title: Acute air pollution exposure and blood pressure at delivery among women with and without hypertension.
abstract: BACKGROUND
  Chronic air pollution exposure increases risk for hypertensive disorders of pregnancy, but the effect of acute air pollution exposure on blood pressure during pregnancy is less well known.
  
  
  METHODS
  We studied 151,276 singleton term deliveries from the Consortium on Safe Labor (2002-2008) with clinical blood pressure measured at admission to labor/delivery and diagnoses of hypertensive disorders collected from electronic medical records and hospital discharge summaries. Air pollution exposures were estimated for the admission hour and the 4 hours preceding admission using a modified version of the Community Multiscale Air Quality models and observed air monitoring data. Blood pressure was categorized as normal; high normal; and mild, moderate, or severe hypertension based on pregnancy cut points. Adjusted ordinal logistic regression estimated the odds of women having a higher admission blood pressure category as a function of air pollutant, hypertensive disorders, and their interaction effect.
  
  
  RESULTS
  Odds of high blood pressure at admission to labor/delivery were increased in normotensive women after exposure to nitrogen oxides (by 0.2%/5 units), sulfur dioxide (by 0.3%/1 unit), carbon monoxide and several air toxics (by 3%-4%/high exposure). The effects were often similar or stronger among women with gestational hypertension and preeclampsia. Exposure to particulate matter <10 μm increased odds of high blood pressure in women with preeclampsia by 3%/5 units.
  
  
  CONCLUSIONS
  Air pollution can influence admission blood pressure in term deliveries and may increase likelihood of preeclampsia screening at delivery admission.
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland;
authors.forename: Tuija
authors.initials: T
authors.lastname: Männistö
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland; pauline.mendola@nih.gov.
authors.forename: Pauline
authors.initials: P
authors.lastname: Mendola
authors.affiliation: Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland;
authors.forename: Danping
authors.initials: D
authors.lastname: Liu
authors.affiliation: Glotech, Rockville, Maryland;
authors.forename: Kira
authors.initials: K
authors.lastname: Leishear
authors.affiliation: The EMMES Corporation, Rockville, Maryland.
authors.forename: Seth
authors.initials: S
authors.lastname: Sherman
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland;
authors.forename: S Katherine
authors.initials: SK
authors.lastname: Laughon
mesh_terms: D000328:Adult; D000393:Air Pollutants / Q000009:adverse effects*; D001794:Blood Pressure; D016022:Case-Control Studies; D036861:Delivery, Obstetric; D004781:Environmental Exposure / Q000009:adverse effects*; D004784:Environmental Monitoring; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D016015:Logistic Models; D016017:Odds Ratio; D010316:Particle Size; D052638:Particulate Matter / Q000009:adverse effects*; D010343:Patient Admission; D011247:Pregnancy; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter
keywords: air pollution; blood pressure; epidemiology; hypertension; pregnancy.