Association of Air Pollution and Heat Exposure With Preterm Birth, LowBirthWeight, and Stillbirth in the US

The current climate crisis, also known as climate change or global warming, has been widely recognized as an environmental emergency that threatens many critical resources and protections including sustainable food and water supplies, natural disaster preparedness, and US national security. However, as the World Health Organization and The Lancet Countdown have identified, one of the greatest consequences of climate change is its association with human health. Specific to women’s health, the American College of Obstetricians and Gynecologists position statement recognizes that “climate change is an urgent women’s health concern as well as a major public health challenge.” The associations of climate change with women’s health have been further outlined to include a wide range of undesirable outcomes, such as worsening of cardiac disease, respiratory disease, and mental health, and exposure to an increasing number of infectious diseases. These adverse health effects are most consequential to at-risk populations, which include a high number of pregnant women and developing fetuses. The obstetrical literature has included numerous observational studies demonstrating an association between air pollution and heat and increased risk of adverse birth outcomes. Two components of air pollution that are exacerbated by climate change and continued use of fossil fuels are fine particulate matter less than 2.5 μm in diameter (PM2.5) and ozone.12,13. In this review, we assessed the associations between exposure to PM2.5, ozone, and heat and preterm birth, low birth weight, and stillbirth. Although these associations have largely been studied in a global setting,14-17 we focused specifically on the US population, in which these exposures are increasingly common.

JAMA Network Open. 2020;3(6):e208243. doi:10.1001/jamanetworkopen.2020.8243