Publications by authors named "Sandie Ha"

45 Publications

Joint effects of ethnic enclave residence and ambient volatile organic compounds exposure on risk of gestational diabetes mellitus among Asian/Pacific Islander women in the United States.

Environ Health 2021 May 8;20(1):56. Epub 2021 May 8.

Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, MSC, Bethesda, MD, 7004, USA.

Background: Asian/Pacific Islander (API) communities in the United States often reside in metropolitan areas with distinct social and environmental attributes. Residence in an ethnic enclave, a socially distinct area, is associated with lower gestational diabetes mellitus (GDM) risk, yet exposure to high levels of air pollution, including volatile organic compounds (VOCS), is associated with increased GDM risk. We examined the joint effects of ethnic enclaves and VOCs to better understand GDM risk among API women, the group with the highest prevalence of GDM.

Methods: We examined 9069 API births in the Consortium on Safe Labor (19 hospitals, 2002-2008). API ethnic enclaves were defined as areas ≥66th percentile for percent API residents, dissimilarity (geographic dispersal of API and White residents), and isolation (degree that API individuals interact with another API individual). High levels of 14 volatile organic compounds (VOC) were defined as ≥75th percentile. Four joint categories were created for each VOC: Low VOC/Enclave (reference group), Low VOC/No Enclave, High VOC/Enclave, High VOC/No Enclave. GDM was reported in medical records. Hierarchical logistic regression estimated odds ratios (OR) and 95% confidence intervals (95%CI) between joint exposures and GDM, adjusted for maternal factors and area-level poverty. Risk was estimated for 3-months preconception and first trimester exposures.

Results: Enclave residence was associated with lower GDM risk regardless of VOC exposure. Preconception benzene exposure was associated with increased risk when women resided outside enclaves [High VOC/No Enclave (OR:3.45, 95%CI:1.77,6.72)], and the effect was somewhat mitigated within enclaves, [High VOC/Enclave (OR:2.07, 95%:1.09,3.94)]. Risks were similar for 12 of 14 VOCs during preconception and 10 of 14 during the first trimester.

Conclusions: API residence in non-enclave areas is associated with higher GDM risk, regardless of VOC level. Ethnic enclave residence may mitigate effects of VOC exposure, perhaps due to lower stress levels. The potential benefit of ethnic enclaves warrants further study.
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http://dx.doi.org/10.1186/s12940-021-00738-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8106843PMC
May 2021

Associations between Disability and Infertility among U.S. Reproductive-Aged Women.

Int J Environ Res Public Health 2021 03 19;18(6). Epub 2021 Mar 19.

Department of Public Health, School of Social Sciences, Humanities and Arts, Health Science Research Institute, University of California, Merced, CA 95343, USA.

We aim to evaluate the association between self-reported disabilities and infertility and whether disabilities are associated with decreased likelihood of seeking infertility-related care. This US nationally representative cross-sectional analysis includes 3789 non-pregnant women aged 18-49 years without history of hysterectomy or oophorectomy (NHANES, 2013-2018). Disabilities and infertility were both self-reported in personal interviews with trained interviewers. Logistic regression models estimated the adjusted odds ratio (aOR) and 95% confidence intervals for the association between disabilities and infertility and related care seeking. Models adjusted for potential confounders and complex probability sampling. Compared to women without disabilities, women with disabilities (WWD) had higher odds of infertility (aOR: 1.78 (1.31-2.40)). Similar findings were observed for sensory (2.32 (1.52-3.52)) and cognitive disabilities (1.77 (1.28-2.44)). Among women with infertility, WWD were less likely to seek infertility-related care (0.68 (0.32-1.44)) but these estimates were not statistically significant. WWD have increased odds of reporting infertility, and if affected, are less likely to visit a health care provider for this condition. While more research is needed to understand reproductive health issues and needs among WWD, it is important to push for more equitable policies and practices to address the health needs of this underserved population.
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http://dx.doi.org/10.3390/ijerph18063202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003727PMC
March 2021

Air pollution and neurological development in children.

Authors:
Sandie Ha

Dev Med Child Neurol 2021 Apr 9;63(4):374-381. Epub 2020 Dec 9.

