title: Exposures to airborne particulate matter and adverse perinatal outcomes: a biologically plausible mechanistic framework for exploring potential effect modification by nutrition.
abstract: OBJECTIVE
  The specific objectives are threefold: to describe the biologically plausible mechanistic pathways by which exposure to particulate matter (PM) may lead to the adverse perinatal outcomes of low birth weight (LBW), intrauterine growth retardation (IUGR), and preterm delivery (PTD); review the evidence showing that nutrition affects the biologic pathways; and explain the mechanisms by which nutrition may modify the impact of PM exposure on perinatal outcomes.
  
  
  METHODS
  We propose an interdisciplinary conceptual framework that brings together maternal and infant nutrition, air pollution exposure assessment, and cardiopulmonary and perinatal epidemiology. Five possible albeit not exclusive biologic mechanisms have been put forth in the emerging environmental sciences literature and provide corollaries for the proposed framework.
  
  
  CONCLUSIONS
  Protecting the environmental health of mothers and infants remains a top global priority. The existing literature indicates that the effects of PM on LBW, PTD, and IUGR may manifest through the cardiovascular mechanisms of oxidative stress, inflammation, coagulation, endothelial function, and hemodynamic responses. PM exposure studies relating mechanistic pathways to perinatal outcomes should consider the likelihood that biologic responses and adverse birth outcomes may be derived from both PM and non-PM sources (e.g., nutrition). In the concluding section, we present strategies for empirically testing the proposed model and developing future research efforts.
authors.affiliation: Department of Environmental Health Sciences, Human Nutrition Program, University of Michigan, Ann Arboe, Michigan 48109-2029, USA. kannans@umich.edu
authors.forename: Srimathi
authors.initials: S
authors.lastname: Kannan
authors.forename: Dawn P
authors.initials: DP
authors.lastname: Misra
authors.forename: J Timothy
authors.initials: JT
authors.lastname: Dvonch
authors.forename: Ambika
authors.initials: A
authors.lastname: Krishnakumar
mesh_terms: D000393:Air Pollutants / Q000633:toxicity*; D004032:Diet; D015987:Effect Modifier, Epidemiologic; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006801:Humans; D052638:Particulate Matter / Q000633:toxicity*; D011247:Pregnancy; D011256:Pregnancy Outcome; D039401:Prenatal Nutritional Physiological Phenomena
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter