title: Ambient air pollution and low birthweight: a European cohort study (ESCAPE).
abstract: BACKGROUND
  Ambient air pollution has been associated with restricted fetal growth, which is linked with adverse respiratory health in childhood. We assessed the effect of maternal exposure to low concentrations of ambient air pollution on birthweight.
  
  
  METHODS
  We pooled data from 14 population-based mother-child cohort studies in 12 European countries. Overall, the study population included 74 178 women who had singleton deliveries between Feb 11, 1994, and June 2, 2011, and for whom information about infant birthweight, gestational age, and sex was available. The primary outcome of interest was low birthweight at term (weight <2500 g at birth after 37 weeks of gestation). Mean concentrations of particulate matter with an aerodynamic diameter of less than 2·5 μm (PM2·5), less than 10 μm (PM10), and between 2·5 μm and 10 μm during pregnancy were estimated at maternal home addresses with temporally adjusted land-use regression models, as was PM2·5 absorbance and concentrations of nitrogen dioxide (NO2) and nitrogen oxides. We also investigated traffic density on the nearest road and total traffic load. We calculated pooled effect estimates with random-effects models.
  
  
  RESULTS
  A 5 μg/m(3) increase in concentration of PM2·5 during pregnancy was associated with an increased risk of low birthweight at term (adjusted odds ratio [OR] 1·18, 95% CI 1·06-1·33). An increased risk was also recorded for pregnancy concentrations lower than the present European Union annual PM2·5 limit of 25 μg/m(3) (OR for 5 μg/m(3) increase in participants exposed to concentrations of less than 20 μg/m(3) 1·41, 95% CI 1·20-1·65). PM10 (OR for 10 μg/m(3) increase 1·16, 95% CI 1·00-1·35), NO2 (OR for 10 μg/m(3) increase 1·09, 1·00-1·19), and traffic density on nearest street (OR for increase of 5000 vehicles per day 1·06, 1·01-1·11) were also associated with increased risk of low birthweight at term. The population attributable risk estimated for a reduction in PM2·5 concentration to 10 μg/m(3) during pregnancy corresponded to a decrease of 22% (95% CI 8-33%) in cases of low birthweight at term.
  
  
  CONCLUSIONS
  Exposure to ambient air pollutants and traffic during pregnancy is associated with restricted fetal growth. A substantial proportion of cases of low birthweight at term could be prevented in Europe if urban air pollution was reduced.
  
