Sewor Christian, Rappazzo Kristen M, Clark Maggie L
Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States of America.
U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, Research Triangle Park, Durham, NC, United States of America.
Environ Res Commun. 2025 Apr;7(4):042002. doi: 10.1088/2515-7620/adc903. Epub 2025 Apr 16.
Air pollution is a prominent contributor to the burden of adverse birth and early child health outcomes. However, considerable heterogeneity of impacts has been observed, which may be due to limited exploration of key effect modifiers. This scoping review was conducted to synthesize evidence on the potential effect modifying roles of nutrition, physical activity, and body mass index (BMI) on the associations between early-life air pollution exposures and adverse birth and early-life health outcomes.
PubMed, Web of Science, and Scopus databases were systematically searched for relevant studies through July 2023. Studies were included if they were conducted amongst pregnant women or individuals between 0-17 years, provided empirical evidence on associations between air pollution exposure and adverse birth and/or early-childhood health outcomes, and conducted effect modification-related analyses by maternal (i.e., in-utero) or early childhood nutrition, physical activity, or BMI. Data from selected studies were abstracted and summarized based on study design, population characteristics, and the exposures, outcomes, and effect modifiers assessed.
A total of 13 studies were included; 10 were cohort studies, and 3 were cross-sectional studies. All but one of the studies explored the impact of ambient air pollutants (particulate matter, nitrogen dioxide, ozone, ultra-fine particles, elemental carbon, and black carbon) prenatally or in early life on adverse birth (preterm birth, birth weight, low birth weight) and early childhood outcomes (childhood obesity). Effect modifiers examined included pre-pregnancy BMI (n = 5 studies), maternal and child dietary characteristics (n = 7 studies), and child physical activity patterns (n = 2 studies).
Evidence for effect modification, although present, was inconsistent and weak. Consideration should be given to exploring effect modification of air pollution-related impacts to help explain heterogeneity of associations observed across populations, a key knowledge gap limiting public health messaging strategies.
空气污染是导致不良出生和儿童早期健康结局负担的一个重要因素。然而，已观察到影响存在相当大的异质性，这可能是由于对关键效应修饰因素的探索有限。本范围综述旨在综合关于营养、身体活动和体重指数（BMI）对生命早期空气污染暴露与不良出生及生命早期健康结局之间关联的潜在效应修饰作用的证据。
系统检索了PubMed、Web of Science和Scopus数据库，截至2023年7月的相关研究。纳入的研究需在孕妇或0至17岁个体中进行，提供空气污染暴露与不良出生和/或儿童早期健康结局之间关联的实证证据，并通过孕产妇（即宫内）或儿童早期营养、身体活动或BMI进行效应修饰相关分析。根据研究设计、人群特征以及评估的暴露、结局和效应修饰因素，对所选研究的数据进行提取和总结。
共纳入13项研究；10项为队列研究，3项为横断面研究。除一项研究外，所有研究均探讨了产前或生命早期环境空气污染物（颗粒物、二氧化氮、臭氧、超细颗粒、元素碳和黑碳）对不良出生（早产、出生体重、低出生体重）和儿童早期结局（儿童肥胖）的影响。所检查的效应修饰因素包括孕前BMI（5项研究）、母婴饮食特征（7项研究）和儿童身体活动模式（2项研究）。
尽管存在效应修饰的证据，但并不一致且较弱。应考虑探索空气污染相关影响的效应修饰，以帮助解释不同人群中观察到的关联异质性，这是限制公共卫生信息传播策略的一个关键知识空白。
