Air Pollution: Impact on Maternal and Perinatal Health

Barbara Hackley, CNM, MSN; Abigail Feinstein, CNM, MSN; Jane Dixon, PhD

J Midwifery Womens Health. 2007;52(5):435-443.

Abstract and Introduction

While air pollution levels have fallen in recent years, air quality in the United States is still poor and adversely affects the health of millions of persons. Because of physiologic changes in pregnancy, pregnant women and their fetuses are among the most vulnerable. This paper reviews the current state of our air quality, the impact that exposure to air pollution has on general health and the health of a pregnancy, and offers suggestions on how to minimize exposures.

Since the time of the Industrial Revolution, it has been evident that the air we breathe has a direct impact on our health. In 1880, 2200 Londoners were killed by a toxic smog of coal smoke; in December 1952, the "Great Smog" of London brought the capital to a standstill and caused an estimated 4000 acute deaths, and an additional 8600 excess deaths during the first 3 months of 1953.^[1] The air quality in the United States has improved since the passage of the Clean Air Act in 1970; however, it still poses a threat to human health. In 2005, the Environmental Protection Agency (EPA) estimated that over 122 million Americans live in areas with poor to marginal outdoor air quality.^[2]

Protecting our health from the surrounding environment is a challenge—particularly for vulnerable populations, such as the elderly, children, those residing in minority and disadvantaged communities, and those suffering from chronic health conditions, as well as for pregnant women and their fetuses. Site-specific analyses have shown that minority communities are exposed more often and more intensely to environmental hazards, such as lead, air pollution, agrochemicals, incinerator emissions, and releases from hazardous waste sites in both the home and work environments.^[3,4] In a study of more than 4 million births from 264 counties in the United States, Woodruff et al.^[5] found that Hispanic, African American, and Asian American mothers were more likely than white mothers to live in a highly polluted county. In addition, studies have found that the residents most affected in these communities are women and children. For example, the risk of exposure to lead and mercury is most hazardous to children, with risk beginning in utero as a function of the mother's environmental exposures affecting the uterine environment of the fetus.^[6] This article explores the current state of our air quality, the impact that exposure to air pollution has on general health and the health of a pregnancy, and will offer suggestions on how to minimize exposures.

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Abstract and Introduction
Major Pollutants: Sources, Health Effects, and Prevalence
The Influence of Maternal and Fetal Physiology
Fetal and Neonatal Outcomes
Management Strategies
Conclusion
References

Criteria Air Pollutants
Pollutant	Sources	Effect
Ozone (O₃) (ground-level) - A colorless gas that is the major constituent of photochemical smog	Formed as a result of chemical reactions between oxygen, volatile organic compounds, and oxides of nitrogen. Sources include vehicles, factories, landfills, industrial solvents, and miscellaneous small sources, such as gas stations, lawn equipment, etc.	Irritates the respiratory tract; produces impaired lung function, such as the inability to take a deep breath; causes throat irritation, chest pain, cough, lung inflammation, and possibly susceptibility to lung infection; aggravates existing respiratory conditions like asthma in certain individuals; may reduce yield of agricultural crops and injure forest and other vegetation
Carbon monoxide (CO) - An odorless, colorless gas resulting from incomplete fossil fuel combustion	Automobiles, buses, trucks, small engines, boilers, and some industrial processes. High concentrations can be found in confined spaces like parking garages, poorly ventilated tunnels, or traffic intersections, especially during peak traffic hours. Levels are highest during cold weather months.	Reduces the ability of blood to deliver oxygen to vital tissues, affecting the cardiovascular and nervous systems; symptoms include dizziness, headaches, nausea, fatigue, memory and visual impairment, and decreased muscular control and ability to exercise
Nitrogen dioxide (NO₂) - Causes respiratory illnesses and lung disease and is an important component of smog	A component of nitrogen oxides (a smog-forming chemical). Result of burning fuels in utilities, industrial boilers, automobiles, and trucks.	Major pollutant that causes smog and acid rain; can harm humans and vegetation when concentrations are sufficiently high; may cause lung damage and illnesses of breathing passages and lungs
Particulate matter - Solid matter or liquid droplets from smoke, dust, fly ash, and condensing vapors	Result of burning of wood and diesel and other fuels; industrial plants; agriculture (plowing, burning off fields); unpaved roads and construction	Causes nose and throat irritation, lung damage, bronchitis, and possibly premature death; children, the elderly, and people suffering from heart or lung disease are especially at risk; also damages paint, soils clothing and furniture, and reduces visibility
Sulfur dioxide (SO₂) - A colorless gas, odorless at low concentrations but pungent at very high concentrations	Emitted from industrial, institutional, and utility boilers; petroleum refineries, smelters, paper mills, and chemical plants	May cause breathing problems and permanent damage to the lungs; an ingredient in acid rain which can damage trees, lakes, and metals, and reduce visibility
Lead (Pb) - A heavy metal which can cause adverse health effects either through ingestion or direct inhalation	Lead-contaminated soil, dust, paint (in homes and on furniture before 1978), etc.; transportation sources using lead in their fuels; coal combustion, smelters, car battery plants, and combustion of garbage containing lead products	Elevated levels can cause brain and other nervous system damage and adversely affect kidney function, blood chemistry, and digestion; thought to be related to hypertension and heart disease; high levels related to seizures, mental retardation, and behavioral disorders; low level exposure in children related to learning deficits and lowered intelligence quotients

Reprinted with permission from the New Hampshire Department of Environmental Sciences._[7]

Air Quality Index
Air Quality Index (AQI) Values	Levels of Health Concern
When the AQI is in this range:	...air quality conditions are:
0 - 50	Good
51 - 100	Moderate
101 - 150	Unhealthy for Sensitive Groups
151 - 200	Unhealthy
201 - 300	Very Unhealthy

Reprinted with permission from the Environmental Protection Agency.^[36]

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Air Pollution: Impact on Maternal and Perinatal Health

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