J Korean Med Sci.  2024 Apr;39(13):e131. 10.3346/jkms.2024.39.e131.

Association Between Individual Air Pollution (PM ₁₀ , PM_2.5) Exposure and Adverse Pregnancy Outcomes in Korea: A Multicenter Prospective Cohort, Air Pollution on Pregnancy Outcome (APPO) Study

• Ahn TG
• Kim YJ
• Lee G
• You YA
• Kim SM
• Chae R
• Hur YM
• Park MH
• Bae JG
• Lee SJ
• Kim YH
• Na S

• KMID: 2554581
• DOI: http://doi.org/10.3346/jkms.2024.39.e131

Abstract

Background
Prenatal exposure to ambient air pollution is linked to a higher risk of unfavorable pregnancy outcomes. However, the association between pregnancy complications and exposure to indoor air pollution remains unclear. The Air Pollution on Pregnancy Outcomes research is a hospital-based prospective cohort research created to look into the effects of aerodynamically exposed particulate matter (PM) ₁₀ and PM _2.5 on pregnancy outcomes.
Methods
This prospective multicenter observational cohort study was conducted from January 2021 to June 2023. A total of 662 women with singleton pregnancies enrolled in this study. An AirguardK ^® air sensor was installed inside the homes of the participants to measure the individual PM ₁₀ and PM _2.5 levels in the living environment. The time–activity patterns and PM ₁₀0 and PM _2.5 , determined as concentrations from the time-weighted average model, were applied to determine the anticipated exposure levels to air pollution of each pregnant woman. The relationship between air pollution exposure and pregnancy outcomes was assessed using logistic and linear regression analyses.
Results
Exposure to elevated levels of PM ₁₀ throughout the first, second, and third trimesters as well as throughout pregnancy was strongly correlated with the risk of pregnancy problems according to multiple logistic regression models adjusted for variables. Except for in the third trimester of pregnancy, women exposed to high levels of PM _2.5 had a high risk of pregnancy complications. During the second trimester and entire pregnancy, the risk of preterm birth (PTB) increased by 24% and 27%, respectively, for each 10 μg/m 3 increase in PM ₁₀. Exposure to high PM ₁₀ levels during the second trimester increased the risk of gestational diabetes mellitus (GDM) by 30%. The risk of GDM increased by 15% for each 5 μg/m 3 increase in PM_2.5 during the second trimester and overall pregnancy, respectively. Exposure to high PM ₁₀ and PM _2.5 during the first trimester of pregnancy increased the risk of delivering small for gestational age (SGA) infants by 96% and 26%, respectively.
Conclusion
Exposure to high concentrations of PM ₁₀ and PM _2.5 is strongly correlated with the risk of adverse pregnancy outcomes. Exposure to high levels of PM₁₀ and PM_2.5 during the second trimester and entire pregnancy, respectively, significantly increased the risk of PTB and GDM. Exposure to high levels of PM ₁₀ and PM_2.5 during the first trimester of pregnancy considerably increased the risk of having SGA infants. Our findings highlight the need to measure individual particulate levels during pregnancy and the importance of managing air quality in residential environment.

Keyword

Air Pollution; PM ₁₀; PM_2.5; Pregnancy; Adverse Pregnancy Outcomes

Figure

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  Fig. 1 Map of Korea showing regional boundaries and locations of hospitals participating in the study.

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  Fig. 2 Average concentrations of PM10, PM2.5 (µg/m3) according to district in South Korea.PM = particulate matter.

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  Fig. 3 Map of Korea showing locations of outdoor monitoring station.

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