Particulate air pollution and fetal health: a systematic review of the epidemiologic evidence.
BACKGROUND
Research on the potential impact of air pollution on the health of adults and children has grown rapidly over the last decade. Recent studies have suggested that air pollution could also be associated with adverse effects on the developing fetus. This systematic review evaluates the current level of epidemiologic evidence on the association between ambient particulate air pollution and fetal health outcomes. We also suggest further research questions.


METHODS
Using database searches and other approaches, we identified relevant publications published between 1966 and 2001 in English. Articles were included if they reported original data on birthweight, gestational age at delivery, or stillbirth related to directly measured nonaccidental exposure to particulate matter.


RESULTS
Twelve studies met the inclusion criteria. There was little consistency in the evidence linking particulate air pollution and fetal outcomes. Many studies had methodologic weaknesses in their design and adjustment for confounding factors. Even in well-designed studies, the reported magnitude of the effects was small and inconsistently associated with exposure at specific stages of pregnancy.


CONCLUSIONS
The currently available evidence is compatible with either a small adverse effect of particulate air pollution on fetal growth and duration of pregnancy or with no effect. Further research should be directed toward clarifying and quantifying these possible effects and generating testable hypotheses on plausible biologic mechanisms.
Glinianaia
Svetlana V
SV
School of Population and Health Sciences, Faculty of Medical Sciences, University of Newcastle, Newcastle-upon-Tyne, United Kigndom. svetlana.glinianaia@ncl.ac.uk
Rankin
Judith
J
Bell
Ruth
R
Pless-Mulloli
Tanja
T
Howel
Denise
D
D000328:Adult; D000393:Air Pollutants / Q000009:adverse effects*; D005314:Embryonic and Fetal Development; D016021:Epidemiologic Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000209:etiology*; D006801:Humans; D007229:Infant Welfare; D007231:Infant, Newborn; D007234:Infant, Premature; D018811:Maternal Exposure; D007752:Obstetric Labor, Premature; D010316:Particle Size; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D018570:Risk Assessment
D000393:Air Pollutants