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Open AccessArticle

Chronic and Acute Ozone Exposure in the Week Prior to Delivery Is Associated with the Risk of Stillbirth

Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD 20892, USA
Department of Global and Community Health, College of Health and Human Services, George Mason University, 4400 University Drive/MS5B7, Fairfax, VA 22030, USA
Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
Center for Genome Science, National Research Institute of Health, OHTAC, 200 Osongsaengmyeong2-ro, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do 28160, Korea
The Emmes Corporation, 401 N Washington St # 700, Rockville, MD 20850, USA
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2017, 14(7), 731;
Received: 12 May 2017 / Revised: 26 June 2017 / Accepted: 29 June 2017 / Published: 6 July 2017
(This article belongs to the Special Issue Environmental Influences on Maternal and Child Health)
Chronic and acute air pollution has been studied in relation to stillbirth with inconsistent findings. We examined stillbirth risk in a retrospective cohort of 223,375 singleton deliveries from 12 clinical sites across the United States. Average criteria air pollutant exposure was calculated using modified Community Multiscale Air Quality models for the day of delivery and each of the seven days prior, whole pregnancy, and first trimester. Poisson regression models using generalized estimating equations estimated the relative risk (RR) of stillbirth and 95% confidence intervals (CI) in relation to an interquartile range increase in pollutant with adjustment for temperature, clinical, and demographic factors. Ozone (O3) was associated with a 13–22% increased risk of stillbirth on days 2, 3, and 5–7 prior to delivery in single pollutant models, and these findings persisted in multi-pollutant models for days 5 (RR = 1.22, CI = 1.07–1.38) and 6 (RR = 1.18, CI = 1.04–1.33). Whole pregnancy and first trimester O3 increased risk 18–39% in single pollutant models. Maternal asthma increased stillbirth risk associated with chronic PM2.5 and carbon monoxide exposures. Both chronic and acute O3 exposure consistently increased stillbirth risk, while the role of other pollutants varied. Approximately 8000 stillbirths per year in the US may be attributable to O3 exposure. View Full-Text
Keywords: stillbirth; ozone; air pollution; pregnancy stillbirth; ozone; air pollution; pregnancy
MDPI and ACS Style

Mendola, P.; Ha, S.; Pollack, A.Z.; Zhu, Y.; Seeni, I.; Kim, S.S.; Sherman, S.; Liu, D. Chronic and Acute Ozone Exposure in the Week Prior to Delivery Is Associated with the Risk of Stillbirth. Int. J. Environ. Res. Public Health 2017, 14, 731.

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