title: Residential proximity to major roads and adverse birth outcomes: a hospital-based study.
abstract: BACKGROUND
  Exposure to air pollution has been demonstrated to increase the risk of preterm birth and low birth weight (LBW). Although evidence has accumulated on characteristics associated with increased risk of air pollution-related health effects, most studies have been conducted in the adult population and evidence on reproductive outcomes is limited. We examined whether socio-economic position (SEP) and parental characteristics (parental behavior and co-morbidity) modified the relationship between air pollution and adverse birth outcomes.
  
  
  METHODS
  Data were extracted from a perinatal hospital database based in Shizuoka, Japan. We restricted the analysis to mothers who delivered live-born single births from January 1997 to December 2010 (n = 16,615). Each birth was assigned proximity to major roads. Multivariate adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated for the outcomes of preterm birth and term LBW. We stratified subjects by individual/area-level SEP and parental characteristics. We then measured interactions on the additive scale between the respective factors and exposure.
  
  
  RESULTS
  Lower SEP at both individual and area levels was associated with the increased occurrence of adverse birth outcomes. Living within 200 m from a major road increased the risk of preterm birth by 1.5 times (95% CI: 1.3-1.9) and LBW by 1.2 times (95% CI: 0.9-1.6). Mothers with lower individual SEP defined by household occupation experienced higher ORs for term LBW (OR = 3.1, 95% CI: 1.2-8.2) compared with those with higher individual SEP. In contrast, mothers who lived in the highest area-level SEP region (i.e., affluent areas) showed slightly higher point estimates compared with those who lived in middle or poor areas. In addition, maternal diabetic and hypertensive status modified the association between proximity and preterm birth, while maternal smoking status modified the association between proximity and term LBW.
  
  
  CONCLUSIONS
  The present study demonstrated that air pollution is an independent risk factor for adverse birth outcomes. Mothers with lower individual SEP and mothers living in higher SEP region may be susceptible to the adverse effect of air pollution. Maternal diabetic, hypertensive, and smoking status may also increase susceptibility to this air pollution-related health effect.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yorifuji
authors.forename: Hiroo
authors.initials: H
authors.lastname: Naruse
authors.forename: Saori
authors.initials: S
authors.lastname: Kashima
authors.forename: Soshi
authors.initials: S
authors.lastname: Takao
authors.forename: Takeshi
authors.initials: T
authors.lastname: Murakoshi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Doi
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
mesh_terms: D000328:Adult; D000393:Air Pollutants / Q000032:analysis* / Q000633:toxicity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006769:Hospitals, General; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D008297:Male; D009035:Mothers; D047928:Premature Birth / Q000453:epidemiology* / Q000209:etiology; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D001335:Vehicle Emissions / Q000032:analysis* / Q000633:toxicity
chemical_list: D000393:Air Pollutants; D001335:Vehicle Emissions