Low birth weight and air pollution in California: Which sources and components drive the risk?

INTRODUCTION Intrauterine growth restriction has been associated with exposure to air pollution, but there is a need to clarify which sources and components are most likely responsible. This study investigated the associations between low birth weight (LBW, <2500g) in term born infants (≥37 gestational weeks) and air pollution by source and composition in California, over the period 2001-2008. METHODS Complementary exposure models were used: an empirical Bayesian kriging model for the interpolation of ambient pollutant measurements, a source-oriented chemical transport model (using California emission inventories) that estimated fine and ultrafine particulate matter (PM2.5 and PM0.1, respectively) mass concentrations (4km×4km) by source and composition, a line-source roadway dispersion model at fine resolution, and traffic index estimates. Birth weight was obtained from California birth certificate records. A case-cohort design was used. Five controls per term LBW case were randomly selected (without covariate matching or stratification) from among term births. The resulting datasets were analyzed by logistic regression with a random effect by hospital, using generalized additive mixed models adjusted for race/ethnicity, education, maternal age and household income. RESULTS In total 72,632 singleton term LBW cases were included. Term LBW was positively and significantly associated with interpolated measurements of ozone but not total fine PM or nitrogen dioxide. No significant association was observed between term LBW and primary PM from all sources grouped together. A positive significant association was observed for secondary organic aerosols. Exposure to elemental carbon (EC), nitrates and ammonium were also positively and significantly associated with term LBW, but only for exposure during the third trimester of pregnancy. Significant positive associations were observed between term LBW risk and primary PM emitted by on-road gasoline and diesel or by commercial meat cooking sources. Primary PM from wood burning was inversely associated with term LBW. Significant positive associations were also observed between term LBW and ultrafine particle numbers modeled with the line-source roadway dispersion model, traffic density and proximity to roadways. DISCUSSION This large study based on complementary exposure metrics suggests that not only primary pollution sources (traffic and commercial meat cooking) but also EC and secondary pollutants are risk factors for term LBW.