Background Ambient air pollution has been associated with restricted fetal growth, which is linked with adverse respiratory health in childhood. We assessed the effect of maternal exposure to low concentrations of ambient air pollution on birthweight. Methods We pooled data from 14 population-based mother-child cohort studies in 12 European countries. Overall, the study population included 74 178 women who had singleton deliveries between Feb 11, 1994, and June 2, 2011, and for whom information about infant birthweight, gestational age, and sex was available. The primary outcome of interest was low birthweight at term (weight <2500 g at birth after 37 weeks of gestation). Mean concentrations of particulate matter with an aerodynamic diameter of less than 2.5 mu m (PM2.5), less than 10 mu m (PM10), and between 2.5 mu m and 10 mu m during pregnancy were estimated at maternal home addresses with temporally adjusted land-use regression models, as was PM2.5 absorbance and concentrations of nitrogen dioxide (NO 2) and nitrogen oxides. We also investigated traffic density on the nearest road and total traffic load. We calculated pooled effect estimates with random-effects models. Findings A 5 mu g/m(3) increase in concentration of PM2.5 during pregnancy was associated with an increased risk of low birthweight at term (adjusted odds ratio [OR] 1.18, 95% CI 1.06-1.33). An increased risk was also recorded for pregnancy concentrations lower than the present European Union annual PM2.5 limit of 25 mu g/m(3) (OR for 5 mu g/m(3) increase in participants exposed to concentrations of less than 20 mu g/m(3) 1.41, 95% CI 1.20-1.65). PM10 (OR for 10 mu g/m(3) increase 1.16, 95% CI 1.00-1.35), NO2 (OR for 10 mu g/m(3) increase 1.09, 1.00-1.19), and traffic density on nearest street (OR for increase of 5000 vehicles per day 1.06, 1.01-1.11) were also associated with increased risk of low birthweight at term. The population attributable risk estimated for a reduction in PM2.5 concentration to 10 mu g/m(3) during pregnancy corresponded to a decrease of 22% (95% CI 8-33%) in cases of low birthweight at term. Interpretation Exposure to ambient air pollutants and traffic during pregnancy is associated with restricted fetal growth. A substantial proportion of cases of low birthweight at term could be prevented in Europe if urban air pollution was reduce
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