Department of Public Health, School of Social Sciences, Humanities and Arts, Health Science Research Institute, University of California, Merced, CA, USA.

Pregnancy and early childhood are periods with high plasticity in neurological development. Environmental perturbations during these sensitive windows can have lifelong developmental consequences. This review summarizes key findings relevant to the effects of air pollution on neurological development. Mounting evidence suggests that exposure to air pollution, both during pregnancy and childhood, is associated with childhood developmental outcomes ranging from changes in brain structures to subclinical deficits in developmental test scores, and, ultimately, developmental disorders such as attention-deficit/hyperactivity disorders or autism spectrum disorders. Although the biological mechanisms of effects remain to be elucidated, multiple pathways are probably involved and include oxidative stress, inflammation, and/or endocrine disruption. Given the alarming global increase in developmental disorders in recent years, and increased human exposures to pollution, it is critical to reduce personal and community-level exposures through tight collaboration of interdisciplinary and multi-level bodies including community partners, physicians, industry partners, policy makers, public health practitioners, and researchers. WHAT THIS PAPER ADDS: Exposure to air pollution is associated with a range of childhood developmental complications. Biological mechanisms may include oxidative stress, inflammation, and endocrine disruption.
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http://dx.doi.org/10.1111/dmcn.14758DOI Listing
April 2021

Ambient temperature and stillbirth: Risks associated with chronic extreme temperature and acute temperature change.

Environ Res 2020 10 19;189:109958. Epub 2020 Jul 19.

Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, USA. Electronic address:

Background: Ambient temperature events are increasing in frequency and intensity. Our prior work in a U.S. nationwide study suggests a strong association between both chronic and acute temperature extremes and stillbirth risk.

Objective: We attempted to replicate our prior study by assessing stillbirth risk associated with average whole-pregnancy temperatures and acute ambient temperature changes in a low-risk U.S.

Population:

Methods: Singleton deliveries in the NICHD Consecutive Pregnancies Study (Utah, 2002-2010; n = 112,005) were identified using electronic medical records. Ambient temperature was derived from the Weather Research and Forecasting model. Binary logistic regression determined the adjusted odds ratio (aOR) and 95% confidence interval (95% CI) for stillbirth associated with whole-pregnancy exposure to extreme cold (<10th percentile) and hot (>90th percentile) versus moderate (10th-90th percentiles) average temperature, adjusting for maternal demographics, season of conception, hypertensive disorders of pregnancy, and gestational diabetes. In a case-crossover analysis, we estimated the stillbirth aOR and 95% CI for each 1° Celsius increase during the week prior to delivery using conditional logistic regression. In both models, we adjusted for relative humidity, ozone, and fine particulates.

Results: We observed 500 stillbirth cases among 498 mothers. Compared to moderate temperatures, whole-pregnancy exposure to extreme cold (aOR: 4.42, 95% CI:3.43, 5.69) and hot (aOR: 5.06, 95% CI: 3.34, 7.68) temperatures were associated with stillbirth risk. Case-crossover models observed a 7% increased odds (95% CI: 1.04, 1.10) associated with each 1° Celsius increase during the week prior to delivery.

Discussion: Both chronic and acute ambient temperature were associated with odds of stillbirth in this low-risk population, similar to our prior nationwide findings. Future increases in temperature extremes are likely and the observed risk in a low-risk population suggests this association merits attention.
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http://dx.doi.org/10.1016/j.envres.2020.109958DOI Listing
October 2020

Air Pollution Exposure Monitoring among Pregnant Women with and without Asthma.

Int J Environ Res Public Health 2020 07 7;17(13). Epub 2020 Jul 7.

Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20892, USA.

