Prenatal Exposure to Air Pollution and Respiratory Distress in Term Newborns: Results from the MIREC Prospective Pregnancy Cohort

Markey Johnson, Lauren Mazur, Mandy Fisher, William D. Fraser, Liu Sun, Perry Hystad, Chintan K. Gandhi

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1 Scopus citations


BACKGROUND: Respiratory distress is the leading cause of neonatal morbidity and mortality worldwide, and prenatal exposure to air pollution is associated with adverse long-term respiratory outcomes; however, the impact of prenatal air pollution exposure on neonatal respiratory distress has not been well studied. OBJECTIVES: We examined associations between prenatal exposures to fine particular matter (PM2:5) and nitrogen dioxide (NO2) with respiratory distress and related neonatal outcomes. RESULTS: Approximately 7% of newborns experienced respiratory distress. Neonates received clinical interventions including oxygen therapy (6%), assisted ventilation (2%), and systemic antibiotics (3%). Two percent received multiple interventions and 4% were admitted to the neonatal intensive care unit (NICU). Median PM2:5 and NO2 concentrations during pregnancy were 8:81 lg=m3 and 18:02 ppb, respectively. Prenatal exposures to air pollution were not associated with physician-diagnosed respiratory distress, oxygen therapy, or NICU admissions. However, PM2:5 exposures were strongly associated with assisted ventilation (OR per 1-lg=m3 increase in PM2:5 =1:17; 95% CI: 1.02, 1.35), multiple clinical interventions (OR per 1-lg=m3 increase in PM2:5 =1:16; 95% CI: 1.07, 1.26), and systemic antibiotics, (OR per 1-lg=m3 increase in PM2:5 =1:12; 95% CI: 1.04, 1.21). These associations were consistent across exposure periods—that is, during prepregnancy, individual trimesters, and total pregnancy—and robust to model specification. NO2 exposure was associated with administration of systemic antibiotics (OR per 1-ppb increase in NO2 =1:03; 95% CI: 1.00, 1.06). DISCUSSION: Prenatal exposures to PM2:5 increased the risk of severe respiratory distress among term newborns. These findings support the development and prioritization of public health and prenatal care strategies to increase awareness and minimize prenatal exposures to air pollution. https://

Original languageEnglish (US)
Article number017007
JournalEnvironmental health perspectives
Issue number1
StatePublished - Jan 2024

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis

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