Air Pollution and Birth Outcomes: Health Impact and Economic Value Assessment in Spain

Abstract

Air pollution is considered an ongoing major public health and environmental issue around the globe, affecting the most vulnerable, such as pregnant women and fetuses. The aim of this study is to estimate the health impact and economic value on birth outcomes, such as low birthweight (LBW), preterm birth (PTB), small for gestational age (SGA), attributable to a reduction of PM10 levels in Spain. Reduction based on four scenarios was implemented: fulfillment of WHO guidelines and EU limits, and an attributable reduction of 15% and 50% in annual PM10 levels. Retrospective study on 288,229 live-born singleton children born between 2009–2010, using data from Spain Birth Registry Statistics database, as well as mean PM10 mass concentrations. Our finding showed that a decrease in annual exposure to PM10 appears to be associated with a decrease in the annual cases of LBW, SGA and PTB, as well as a reduction in hospital cost attributed to been born with LBW. Improving pregnancy outcomes by reducing the number of LBW up to 5% per year, will result in an estimate associated monetary saving of 50,000 to 7,000,000 euros annually. This study agrees with previous literature and highlights the need to implement, and ensure compliance with, stricter policies that regulate the maximum exposure to outdoor PM permitted in Spain, contributing to decreased environmental health risk, especially negative birth outcomes.

Does Exposure to Ambient Air Pollution Affect Gestational Age and Newborn Weight?—A Systematic Review

“…The systematic review comprised a total of 69 papers [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 ,…”

“…There were 16 studies performed throughout Europe: three in Lithuania [ 48 , 83 , 89 ], three in the Netherlands [ 38 , 65 , 70 ], three in the UK [ 35 , 57 , 61 ], two in Spain [ 22 , 72 ], two in Sweden [ 62 , 68 ], one in Norway [ 71 ], one in Poland [ 39 ], and one in Italy [ 49 ].…”

“…Emphasis was placed on pollution with PM 2.5 and PM 10 . Among the included studies, 33 examined the impact of PM 10 [ 22 , 25 , 26 , 28 , 30 , 31 , 36 , 38 , 41 , 42 , 43 , 47 , 49 , 54 , 56 , 57 , 61 , 64 , 65 , 66 , 67 , 71 , 73 , 75 , 76 , 77 , 78 , 79 , 81 , 82 , 84 , 86 , 87 ] while 35 analyzed the impact of PM 2.5 [ 23 , 24 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 39 , 40 , 41 , 43 , 44 , 46 , 50 ,…”

“…The average Odds Ratio (OR) of PM 10 exposure influence on TLBW occurrence was 1.138 (minimal-maximal: 1.02–1.57) and 1.338 (minimal-maximal: 1.02–4.3) for PM 2.5 . Only seven papers performed analyses to estimate the influence of PM 10 [ 22 , 25 , 43 , 57 , 64 , 65 , 66 ] and seven examined the influence of PM 2.5 on SGA occurrence [ 23 , 27 , 33 , 43 , 44 , 58 , 74 ]. There were also two papers that showed a paradoxical protective effect of both PM 10 (aOR 0.72) (95%CI: 0.56–0.92) and PM 2.5 (aOR 0.86) (95%CI: 0.81–0.92) on TLBW [ 47 , 53 ].…”

“…Three papers considered patients above the median concentration of air pollutants as the exposed group [ 66 , 67 , 88 ]. In addition, three papers used the World Health Organisation (WHO), European Union (EU), and United States of America Environmental Protection Agency (US EPA) air quality guidelines in their exposure criteria [ 22 , 39 , 44 ]. In yet another three papers, the authors arbitrarily set a cut-off level for the exposed and unexposed groups due to the lack of specific and unambiguous norms of concentration for the substances they analyzed [ 29 , 52 , 89 ].…”