: We monitored exposure to fine particulates (PM), ozone, nitrogen dioxide (NO), and ambient temperature for pregnant women with and without asthma. : Women ( = 40) from the Breathe-Well-Being, Environment, Lifestyle, and Lung Function Study (2015-2018) were enrolled during pregnancy and monitored for 2-4 days. Daily pollutants were measured using personal air monitors, indoor air monitors, and nearest Environmental Protection Agency's stationary monitors based on GPS tracking and home address. : Personal-monitor measurements of PM, ozone, and NO did not vary by asthma status but exposure profiles significantly differed by assessment methods. EPA stationary monitor-based methods appeared to underestimate PM and temperature exposure and overestimate ozone and NO exposure. Higher indoor-monitored PM exposures were associated with smoking and the use of gas appliances. The proportion of waking-time during which personal monitors were worn was ~56%. Lower compliance was associated with exercise, smoking, being around a smoker, and the use of a prescription drug. : Exposure did not vary by asthma status but was influenced by daily activities and assessment methods. Personal monitors may better capture exposures but non-compliance merits attention. Meanwhile, larger monitoring studies are warranted to further understand exposure profiles and the health effects of air pollution during pregnancy.
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http://dx.doi.org/10.3390/ijerph17134888DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369909PMC
July 2020

Extrapulmonary Coccidioidomycosis Among Children in Central California: A Retrospective Review.

Pediatr Infect Dis J 2019 12;38(12):1189-1194

Department of Pediatrics, University of California San Francisco, Fresno, CA.

Background: The literature on pediatric extrapulmonary coccidioidomycosis is limited. We reviewed the clinical course, diagnostic studies, treatment and outcomes of children with extrapulmonary coccidioidomycosis followed at a tertiary care center in central California.

Methods: Retrospective study of 78 patients ≤21 years old with extrapulmonary coccidioidomycosis diagnosed over 10 years (1/1/07-12/31/16).

Results: The median age was 9.7 years (interquartile range, 4.5-14.8). The majority of patients were males (55%), Hispanic (65%) and without comorbid conditions (85%). Over two-thirds (68%) had concurrent pulmonary disease. Organ involvements included bones and joints (33%), mediastinum (19%), central nervous system (19%), cervical lymph nodes (15%), larynx (6%) and skin (5%). Most cases (84%) resolved and/or became stable on maintenance therapy, 14% experienced relapse and/or progressive disease, and 2% were fatal. Children ≥10 years of age tended to have >1 site of involvement (47% vs. 25%, P = 0.06), and more relapsed/progressive/fatal disease (21% vs. 5%, P = 0.06) compared with those <10 years. They also required longer durations of treatment (median, 611 vs. 349 days, P = 0.02). Non-Hispanics were more likely to require >1 drug therapy (85% vs. 70%, P = 0.04) and tended to have Coccidioides complement fixation titers ≥1:32 (89% vs. 72%, P = 0.04) compared with Hispanics.

Conclusions: Extrapulmonary coccidioidomycosis in children can be severe and spread to multiple sites and requires prolonged treatment. Non-Hispanics and those ≥10 years of age are more likely to experience severe disease, suggesting a need for early recognition and intervention in these populations.
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http://dx.doi.org/10.1097/INF.0000000000002470DOI Listing
December 2019

Ethnic Enclaves and Pregnancy and Behavior Outcomes Among Asian/Pacific Islanders in the USA.

J Racial Ethn Health Disparities 2020 04 14;7(2):224-233. Epub 2019 Nov 14.

Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, MSC, Bethesda, MD, 7004, USA.

Objectives: Ethnic enclaves are ethnically, spatially, and socially distinct communities that may promote health through access to culturally appropriate resources and reduced exposure to discrimination. This study examined ethnic enclave residence and pregnancy outcomes among Asian/Pacific Islander (API) women in the USA.

Design: We examined 9206 API births in the Consortium on Safe Labor (2002-2008). Ethnic enclaves were defined as hospital regions with high percentage of API residents (> 4%), high dissimilarity index (> 0.41; distribution of API and white residents within a geographic area), and high isolation index (> 0.03; interaction between API and white residents in an area). Gestational diabetes mellitus (GDM), preterm birth (PTB), small for gestational age (SGA), and smoking and alcohol use during pregnancy were reported in medical records supplemented with ICD-9 codes. Hierarchical logistic regression models estimated associations between ethnic enclaves and pregnancy outcomes, adjusted for maternal factors, area-level poverty, and air pollution.

Results: Women in enclaves had lower odds of GDM (OR 0.61; 95%CI 0.45, 0.82), PTB (OR 0.74; 95%CI 0.56, 0.99), and SGA (OR 0.68; 95%CI 0.52, 0.89) compared with women in non-enclaves. Prenatal smoking and alcohol use appeared less likely in enclaves, but estimates were imprecise. Within enclaves, about 10.5% of homes speak an API language, compared with 6.0% in non-enclaves. The mean percent of foreign-born API populations was 67.4% in enclaves and 68.8% in non-enclaves.

