Exposures to Air Pollution and Risk of Acute-onset Placental Abruption

Ananth, Cande V.; Kioumourtzoglou, Marianthi-Anna; Huang, Yongmei; Ross, Zev; Friedman, Alexander M.; Williams, Michelle A.; Wang, Shuang; Mittleman, Murray A.; Schwartz, Joel

doi:10.1097/ede.0000000000000859

Cited by 24 publications

(19 citation statements)

References 44 publications

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“…Our findings are consistent with our earlier work which demonstrated an association of PM 2.5 with a severe smoke event resulting from a coal mine fire in regional Victoria, Australia and increased likelihood of GDM [27]. To our knowledge, only three studies have explored maternal exposure to PM 2.5 and NO 2 in relation to placental abruption, with all reporting an increased likelihood of abruption with greater exposure [11][12][13].…”

Section: Discussionsupporting

confidence: 92%

“…A meta-analysis of 11 studies exploring NO 2 , nitrogen oxides, ozone and sulfur dioxide only found an association between second trimester PM 2.5 and first and second trimester NO x exposure and GDM [10]. Only a handful of studies have specifically explored ambient air pollution and placental abruption; with all three studies finding an adverse association [11][12][13]. Synthesising findings is challenging owing to the relatively limited evidence base, various pollutants studied, various ranges of exposure (high-level vs. low-level), various periods of exposure (whole of pregnancy, trimester-specific or days prior to labour) and definition of outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Maternal Exposure to Ambient Air Pollution and Pregnancy Complications in Victoria, Australia

Melody

Wills

Knibbs

et al. 2020

IJERPH

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The relationship between maternal exposure to ambient air pollution and pregnancy complications is not well characterized. We aimed to explore the relationship between maternal exposure to ambient nitrogen dioxide (NO2) and fine particulate matter (PM2.5) and hypertensive disorders of pregnancy, gestational diabetes mellitus (GDM) and placental abruption. Using administrative data, we defined a state-wide cohort of singleton pregnancies born between 1 March 2012 and 31 December 2015 in Victoria, Australia. Annual average NO2 and PM2.5 was assigned to maternal residence at the time of birth. 285,594 singleton pregnancies were included. An IQR increase in NO2 (3.9 ppb) was associated with reduced likelihood of hypertensive disorders of pregnancy (RR 0.89; 95%CI 0.86, 0.91), GDM (RR 0.92; 95%CI 0.90, 0.94) and placental abruption (RR 0.81; 95%CI 0.69, 0.95). Mixed observations and smaller effect sizes were observed for IQR increases in PM2.5 (1.3 µg/m3) and pregnancy complications; reduced likelihood of hypertensive disorders of pregnancy (RR 0.95; 95%CI 0.93, 0.97), increased likelihood of GDM (RR 1.02; 95%CI 1.00, 1.03) and no relationship for placental abruption. In this exploratory study using an annual metric of exposure, findings were largely inconsistent with a priori expectations and further research involving temporally resolved exposure estimates are required.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Maternal Exposure to Ambient Air Pollution and Pregnancy Complications in Victoria, Australia

Melody

Wills

Knibbs

et al. 2020

IJERPH

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“…Thus, Asian dust exposure in the study may have been a surrogate marker of high exposure to particulate matter. Indeed, a case‐crossover study based on birth records and hospital discharge data in New York from 2008 to 2014, reported the increased odds of placental abruption with exposure to fine particulate matter . Exposure to particulate matter may lead to acute biological responses, such as inflammation and ischaemia, which appear capable of extending into the uterus .…”

Section: Discussionmentioning

confidence: 99%

Exposure to Asian dust within a few days of delivery is associated with placental abruption in Japan: a case‐crossover study

