Air pollution from incinerators and reproductive outcomes: a multisite study.
BACKGROUND
The few studies that have investigated the relationship between emissions from municipal solid-waste incinerators and adverse pregnancy outcomes have had conflicting results. We conducted a study to assess the effects of air emissions from the eight incinerators currently in operation in the Emilia-Romagna Region of Italy on reproductive outcomes (sex ratio, multiple births, preterm births, and small for gestational age [SGA] births).


METHODS
We considered all births (n = 21,517) to women residing within a 4-km radius of an incinerator at the time of delivery during the period 2003-2010 who were successfully linked to the Delivery Certificate database. This source also provided information on maternal characteristics and deliveries. Each newborn was georeferenced and characterized by a specific level of exposure to incinerator emissions, categorized in quintiles of PM10, and other sources of pollution (NOx quartiles), evaluated by means of ADMS-Urban system dispersion models. We ran logistic regression models for each outcome, adjusting for exposure to other pollution sources and maternal covariates.


RESULTS
Incinerator pollution was not associated with sex ratio, multiple births, or frequency of SGA. Preterm delivery increased with increasing exposure (test for trend, P < 0.001); for the highest versus the lowest quintile exposure, the odds ratio was 1.30 (95% confidence interval = 1.08-1.57). A similar trend was observed for very preterm babies. Several sensitivity analyses did not alter these results.


CONCLUSIONS
Maternal exposure to incinerator emissions, even at very low levels, was associated with preterm delivery.
From the aEpidemiology Unit, Local Health Authority, Reggio Emilia, Italy; bRegional Reference Centre on Environment and Health, ARPA Emilia-Romagna, Modena, Italy; cPublic Health Service, Emilia-Romagna Region, Italy; and dDepartment of Epidemiology, Lazio Region, Italy.
Silvia
S
Candela
Andrea
A
Ranzi
Laura
L
Bonvicini
Flavia
F
Baldacchini
Paolo
P
Marzaroli
Andrea
A
Evangelista
Ferdinando
F
Luberto
Elisa
E
Carretta
Paola
P
Angelini
Anna Freni
AF
Sterrantino
Serena
S
Broccoli
Michele
M
Cordioli
Carla
C
Ancona
Francesco
F
Forastiere
D000328:Adult; D000393:Air Pollutants / Q000009:adverse effects* / Q000032:analysis; D000397:Air Pollution / Q000009:adverse effects* / Q000032:analysis; D016208:Databases, Factual; D005260:Female; D006801:Humans; D017745:Incineration; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007558:Italy / Q000453:epidemiology; D008297:Male; D018811:Maternal Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data; D009099:Multiple Birth Offspring / Q000706:statistics & numerical data; D011247:Pregnancy; D047928:Premature Birth / Q000139:chemically induced / Q000453:epidemiology*; D012744:Sex Ratio; D055815:Young Adult
D000393:Air Pollutants