Conclusions: API women residing in ethnic enclaves had better pregnancy outcomes than API women residing in non-enclave areas. Access to culturally appropriate social supports and resources may be important for health promotion among API populations.
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http://dx.doi.org/10.1007/s40615-019-00650-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7104626PMC
April 2020

Are we ready to establish a causal relationship between air pollution and pregnancy loss?

Lancet Planet Health 2019 05;3(5):e198-e199

Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research, Epidemiology Branch, Bethesda, MD, USA.

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http://dx.doi.org/10.1016/S2542-5196(19)30073-7DOI Listing
May 2019

Prenatal and early life exposures to ambient air pollution and development.

Environ Res 2019 07 9;174:170-175. Epub 2019 Apr 9.

Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.

Background: Residential proximity to major roadways, and prenatal exposures to particulate matter <2.5 μm (PM) and ozone (O) are linked to poor fetal outcomes but their relationship with childhood development is unclear.

Objectives: We investigated whether proximity to major roadways, or prenatal and early-life exposures to PM and O increase the risk of early developmental delays.

Study Design: Prospective cohort.

Settings: New York State excluding New York City.

Participants: 4089 singletons and 1016 twins born between 2008 and 2010.

Exposures: Proximity to major roadway was calculated using road network data from the NY Department of Transportation. Concentrations of PM and O estimated by the Environmental Protection Agency Downscaler models were spatiotemporally linked to each child's prenatal and early-life addresses incorporating residential history, and locations of maternal work and day-care.

Outcomes: Parents reported their children's development at ages 8, 12, 18, 24, 30 and 36 months in five domains using the Ages and Stages Questionnaire. Generalized mixed models estimated the relative risk (RR) and 95% CI for failing any developmental domain per 10 units increase in PM and O, and for those living <1000 m away from a major roadway compared to those living further. Models adjusted for potential confounders.

Results: Compared to those >1000 m away from a major roadway, those resided 50-100 m [RR: 2.12 (1.00-4.52)] and 100-500 m [RR: 2.07 (1.02-4.22)] away had twice the risk of failing the communication domain. Prenatal exposures to both PM and ozone during various pregnancy windows had weak but significant associations with failing any developmental domain with effects ranging from 1.6% to 2.7% for a 10 μg/m increase in PM and 0.7%-1.7% for a 10 ppb increase in ozone. Average daily postnatal ozone exposure was positively associated with failing the overall screening by 8 months [3.3% (1.1%-5.5%)], 12 months [17.7% (10.4%-25.5%)], and 30 months [7.6%, (1.3%-14.3%)]. Findings were mixed for postnatal PM exposures.

Conclusions: In this prospective cohort study, proximity to major roadway and prenatal/early-life exposures to PM and O were associated with developmental delays. While awaiting larger studies with personal air pollution assessment, efforts to minimize air pollution exposures during critical developmental windows may be warranted.
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http://dx.doi.org/10.1016/j.envres.2019.03.064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6541527PMC
July 2019

Opportunities and challenges for population-based studies investigating the effects of air pollution on pregnancy loss.

Fertil Steril 2019 02;111(2):256-257

Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research, Epidemiology Branch, Bethesda, Maryland.

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http://dx.doi.org/10.1016/j.fertnstert.2018.11.027DOI Listing
February 2019

Ozone pollution and asthma emergency department visits in the Central Valley, California, USA, during June to September of 2015: a time-stratified case-crossover analysis.

J Asthma 2019 10 9;56(10):1037-1048. Epub 2018 Oct 9.

Health Sciences Research Institute, University of California, Merced, CA, USA.

