title: Exposure to emissions from municipal solid waste incinerators and miscarriages: a multisite study of the MONITER Project.
abstract: BACKGROUND
  Miscarriages are an important indicator of reproductive health but only few studies have analyzed their association with exposure to emissions from municipal solid waste incinerators. This study analyzed the occurrence of miscarriages in women aged 15-49years residing near seven incinerators of the Emilia-Romagna Region (Northern Italy) in the period 2002-2006.
  
  
  METHODS
  We considered all pregnancies occurring in women residing during the first trimester of pregnancy within a 4km radius of each incinerator. Addresses were geocoded and exposures were characterized by a dispersion model (ADMS Urban model) producing pollution maps for incinerators based on PM10 stack measurements and for other pollution sources based on NOx ground measurements. Information on pregnancies and their outcomes was obtained from the Hospital Discharge Database. Simplified True Abortion Risks (STAR)×100 estimated pregnancies were calculated. We ran logistic regressions adjusting for maternal characteristics, exposure to other sources of pollution, and sites, considering the whole population and stratifying by miscarriage history.
  
  
  RESULTS
  The study analyzed 11,875 pregnancies with 1375 miscarriages. After adjusting for confounders, an increase of PM10 due to incinerator emissions was associated with an increased risk of miscarriage (test for trend, p=0.042). The odds ratio for the highest quartile of exposed versus not exposed women was 1.29, 95% CI 0.97-1.72. The effect was present only for women without previous miscarriages (highest quartile of exposed versus not exposed women 1.44, 95% CI 1.06-1.96; test for trend, p=0.009).
  
  
  CONCLUSIONS
  Exposure to incinerator emissions is associated with an increased risk of miscarriage. This result should be interpreted with those of a previous study on reproductive health conducted in the same area that observed an association between incinerator exposure and preterm births.
authors.affiliation: Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. Electronic address: silvia.candela@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Candela
authors.affiliation: Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. Electronic address: laurabonvicini@ausl.re.it.
authors.forename: L
authors.initials: L
authors.lastname: Bonvicini
authors.affiliation: Regional Reference Centre on Environment and Health, ARPA Emilia-Romagna Region, Modena, Italy. Electronic address: aranzi@arpa.emr.it.
authors.forename: A
authors.initials: A
authors.lastname: Ranzi
authors.affiliation: Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. Electronic address: flavia.baldacchini@audl.re.it.
authors.forename: F
authors.initials: F
authors.lastname: Baldacchini
authors.affiliation: Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. Electronic address: serena.broccoli@ausl.re.it.
authors.forename: S
authors.initials: S
authors.lastname: Broccoli
authors.affiliation: Regional Reference Centre on Environment and Health, ARPA Emilia-Romagna Region, Modena, Italy. Electronic address: mcordioli@arpa.emr.it.
authors.forename: M
authors.initials: M
authors.lastname: Cordioli
authors.affiliation: Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. Electronic address: elisa.carretta2@unibo.it.
authors.forename: E
authors.initials: E
authors.lastname: Carretta
authors.affiliation: Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. Electronic address: ferdinando.luberto@ausl.re.it.
authors.forename: F
authors.initials: F
authors.lastname: Luberto
authors.affiliation: Public Health Service, Emilia-Romagna Region, Italy. Electronic address: pangelini@regione.emilia-romagna.it.
authors.forename: P
authors.initials: P
authors.lastname: Angelini
authors.affiliation: Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. Electronic address: a.evangelist@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Evangelista
authors.affiliation: Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. Electronic address: paolo.marzaroli@ausl.bologna.it.
authors.forename: P
authors.initials: P
authors.lastname: Marzaroli
authors.affiliation: Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. Electronic address: paolo.giorgirossi@ausl.re.it.
authors.forename: P
authors.initials: P
authors.lastname: Giorgi Rossi
authors.affiliation: Department of Epidemiology, Lazio Region, Italy. Electronic address: f.forastiere@deplazio.it.
authors.forename: F
authors.initials: F
authors.lastname: Forastiere
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology* / Q000209:etiology; D000293:Adolescent; D000328:Adult; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis; D004785:Environmental Pollutants / Q000032:analysis / Q000633:toxicity*; D005260:Female; D006801:Humans; D017745:Incineration; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008875:Middle Aged; D008962:Models, Theoretical; D016017:Odds Ratio; D011247:Pregnancy; D062611:Solid Waste / Q000009:adverse effects* / Q000032:analysis; D055815:Young Adult
chemical_list: D004785:Environmental Pollutants; D062611:Solid Waste
keywords: Abortion risk factors; Incinerator exposure; Miscarriage; Spontaneous abortion