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Air pollution exposure during pregnancy and spontaneous abortion and stillbirth

Alexandra Grippo , Jun Zhang , Li Chu , Yanjun Guo , Lihua Qiao , Jun Zhang , Ajay A. Myneni and Lina Mu EMAIL logo


The developing fetus is particularly susceptible to environmental pollutants, and evidence has shown adverse effects of air pollutants on pregnancy and birth outcomes. Pregnancy loss, including spontaneous abortion (miscarriage) and stillbirth, is the most severe adverse pregnancy outcome. This review focuses on air pollution exposure during pregnancy in relation to spontaneous abortion and stillbirth. A total of 43 studies are included in this review, including 35 human studies and eight animal studies. Overall, these studies suggest that exposure to air pollutants such as particulate matter (PM), carbon monoxide (CO) and cooking smoke may be associated with higher risk for stillbirth and spontaneous abortion. PM10 exposure during an entire pregnancy was associated with increased risk of spontaneous abortion, and exposure to PM2.5 and PM10 in the third trimester might increase the risk of stillbirth. CO exposure during the first trimester of pregnancy was associated with an increased risk of spontaneous abortion and exposure during the third trimester was associated with an increased risk of stillbirth. Cooking smoke was found to increase the risk of stillbirths, and the evidence was consistent. Insufficient and conflicting evidence was found for various other pollutants, such as NO2 and SO2. Studies did not show clear evidence for associations between pregnancy loss and others pollutants such as heavy metals, organochlorine compounds, PAH and total dust count. Further research is warranted to better understand the relationship between air pollution exposure and pregnancy loss.

Corresponding author: Lina Mu, MD, PhD, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, The State University of New York (SUNY) at Buffalo, 270 Farber Hall, Buffalo, NY 14214-8001, USA, Phone: +1 716 829 5381, Fax: +1 716 829 2979

  1. Research funding: U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Environmental Health Sciences R21ES026429.

  2. Conflict of interest: Authors state no conflict of interest.

  3. Informed consent: Informed consent is not applicable.

  4. Ethical approval: The conducted research is not related to either human or animal use.


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Received: 2017-10-05
Accepted: 2018-06-08
Published Online: 2018-07-05
Published in Print: 2018-09-25

©2018 Walter de Gruyter GmbH, Berlin/Boston

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