: The San Joaquin Valley (SJV) exceeds the state and national standards for ozone (O). This study investigates whether short-term exposure to O is associated with asthma emergency department (ED) visits. : We identified 1,101 ED visits in June-September of 2015 in SJV, California, who lived within 15 km of active air monitors. Conditional logistic regression models were used to obtain the odds ratio (OR) and 95% confidence interval (CI) associated with an interquartile (IQR) increase in ozone. We explored the potential effect modification by sex (female and male), race (White, Black and Hispanic), age (2-5, 6-18, 19-40, 41-64 and > = 65) and county (Merced, Madera, Kings, Fresno and Kern). : An IQR range (18.1 ppb) increase in O exposure three days before an asthma attack (lag 3) was associated with a 6.6% [OR: 1.066 (95% CI: 1.032, 1.082)] increase in the odds of having an asthma ED visit. The overall ORs differed across age groups and races/ethnicities, with strongest for children aged 6-18 years [OR: 1.219 (95% CI: 1.159, 1.280)], adults 19-40 years [OR: 1.102 (95% CI: 1.053, 1.154)] and Blacks [OR: 1.159 (95% CI: 1.088, 1.236)], respectively. O exposure was not positively associated with asthma ED visits for Whites, while it was for other underrepresented groups. Fresno had the highest number of asthma ED visits and positive association among all five counties. : We found that O exposure is associated with asthma ED visits in the SJV.
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http://dx.doi.org/10.1080/02770903.2018.1523930DOI Listing
October 2019

Air pollution exposure during pregnancy: maternal asthma and neonatal respiratory outcomes.

Ann Epidemiol 2018 09 13;28(9):612-618.e4. Epub 2018 Jun 13.

Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research, Bethesda, MD. Electronic address:

Purpose: Maternal asthma increases adverse neonatal respiratory outcomes, and pollution may further increase risk. Air quality in relation to neonatal respiratory health has not been studied.

Methods: Transient tachypnea of the newborn (TTN), asphyxia, and respiratory distress syndrome (RDS) were identified using medical records among 223,375 singletons from the Consortium on Safe Labor (2002-2008). Community Multiscale Air Quality models estimated pollutant exposures. Multipollutant Poisson regression models calculated adjusted relative risks of outcomes for interquartile range increases in average exposure. Maternal asthma and preterm delivery were evaluated as effect modifiers.

Results: TTN risk increased after particulate matter (PM) less than or equal to 10-micron exposure during preconception and trimester one (9-10%), and whole-pregnancy exposure to PM less than or equal to 2.5 microns (PM; 17%) and carbon monoxide (CO; 10%). Asphyxia risk increased after exposure to PM in trimester one (48%) and whole pregnancy (84%), CO in trimester two and whole pregnancy (28-32%), and consistently for ozone (34%-73%). RDS risk was associated with increased concentrations of nitrogen oxides (33%-42%) and ozone (9%-21%) during all pregnancy windows. Inverse associations were observed with several pollutants, particularly sulfur dioxide. No interaction with maternal asthma was observed. Restriction to term births yielded similar results.

Conclusions: Several pollutants appear to increase neonatal respiratory outcome risks.
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http://dx.doi.org/10.1016/j.annepidem.2018.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6232679PMC
September 2018

Ambient air pollution and semen quality.

Environ Res 2018 05 22;163:228-236. Epub 2018 Feb 22.

National Institute of Child Health and Human Development, Division of Intramural Population Health Research, Epidemiology Branch, 6710B Rockledge Drive, MSC 7004, Bethesda, MD 20892, USA. Electronic address:

Background: Ambient air pollution is associated with systemic increases in oxidative stress, to which sperm are particularly sensitive. Although decrements in semen quality represent a key mechanism for impaired fecundability, prior research has not established a clear association between air pollution and semen quality. To address this, we evaluated the association between ambient air pollution and semen quality among men with moderate air pollution exposure.

Methods: Of 501 couples in the LIFE study, 467 male partners provided one or more semen samples. Average residential exposure to criteria air pollutants and fine particle constituents in the 72 days before ejaculation was estimated using modified Community Multiscale Air Quality models. Generalized estimating equation models estimated the association between air pollutants and semen quality parameters (volume, count, percent hypo-osmotic swollen, motility, sperm head, morphology and sperm chromatin parameters). Models adjusted for age, body mass index, smoking and season.

Results: Most associations between air pollutants and semen parameters were small. However, associations were observed for an interquartile increase in fine particulates ≤2.5 µm and decreased sperm head size, including -0.22 (95% CI -0.34, -0.11) µm for area, -0.06 (95% CI -0.09, -0.03) µm for length and -0.09 (95% CI -0.19, -0.06) µm for perimeter. Fine particulates were also associated with 1.03 (95% CI 0.40, 1.66) greater percent sperm head with acrosome.