  
  BACKGROUND
  The European Union.
authors.affiliation: Centre for Research in Environmental Epidemiology, Barcelona, Spain; Centros de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid, Spain; INSERM, U823, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute Albert Bonniot, Grenoble, France. Electronic address: mpedersen@creal.cat.
authors.forename: Marie
authors.initials: M
authors.lastname: Pedersen
authors.affiliation: INSERM, U823, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute Albert Bonniot, Grenoble, France; University Joseph Fourier, Institute Albert Bonniot, Grenoble, France.
authors.forename: Lise
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authors.lastname: Giorgis-Allemand
authors.affiliation: INSERM, U823, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute Albert Bonniot, Grenoble, France; University Joseph Fourier, Institute Albert Bonniot, Grenoble, France.
authors.forename: Claire
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authors.lastname: Bernard
authors.affiliation: Centre for Research in Environmental Epidemiology, Barcelona, Spain; Centros de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid, Spain.
authors.forename: Inmaculada
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authors.lastname: Aguilera
authors.affiliation: Department of Social Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Anne-Marie Nybo
authors.initials: AM
authors.lastname: Andersen
authors.affiliation: Centros de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid, Spain; Centre for Public Health Research, Valencia, Spain; University of Valencia, Valencia, Spain; Centre for Public Health Research-Fundación para la Investigación Sanitaria y Biomédica, Valencia, Spain.
authors.forename: Ferran
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authors.lastname: Ballester
authors.affiliation: Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands.
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authors.affiliation: Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
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authors.affiliation: Centre for Research in Environmental Epidemiology, Barcelona, Spain.
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authors.affiliation: Department of Environmental Sciences, Vytauto Didziojo Universitetas, Kaunas, Lithuania.
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authors.affiliation: Department of Environmental Sciences, Vytauto Didziojo Universitetas, Kaunas, Lithuania.
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authors.affiliation: Department of Epidemiology, Documentation and Health Promotion, Public Health Service, Amsterdam, Netherlands.
authors.forename: Manon van
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authors.affiliation: Centros de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid, Spain; Centre for Public Health Research-Fundación para la Investigación Sanitaria y Biomédica, Valencia, Spain.
authors.forename: Marisa
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authors.affiliation: Centros de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid, Spain; University of Oviedo, Oviedo, Spain.
authors.forename: Ana
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authors.lastname: Fernández-Somoano
authors.affiliation: Centros de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid, Spain; Biomedical Research Centre of Granada, Laboratory of Medical Investigations, San Cecilio University Hospital, Granada, Spain.
authors.forename: Mariana F
authors.initials: MF
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authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
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authors.affiliation: Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands.
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authors.affiliation: Department of Environmental Sciences, Vytauto Didziojo Universitetas, Kaunas, Lithuania.
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authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Olena
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authors.affiliation: Center for research in Epidemiology and Population Health, INSERM, UMR 1018, Team 10, Centre of Research in Epidemiology and Population Health, Villejuif, France; Université Paris-Sud, UMRS 1018, Villejuif, France.
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authors.affiliation: Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands.
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authors.affiliation: Medical Research Council-Health Protection Agency Centre for Environment and Health, Epidemiology and Biostatistics, Imperial College London, London, UK.
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authors.affiliation: The Generation R Study Group, Department of Epidemiology, and Department of Paediatrics, Erasmus Medical Centre, Rotterdam, Netherlands.
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authors.initials: EH
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authors.affiliation: The Generation R Study Group, Department of Epidemiology, and Department of Paediatrics, Erasmus Medical Centre, Rotterdam, Netherlands.
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authors.initials: VW
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authors.affiliation: Institut für umweltmedizinische Forschung, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
authors.forename: Claudia
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authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Michal
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authors.affiliation: Institut für umweltmedizinische Forschung, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
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authors.lastname: Krämer
authors.affiliation: Department of Public Health and Preventive Medicine, University of the Basque Country, Bilbao, Spain.
authors.forename: Aitana
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authors.affiliation: INSERM, U823, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute Albert Bonniot, Grenoble, France; University Joseph Fourier, Institute Albert Bonniot, Grenoble, France; Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Johanna
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authors.affiliation: Division of Epidemiology, National Institute of Public Health, Oslo, Norway; Department of Community Medicine, Medical Faculty, University of Oslo, Oslo, Norway.
authors.forename: Per
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authors.affiliation: Division of Epidemiology, National Institute of Public Health, Oslo, Norway.
authors.forename: Wenche
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authors.affiliation: Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece; Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK.
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authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
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authors.affiliation: Centre for Research in Environmental Epidemiology, Barcelona, Spain; Centros de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid, Spain; Pompeu Fabra University, Barcelona, Spain.
authors.forename: Jordi
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authors.affiliation: Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK.
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authors.affiliation: Department of Hygiene, Social and Environmental Medicine, Ruhr-University Bochum, Bochum, Germany.
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authors.affiliation: Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK.
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authors.affiliation: Centre for Research in Environmental Epidemiology, Barcelona, Spain; Centros de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid, Spain.
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authors.affiliation: Centre for Research in Environmental Epidemiology, Barcelona, Spain; Centros de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid, Spain; IMIM Hospital del Mar Medicine Research Institute, Barcelona, Spain; National School of Public Health, Athens, Greece.
authors.forename: Manolis
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authors.lastname: Kogevinas
authors.affiliation: INSERM, U823, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute Albert Bonniot, Grenoble, France; University Joseph Fourier, Institute Albert Bonniot, Grenoble, France.
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mesh_terms: D000328:Adult; D000397:Air Pollution / Q000009:adverse effects*; D001724:Birth Weight / Q000187:drug effects*; D004781:Environmental Exposure / Q000009:adverse effects*; D018876:Environmental Illness / Q000453:epidemiology*; D004784:Environmental Monitoring; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D018811:Maternal Exposure / Q000009:adverse effects*; D052638:Particulate Matter / Q000009:adverse effects*; D011247:Pregnancy; D055815:Young Adult
chemical_list: D052638:Particulate Matter