title: Ambient Fine Particulate Matter, Nitrogen Dioxide, and Hypertensive Disorders of Pregnancy in New York City.
abstract: BACKGROUND
  Previous studies suggested a possible association between fine particulate matter air pollution (PM2.5) and nitrogen dioxide (NO2) and the development of hypertensive disorders of pregnancy, but effect sizes have been small and methodologic weaknesses preclude firm conclusions.
  
  
  METHODS
  We linked birth certificates in New York City in 2008-2010 to hospital discharge diagnoses and estimated air pollution exposure based on maternal address. The New York City Community Air Survey provided refined estimates of PM2.5 and NO2 at the maternal residence. We estimated the association between exposures to PM2.5 and NO2 in the first and second trimester and risk of gestational hypertension, mild preeclampsia, and severe preeclampsia among 268,601 births.
  
  
  RESULTS
  In unadjusted analyses, we found evidence of a positive association between both pollutants and gestational hypertension. However, after adjustment for individual covariates, socioeconomic deprivation, and delivery hospital, we did not find evidence of an association between PM2.5 or NO2 in the first or second trimester and any of the outcomes.
  
  
  CONCLUSIONS
  Our data did not provide clear evidence of an effect of ambient air pollution on hypertensive disorders of pregnancy. Results need to be interpreted with caution considering the quality of the available exposure and health outcome measures and the uncertain impact of adjusting for hospital. Relative to previous studies, which have tended to identify positive associations with PM2.5 and NO2, our large study size, refined air pollution exposure estimates, hospital-based disease ascertainment, and little risk of confounding by socioeconomic deprivation, does not provide evidence for an association.
authors.affiliation: From the aDepartments of Epidemiology and Obstetrics and Gynecology, Brown University, Providence, RI; bDepartment of Epidemiology, Brown University, Providence, RI; cDepartment of Biostatistics, Harvard School of Public Health, Boston, MA; dDepartment of Occupational and Environmental Health, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; eNew York City Department of Health and Mental Hygiene, New York, NY; and f ZevRoss Spatial Analysis, Ithaca, NY.
authors.forename: David A
authors.initials: DA
authors.lastname: Savitz
authors.forename: Beth
authors.initials: B
authors.lastname: Elston
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Bobb
authors.forename: Jane E
authors.initials: JE
authors.lastname: Clougherty
authors.forename: Francesca
authors.initials: F
authors.lastname: Dominici
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ito
authors.forename: Sarah
authors.initials: S
authors.lastname: Johnson
authors.forename: Tara
authors.initials: T
authors.lastname: McAlexander
authors.forename: Zev
authors.initials: Z
authors.lastname: Ross
authors.forename: Jessie L C
authors.initials: JL
authors.lastname: Shmool
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Matte
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Wellenius
mesh_terms: D000328:Adult; D000393:Air Pollutants / Q000032:analysis / Q000633:toxicity*; D000397:Air Pollution / Q000009:adverse effects* / Q000032:analysis / Q000706:statistics & numerical data; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000209:etiology*; D015233:Models, Statistical; D009519:New York City; D009585:Nitrogen Dioxide / Q000032:analysis / Q000633:toxicity*; D052638:Particulate Matter / Q000032:analysis / Q000633:toxicity*; D011247:Pregnancy
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter; D009585:Nitrogen Dioxide