Conclusions: Air pollution exposure was not associated with semen quality, except for sperm head parameters. Moderate levels of ambient air pollution may not be a major contributor to semen quality.
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http://dx.doi.org/10.1016/j.envres.2018.02.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878741PMC
May 2018

Ambient air pollution and the risk of pregnancy loss: a prospective cohort study.

Fertil Steril 2018 01 16;109(1):148-153. Epub 2017 Nov 16.

Epidemiology Branch, Division of Intramural Population Health Research, National Institute of Child Health and Human Development, Bethesda, Maryland. Electronic address:

Objective: To estimate the association of pregnancy loss with common air pollutant exposure. Ambient air pollution exposure has been linked to adverse pregnancy outcomes, but few studies have investigated its relationship with pregnancy loss.

Design: Prospective cohort study.

Setting: Not applicable.

Patient(s): A total of 343 singleton pregnancies in a multisite prospective cohort study with detailed protocols for ovulation and pregnancy testing.

Intervention(s): None.

Main Outcome Measure(s): Timing of incident pregnancy loss (from ovulation).

Result(s): The incidence of pregnancy loss was 28% (n = 98). Pollutant levels at women's residences were estimated using modified Community Multiscale Air Quality models and averaged during the past 2 weeks (acute) and the whole pregnancy (chronic). Adjusted Cox proportional hazards models showed that an interquartile range increase in average whole pregnancy ozone (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.07-1.17) and particulate matter <2.5 μm (HR 1.13, 95% CI 1.03-1.24) concentrations were associated with faster time to pregnancy loss. Sulfate compounds also appeared to increase risk (HR 1.58, 95% CI 1.07-2.34). Last 2 weeks of exposures were not associated with loss.

Conclusion(s): In a prospective cohort of couples trying to conceive, we found evidence that exposure to air pollution throughout pregnancy was associated with loss, but delineating specific periods of heightened vulnerability await larger preconception cohort studies with daily measured air quality.
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http://dx.doi.org/10.1016/j.fertnstert.2017.09.037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5758402PMC
January 2018

Time-varying cycle average and daily variation in ambient air pollution and fecundability.

Hum Reprod 2018 01;33(1):166-176

Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Drive Room 3119, MSC 7004, Bethesda, MD 20817, USA; The Emmes Corporation, Rockville, MD 20850, USA.

Study Question: Does ambient air pollution affect fecundability?

Summary Answer: While cycle-average air pollution exposure was not associated with fecundability, we observed some associations for acute exposure around ovulation and implantation with fecundability.

What Is Known Already: Ambient air pollution exposure has been associated with adverse pregnancy outcomes and decrements in semen quality.

Study Design, Size, Duration: The LIFE study (2005-2009), a prospective time-to-pregnancy study, enrolled 501 couples who were followed for up to one year of attempting pregnancy.

Participants/materials, Setting, Methods: Average air pollutant exposure was assessed for the menstrual cycle before and during the proliferative phase of each observed cycle (n = 500 couples; n = 2360 cycles) and daily acute exposure was assessed for sensitive windows of each observed cycle (n = 440 couples; n = 1897 cycles). Discrete-time survival analysis modeled the association between fecundability and an interquartile range increase in each pollutant, adjusting for co-pollutants, site, age, race/ethnicity, parity, body mass index, smoking, income and education.

Main Results And The Role Of Chance: Cycle-average air pollutant exposure was not associated with fecundability. In acute models, fecundability was diminished with exposure to ozone the day before ovulation and nitrogen oxides 8 days post ovulation (fecundability odds ratio [FOR] 0.83, 95% confidence interval [CI]: 0.72, 0.96 and FOR 0.84, 95% CI: 0.71, 0.99, respectively). However, particulate matter ≤10 microns 6 days post ovulation was associated with greater fecundability (FOR 1.25, 95% CI: 1.01, 1.54).

Limitations, Reasons For Caution: Although our study was unlikely to be biased due to confounding, misclassification of air pollution exposure and the moderate study size may have limited our ability to detect an association between ambient air pollution and fecundability.

