Impact of London's road traffic air and noise pollution on birth weight: retrospective population based cohort study

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Abstract

Objective To investigate the relation between exposure to both air and noise pollution from road traffic and birth weight outcomes.

Design Retrospective population based cohort study.

Setting Greater London and surrounding counties up to the M25 motorway (2317 km ²), UK, from 2006 to 2010.

Participants 540 365 singleton term live births.

Main outcome measures Term low birth weight (LBW), small for gestational age (SGA) at term, and term birth weight.

Results Average air pollutant exposures across pregnancy were 41 μg/m ³ nitrogen dioxide (NO ₂), 73 μg/m ³ nitrogen oxides (NO _x), 14 μg/m ³ particulate matter with aerodynamic diameter <2.5 μm (PM _2.5), 23 μg/m ³ particulate matter with aerodynamic diameter <10 μm (PM ₁₀), and 32 μg/m ³ ozone (O ₃). Average daytime (L _Aeq,16hr) and night-time (L _night) road traffic A-weighted noise levels were 58 dB and 53 dB respectively. Interquartile range increases in NO ₂, NO _x, PM _2.5, PM ₁₀, and source specific PM _2.5 from traffic exhaust (PM _{2.5 traffic exhaust}) and traffic non-exhaust (brake or tyre wear and resuspension) (PM _{2.5 traffic non-exhaust}) were associated with 2% to 6% increased odds of term LBW, and 1% to 3% increased odds of term SGA. Air pollutant associations were robust to adjustment for road traffic noise. Trends of decreasing birth weight across increasing road traffic noise categories were observed, but were strongly attenuated when adjusted for primary traffic related air pollutants. Only PM _{2.5 traffic exhaust} and PM _2.5 were consistently associated with increased risk of term LBW after adjustment for each of the other air pollutants. It was estimated that 3% of term LBW cases in London are directly attributable to residential exposure to PM _2.5>13.8 μg/m ³during pregnancy.

Conclusions The findings suggest that air pollution from road traffic in London is adversely affecting fetal growth. The results suggest little evidence for an independent exposure-response effect of traffic related noise on birth weight outcomes.

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Most cited references 47

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Smoothing reference centile curves: the LMS method and penalized likelihood.

Stewart T. Cole, Peter G. Green, Mark P. Green (1992)

Refence centile curves show the distribution of a measurement as it changes according to some covariate, often age. The LMS method summarizes the changing distribution by three curves representing the median, coefficient of variation and skewness, the latter expressed as a Box-Cox power. Using penalized likelihood the three curves can be fitted as cubic splines by non-linear regression, and the extent of smoothing required can be expressed in terms of smoothing parameters or equivalent degrees of freedom. The method is illustrated with data on triceps skinfold in Gambian girls and women, and body weight in U.S.A. girls.

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Ambient air pollution, birth weight and preterm birth: a systematic review and meta-analysis.

David Stieb, Li Chen, Maysoon Eshoul … (2012)

Low birth weight and preterm birth have a substantial public health impact. Studies examining their association with outdoor air pollution were identified using searches of bibliographic databases and reference lists of relevant papers. Pooled estimates of effect were calculated, heterogeneity was quantified, meta-regression was conducted and publication bias was examined. Sixty-two studies met the inclusion criteria. The majority of studies reported reduced birth weight and increased odds of low birth weight in relation to exposure to carbon monoxide (CO), nitrogen dioxide (NO(2)) and particulate matter less than 10 and 2.5 microns (PM(10) and PM(2.5)). Effect estimates based on entire pregnancy exposure were generally largest. Pooled estimates of decrease in birth weight ranged from 11.4 g (95% confidence interval -6.9-29.7) per 1 ppm CO to 28.1g (11.5-44.8) per 20 ppb NO(2), and pooled odds ratios for low birth weight ranged from 1.05 (0.99-1.12) per 10 μg/m(3) PM(2.5) to 1.10 (1.05-1.15) per 20 μg/m(3) PM(10) based on entire pregnancy exposure. Fewer effect estimates were available for preterm birth and results were mixed. Pooled odds ratios based on 3rd trimester exposures were generally most precise, ranging from 1.04 (1.02-1.06) per 1 ppm CO to 1.06 (1.03-1.11) per 20 μg/m(3) PM(10). Results were less consistent for ozone and sulfur dioxide for all outcomes. Heterogeneity between studies varied widely between pollutants and outcomes, and meta-regression suggested that heterogeneity could be partially explained by methodological differences between studies. While there is a large evidence base which is indicative of associations between CO, NO(2), PM and pregnancy outcome, variation in effects by exposure period and sources of heterogeneity between studies should be further explored. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

