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Exposure assessment of indoor particulate matter during pregnancy: a narrative review of the literature

  • Busisiwe Shezi EMAIL logo , Nkosana Jafta and Rajen N. Naidoo



The aim of this review was to summarize the evidence of the exposure assessment approaches of indoor particulate matter (PM) during pregnancy and to recommend future focus areas.


Exposure to indoor PM during pregnancy is associated with adverse birth outcomes. However, many questions remain about the consistency of the findings and the magnitude of this effect. This may be due to the exposure assessment methods used and the challenges of characterizing exposure during pregnancy. Exposure is unlikely to remain constant over the nine-month period. Pregnant females’ mobility and activities vary – for example, employment status may be random among females, but among those employed, activities are likely to be greater in the early pregnancy than closer to the delivery of the child.


Forty three studies that used one of the five categories of indoor PM exposure assessment (self-reported, personal air monitoring, household air monitoring, exposure models and integrated approaches) were assessed. Our results indicate that each of these exposure assessment approaches has unique characteristics, strengths, and weaknesses. While questionnaires and interviews are based on self-report and recall, they were a major component in the reviewed exposure assessment studies. These studies predominantly used large sample sizes. Precision and detail were observed in studies that used integrated approaches (i. e. questionnaires, measurements and exposure models).


Given the limitations presented by these studies, exposure misclassification remains possible because of personal, within and between household variability, seasonal changes, and spatiotemporal variability during pregnancy. Therefore, using integrated approaches (i. e. questionnaire, measurements and exposure models) may provide better estimates of PM levels across trimesters. This may provide precision for exposure estimates in the exposure-response relationship.

Corresponding author: Busisiwe Shezi, Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; and South African Medical Research Council, Environment and Health Research Unit, Durban, South Africa, E-mail:

Funding source: AstraZeneca Research Trust


We would like to thank the University of KwaZulu-Natal (UKZN) and the South African Medical Research Council (SAMRC) for supporting this research. The Mother and Child in the Environment Cohort (MACE) study which is funded by SAMRC, National Research Foundation and the AstraZeneca Research Trust.

  1. Research funding: Authors state no funding involved.

  2. Author contributions: BS and RN made contribution to the conception and design of the study, BS, RN, NJ analysed and interpreted the results, BS drafted the manuscript, BS, RN and NJ revised the drafts.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent is not applicable.

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


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Received: 2020-01-31
Revised: 2020-03-22
Accepted: 2020-05-03
Published Online: 2020-06-29
Published in Print: 2020-11-18

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