Wider Implications Of The Findings: While no associations were observed for cycle-average ambient air pollution exposure, consistent with past research in the United States, exposure during critical windows of hormonal variability was associated with prospectively measured couple fecundability, warranting further investigation.

Study Funding/competing Interest(s): This work was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Longitudinal Investigation of Fertility and the Environment study contract nos. #N01-HD-3-3355, NO1-HD-#-3356, N01-HD-3-3358 and the Air Quality and Reproductive Health Study Contract No. HHSN275200800002I, Task Order No. HHSN27500008). We declare no conflict of interest.
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http://dx.doi.org/10.1093/humrep/dex341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850799PMC
January 2018

Acute Associations Between Outdoor Temperature and Premature Rupture of Membranes.

Epidemiology 2018 03;29(2):175-182

Background: Extreme ambient temperatures have been linked to preterm birth. Preterm premature rupture of membranes is a common precursor to preterm birth but is rarely studied in relation to temperature.

Methods: We linked 15,381 singleton pregnancies with premature rupture of membranes from a nationwide US obstetrics cohort (2002-2008) to local temperature. Case-crossover analyses compared daily temperature during the week preceding delivery and the day of delivery to 2 control periods, before and after the case period. Conditional logistic regression models calculated the odds ratio (OR) and 95% confidence intervals (CIs) of preterm and term premature rupture of membranes for a 1°C increase in temperature during the warm (May-September) and cold (October-April) season separately after adjusting for humidity, barometric pressure, ozone, and particulate matter.

Results: During the warm season, 1°C increase during the week before delivery was associated with a 5% (95% CI, 3%, 6%) increased preterm premature rupture of membranes risk, and a 4% (95% CI, 3%, 5%) increased term premature rupture of membranes risk. During the cold season, 1°C increase was associated with a 2% decreased risk for both preterm (95% CI, 1%, 3%) and term premature rupture of membranes (95% CI, 1%, 3%). The day-specific associations for the week before delivery were similar, but somewhat stronger for days closer to delivery.

Conclusions: Relatively small ambient temperature changes were associated with the risk of both preterm and term premature of membranes. Given the adverse consequences of premature rupture of membranes and concerns over global climate change, these findings merit further investigation. See video abstract at, http://links.lww.com/EDE/B312.
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http://dx.doi.org/10.1097/EDE.0000000000000779DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5792369PMC
March 2018

Ambient temperature and risk of cardiovascular events at labor and delivery: A case-crossover study.

Environ Res 2017 11 18;159:622-628. Epub 2017 Sep 18.

Epidemiology Branch, Division of Intramural Population Health Research, NICHD, 6710B Rockledge Drive Room 3119, MSC 7004 Bethesda, Rockville, MD, USA. Electronic address:

Background: Extreme ambient temperatures are linked to cardiac events in the general population, but this relationship is unclear among pregnant women. We estimated the associations and attributable risk between ambient temperature and the risk of cardiovascular event at labor/delivery, and investigated whether these associations vary by maternal race/ethnicity.

Methods: We identified 680 women with singleton deliveries affected by cardiovascular events across 12 US sites (2002-2008). Average daily temperature during the week before, delivery day, and each of the seven days before delivery was estimated for each woman. In a case-crossover analysis, exposures during these hazard periods were compared to two control periods before and after delivery using conditional logistic regression adjusted for other environmental factors.

Results: During the cold season (October-April), 1°C lower during the week prior to delivery was associated with a 4% (95% CI: 1-7%) increased risk of having a labor/delivery affected by cardiovascular events including cardiac arrest and stroke. During the warm season (May-September), 1°C higher during the week prior was associated with a 7% (95% CI: 3-12%) increased risk. These risks translated to 13.4 and 23.9 excess events per 100,000 singleton deliveries during the cold and warm season, respectively. During the warm season, the risks were more pronounced on days closer to delivery and Black women appeared to be more susceptible to the same temperature increase.

Conclusion: Small changes in temperature appear to affect the risk of having cardiovascular events at labor/delivery. Black women had a differentially higher warm season risk. These findings merit further investigation.
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http://dx.doi.org/10.1016/j.envres.2017.09.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5624535PMC
November 2017

Reply: "Air pollution and cardiovascular events with special reference to labor and delivery".