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New intrauterine growth curves based on United States data.

Irene Olsen, Sue A Groveman, M Louise Lawson … (2010)

The objective of this study was to create and validate new intrauterine weight, length, and head circumference growth curves using a contemporary, large, racially diverse US sample and compare with the Lubchenco curves. Data on 391 681 infants (Pediatrix Medical Group) aged 22 to 42 weeks at birth from 248 hospitals within 33 US states (1998-2006) for birth weight, length, head circumference, estimated gestational age, gender, and race were used. Separate subsamples were used to create and validate curves. Smoothed percentile curves (3rd to 97th) were created by the Lambda Mu Sigma (LMS) method. The validation sample was used to confirm representativeness of the curves. The new curves were compared with the Lubchenco curves. Final sample included 257 855 singleton infants (57.2% male) who survived to discharge. Gender-specific weight-, length-, and head circumference-for-age curves were created (n = 130 111) and successfully validated (n = 127 744). Small-for-gestational age and large-for-gestational age classifications using the Lubchenco curves differed significantly from the new curves for each gestational age (all P 36 weeks) who were large-for-gestational-age. The Lubchenco curves may not represent the current US population. The new intrauterine growth curves created and validated in this study, based on a contemporary, large, racially diverse US sample, provide clinicians with an updated tool for growth assessment in US NICUs. Research into the ability of the new definitions of small-for-gestational-age and large-for-gestational-age to identify high-risk infants in terms of short-term and long-term health outcomes is needed.

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Author and article information

Contributors

Rachel B Smith: Role: research associate

Daniela Fecht: Role: research fellow

John Gulliver: Role: senior lecturer

Sean D Beevers: Role: senior lecturer

David Dajnak: Role: deputy manager

Marta Blangiardo: Role: senior lecturer

Rebecca E Ghosh: Role: research associate

Anna L Hansell: Role: assistant director

Frank J Kelly: Role: professor

H Ross Anderson: Role: emeritus professor

Mireille B Toledano: Role: reader

Journal

Journal ID (nlm-ta): BMJ

Journal ID (iso-abbrev): BMJ

Journal ID (publisher-id): bmj

Title: The BMJ

Publisher: BMJ Publishing Group Ltd.

ISSN (Print): 0959-8138

ISSN (Electronic): 1756-1833

Publication date Collection: 2017

Publication date (Electronic): 05 December 2017

Volume: 395

Electronic Location Identifier: j5299

Affiliations

[1 ]MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk Place, London W2 1PG, UK

[2 ]NIHR HPRU in Health Impact of Environmental Hazards, King's College London, London, UK

[3 ]UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK

[4 ]MRC-PHE Centre for Environment and Health, Environmental Research Group, Faculty of Life Sciences and Medicine, King's College London, London, UK

[5 ]Population Health Research Institute, St George’s, University of London, London, UK

Author notes

Correspondence to: M B Toledano m.toledano@ 123456imperial.ac.uk

Article

Publisher ID: smir039236

DOI: 10.1136/bmj.j5299

PMC ID: 5712860

PubMed ID: 29208602

SO-VID: 02b61759-9ff1-4935-9106-c1d387af21bb

License:

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/.

Impact of London's road traffic air and noise pollution on birth weight: retrospective population based cohort study

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Most cited references 47

Smoothing reference centile curves: the LMS method and penalized likelihood.

Ambient air pollution, birth weight and preterm birth: a systematic review and meta-analysis.

New intrauterine growth curves based on United States data.

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