Michikawa

Yamazaki

Shimizu

et al. 2019

BJOG

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Objective Asian dust is a natural phenomenon in which dust particles are transported from desert areas in China and Mongolia to East Asia. Short‐term exposure to Asian dust has been associated with cardiovascular disease through mechanisms such as systemic inflammation. Because inflammation is a potential trigger of placental abruption, exposure may also lead to abruption. We examined whether exposure to Asian dust was associated with abruption. Design A bi‐directional, time‐stratified case‐crossover design. Setting and population From the Japan Perinatal Registry Network database, we identified 3014 patients who delivered singleton births in hospitals in nine Japanese prefectures from 2009 to 2014 with a diagnosis of placental abruption. Methods Asian dust levels were measured at Light Detection and Ranging monitoring stations, and these measurements were used to define the Asian dust days. As there was no information on the onset day of abruption, we assumed this day was the day before delivery (lag1). Main outcome measures Placental abruption. Results During the study period, the Asian dust days ranged from 15 to 71 days, depending on the prefecture. The adjusted odds ratio of placental abruption associated with exposure to Asian dust was 1.4 (95% confidence interval = 1.0, 2.0) for cumulative lags of 1–2 days. Even after adjustment for co‐pollutant exposures, this association did not change substantially. Conclusions In this Japanese multi‐area study, exposure to Asian dust was associated with an increased risk of placental abruption. Tweetable abstract Exposure to environmental factors such as Asian dust may be a trigger of placental abruption.

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“…A study in New York also reported a higher odds of abruption (1190 cases) on lag days 3 (OR 1.19, 95% CI 0.98, 1.43), lag day 4 (OR 1.21, 95% CI 1.01, 1.46), and lag day 5 (OR 1.17, 95% CI 1.03, 1.33) in relation to every 10 μg/m 3 in ambient fine particulate matter (PM 2.5 ). Similarly, the odds of abruption was also increased on lag day 3 (OR 1.16, 95% CI 0.98, 1.37), lag day 4 (OR 1.19, 95% CI 1.02, 1.39), and lag day 5 (OR 1.16, 95% CI 1.05, 1.27) with every 5 ppb increase in exposure to NO 2 . Placental abruption has been conceptualised as an ischaemic placental disorder, and so, it is worth noting that some of the recent findings on abruption mirror the heightened risk in ischaemic cardiovascular events following transient exposure to physical, chemical, and psychological stressors …”

Section: Commentmentioning

confidence: 96%

“…Outbursts of anger have been well studied as an immediate precipitant of ischaemic cardiovascular events, but studies have only recently begun to investigate immediate precipitants, or triggers, of abruptions of acute onset. Prior research on abruption has assessed the short‐term risk following exposures to higher levels of ambient air pollution and intense physical exertion . Anecdotal evidence also suggests that acute mental stress may precipitate abruption, but there have been no studies examining the acute risk of abruption immediately following episodes of anger.…”

Section: Introductionmentioning

confidence: 99%

Relation of outbursts of anger and the acute risk of placental abruption: A case‐crossover study

Chahal

Gelaye

Mostofsky

et al. 2019

Paediatric Perinatal Epid

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Background Roughly, a fourth of all placental abruption cases have an acute aetiologic underpinning, but the causes of acute abruption are poorly understood. Studies indicate that symptoms of stress, depression, and anxiety during pregnancy may be associated with a higher risk of abruption. Objective We examined the rate of abruption in the 2 hours immediately following outbursts of anger. Methods In a multicentre case‐crossover study, we interviewed 663 women diagnosed with placental abruption admitted to one of the seven Peruvian hospitals between January 2013 and August 2015. We asked women about outbursts of anger before symptom onset and compared this with their usual frequency of anger during the week before abruption. Results The rate of abruption was 2.83‐fold (95% confidence interval [CI] 1.85, 4.33) higher in the 2 hours following an outburst of anger compared with other times. The rate ratio (RR) was lower for women who completed technical school or university (RR 1.38, 95% CI 0.52, 3.69) compared to women with secondary school education or less (RR 3.73, 95% CI 2.32, 5.99, P‐homogeneity = .07). There was no evidence that the association between anger episodes and abruption varied by hypertensive disorders of pregnancy (ie preeclampsia/ eclampsia) or antepartum depressive symptoms. Conclusion There was a higher rate of abruption in the 2 hours following outbursts of anger compared with other times, providing potential clues to the aetiologic mechanisms of abruption of acute onset.

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Exposures to Air Pollution and Risk of Acute-onset Placental Abruption

Abstract: This case-crossover study showed evidence of an association between short-term ambient air pollution exposures and increased abruption risk of acute onset.

Cited by 24 publications

References 44 publications

Maternal Exposure to Ambient Air Pollution and Pregnancy Complications in Victoria, Australia

Maternal Exposure to Ambient Air Pollution and Pregnancy Complications in Victoria, Australia

Exposure to Asian dust within a few days of delivery is associated with placental abruption in Japan: a case‐crossover study

Relation of outbursts of anger and the acute risk of placental abruption: A case‐crossover study

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