Air Pollution and Pregnancy Outcomes

Children born with low birth weight, preterm, or with fetal growth restriction may suffer from significant short and long term morbidity and mortality, making adverse pregnancy outcomes a major public health concern with significant health, social, and economic consequences for families, communities, and the nation. Despite aggressive public heath campaigns, racial and geographic disparities in pregnancy outcomes persist. Disproportionate exposure to environmental hazards may partially account for such disparities. In this chapter, we synthesize the existing literature connecting air pollution exposures and pregnancy outcomes. We begin by providing readers with background on adverse pregnancy outcomes, including their consequences and documented disparities. Next, we summarize existing research on air pollution and pregnancy outcomes with a systematic literature review, describing the state of knowledge regarding associations between each outcome and key pollutants. While the scientific literature clearly points to a detrimental association between maternal air pollution exposure and pregnancy outcomes, the literature does not yet provide a consensus understanding of the details of this association. Thus, we describe key methodological barriers and inconsistencies that make interpretation across studies challenging, noting why these issues arise, how they impact results, and how they may be addressed. Acknowledging these challenges and the need for additional research, this chapter highlights clear evidence of a negative association between air pollution and pregnancy outcomes. Future work addressing methodological issues and, perhaps most importantly, identifying causal pathways, is critical to establishing appropriate regulatory policy and protecting maternal and infant healt

Using geographic health information systems (GHIS) for population health

The entrenched separation of primary care and public health in the United States has been damaging and self-perpetuating. As both sectors struggle to meet their own challenges, population health has deteriorated due to their failure to integrate. For the first time, The Practical Playbook offers professionals in primary care and public health a roadmap to integrating their work with the larger goals of population health. Drawing on the experiences of hundreds of public health and primary care professionals from across the US, this book explains: · Why is population health important? · What are the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community? · What are the signs that you're on the right track, and how can progress be sustained? Comprising case studies, practical recommendations, data resources, and commentaries from national leaders on both sides, The Practical Playbook is the new benchmark for primary care and public health practitioners working to improve population healt

Cross-tabulation of birth outcomes and maternal blood cadmium and cotinine levels.

<p>Note: The percentages in the total column are reported column-wise, all other percentages in this table are row-wise. Blood cadmium levels: low – ≤0.28 µg/L, medium – 0.29–0.49 µg/L, high – ≥0.50 µg/l.</p><p>Cross-tabulation of birth outcomes and maternal blood cadmium and cotinine levels.</p

Study population characteristics.

<p>Note: Percentages are reported as column-wise. Blood cadmium levels: low – ≤0.28 µg/L, medium – 0.29–0.49 µg/L, high – ≥0.50 µg/l.</p><p><i>*</i> p-values represent results from chi-square tests.</p><p>Study population characteristics.</p

Adjusted estimates and standard errors for continuous birth outcomes.

<p>Note: estimates are adjusted for the other model covariates; infant's sex was excluded as a covariate from the birth weight percentile for gestational age model since the birth weight percentiles are sex-adjusted. Blood cadmium levels: low – ≤0.28 µg/L, medium – 0.29–0.49 µg/L, high – ≥0.50 µg/l.</p><p>* p<0.05, ** p<0.01, ***p<0.001.</p><p>Adjusted estimates and standard errors for continuous birth outcomes.</p

Adjusted odds ratios and 95% confidence intervals for dichotomous birth outcomes.

<p>Note: estimates are adjusted for the other model covariates; LBW – low birth weight, SGA – small for gestational age, PTB – preterm birth; Blood cadmium levels: low – ≤0.28 µg/L, medium – 0.29–0.49 µg/L, high – ≥0.50 µg/l.</p><p>* p<0.05, ***p<0.001.</p><p>Adjusted odds ratios and 95% confidence intervals for dichotomous birth outcomes.</p