. Our results indicate positive associations between PM and LBW, mainly in the Southern region. For example, in the state of Santa Catarina (South region), ORs were 1.003 (95% CI: 1.002, 1.004), 1.003 (95% CI: 1.002, 1.004), and 1.005 (95% CI: 1.003, 1.007) for the 1st, 2nd, and 3rd trimesters of exposure, respectively. NO had a robust association with LBW in the Northern and Northeastern states, including the state of Amapá (North region, where the Amazon Forest is located) with ORs of 1.377 (95% CI: 1.010, 1.878), 1.390 (95% CI: 1.020, 1.894), and 1.747 (95% CI: 1.297, 2.352) for the 1st, 2nd, and 3rd trimesters of exposure, respectively. Similarly, O had a robust association in the North and Midwest states, as observed in the state of Amapá with ORs of 1.033 (95% CI: 1.012, 1.054), and 1.033 (95% CI: 1.013, 1.053) for the 2nd, and 3rd trimesters, respectively. In the stratified analysis, boys were more vulnerable than girls, and the lower number of prenatal visits was associated with higher OR. Our findings are essential to the development of guidelines to prevent maternal exposure and protection of newborns in Brazil. This study provides valuable insights for region-specific strategies to improve maternal and neonatal health.
低出生体重（LBW）是一个全球性的健康问题。虽然它通常与产妇健康和行为有关，但暴露于环境空气污染也可能导致 LBW。在巴西，存在着不同的环境条件和地区差异，评估环境空气污染对 LBW 的影响变得尤为重要。据我们所知，在现有的文献中存在一个空白，因为之前没有研究专门调查环境空气污染与巴西全国 LBW 之间的关系。本研究旨在通过检查巴西各州妊娠各期（1 至 3 期）环境空气污染与 LBW 之间的关系来填补这一空白。在这项工作中，使用了 2001 年 1 月 1 日至 2018 年 12 月 31 日的出生数据。我们利用逻辑回归模型来估计与环境空气污染（PM、NO 和 O）相关的 LBW 的比值比（OR）在我们的全国病例对照研究中，在所有 27 个巴西州的妊娠各期（1 至 3 期）。我们根据几个变量调整了我们的模型，包括环境温度、相对湿度和个体层面的社会经济地位（SES）变量。我们还通过婴儿性别、母亲年龄和产前检查次数进行了效应修饰分析。我们的研究包括全国范围内超过 10213144 份出生记录。其中，479204（4.92%）名婴儿被纳入 LBW 病例。我们的结果表明 PM 与 LBW 之间存在正相关关系，主要在南部地区。例如，在圣卡塔琳娜州（南部地区），暴露于 PM 的第 1、2 和 3 个三个月的 OR 分别为 1.003（95%CI：1.002，1.004）、1.003（95%CI：1.002，1.004）和 1.005（95%CI：1.003，1.007）。NO 与北部和东北部各州的 LBW 有很强的关联，包括亚马孙州（位于亚马逊森林的北部地区），暴露于 NO 的第 1、2 和 3 个三个月的 OR 分别为 1.377（95%CI：1.010，1.878）、1.390（95%CI：1.020，1.894）和 1.747（95%CI：1.297，2.352）。同样，O 在北部和中西部各州也有很强的关联，如在亚马孙州观察到的，暴露于 O 的第 2 和 3 个三个月的 OR 分别为 1.033（95%CI：1.012，1.054）和 1.033（95%CI：1.013，1.053）。在分层分析中，男孩比女孩更容易受到影响，产前检查次数较少与较高的 OR 相关。我们的研究结果对于制定预防巴西产妇暴露和保护新生儿的指南至关重要。本研究为改善母婴健康的特定地区战略提供了有价值的见解。