Ann Epidemiol 2017 10 5;27(10):687-688. Epub 2017 Sep 5.

Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, NICHD, Bethesda, MD.

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http://dx.doi.org/10.1016/j.annepidem.2017.08.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6232681PMC
October 2017

Chronic and Acute Ozone Exposure in the Week Prior to Delivery Is Associated with the Risk of Stillbirth.

Int J Environ Res Public Health 2017 07 6;14(7). Epub 2017 Jul 6.

Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD 20892, USA.

Chronic and acute air pollution has been studied in relation to stillbirth with inconsistent findings. We examined stillbirth risk in a retrospective cohort of 223,375 singleton deliveries from 12 clinical sites across the United States. Average criteria air pollutant exposure was calculated using modified Community Multiscale Air Quality models for the day of delivery and each of the seven days prior, whole pregnancy, and first trimester. Poisson regression models using generalized estimating equations estimated the relative risk (RR) of stillbirth and 95% confidence intervals (CI) in relation to an interquartile range increase in pollutant with adjustment for temperature, clinical, and demographic factors. Ozone (O₃) was associated with a 13-22% increased risk of stillbirth on days 2, 3, and 5-7 prior to delivery in single pollutant models, and these findings persisted in multi-pollutant models for days 5 (RR = 1.22, CI = 1.07-1.38) and 6 (RR = 1.18, CI = 1.04-1.33). Whole pregnancy and first trimester O₃ increased risk 18-39% in single pollutant models. Maternal asthma increased stillbirth risk associated with chronic PM and carbon monoxide exposures. Both chronic and acute O₃ exposure consistently increased stillbirth risk, while the role of other pollutants varied. Approximately 8000 stillbirths per year in the US may be attributable to O₃ exposure.
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http://dx.doi.org/10.3390/ijerph14070731DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5551169PMC
July 2017

Ambient Temperature and Stillbirth: A Multi-Center Retrospective Cohort Study.

Environ Health Perspect 2017 06 22;125(6):067011. Epub 2017 Jun 22.

Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) , Bethesda, Maryland, USA.

Background: Climate change is expected to have adverse health effects, but the association between extreme ambient temperatures and stillbirth is unclear.

Objectives: We investigated acute and chronic associations between extreme ambient temperatures and stillbirth risk, and estimated the attributable risk associated with local temperature extremes in the United States.

Methods: We linked 223,375 singleton births ≥23 weeks of gestation (2002–2008) from 12 U.S. sites to local temperature. Chronic exposure to hot (>90th percentile), cold (<10th percentile), or mild (10th–90th percentile) temperatures was defined using window- and site-specific temperature distributions for three-months preconception, first and second trimester, and whole-pregnancy averages. For acute exposure, average temperature for the week preceding delivery was compared to two alternative control weeks in a case-crossover analysis.

Results: In comparison with mild, whole-pregnancy exposure to cold [adjusted odds ratio (aOR) = 4.75; 95% confidence interval (CI): 3.95, 5.71] and hot (aOR = 3.71; 95% CI: 3.07, 4.47) were associated with stillbirth risk, and preconception and first and second trimester exposures were not. Approximately 17–19% of stillbirth cases were potentially attributable to chronic whole-pregnancy exposures to local temperature extremes. This is equivalent to ∼1,116 cold-related and ∼1,019 hot-related excess cases in the United States annually. In the case-crossover analysis, a 1°C increase during the week preceding delivery was associated with a 6% (3–9%) increase in stillbirth risk during the warm season (May–September). This incidence translates to ∼4 (2–6) additional stillbirths per 10,000 births for each 1°C increase.

Conclusions: Extremes of local ambient temperature may have chronic and acute effects on stillbirth risk, even in temperate zones. Temperature-related effects on pregnancy outcomes merit additional investigation. https://doi.org/10.1289/EHP945.
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http://dx.doi.org/10.1289/EHP945DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5743476PMC
June 2017

Air pollution and cardiovascular events at labor and delivery: a case-crossover analysis.

Ann Epidemiol 2017 06 12;27(6):377-383. Epub 2017 May 12.

Epidemiology Branch, Division of Intramural Population Health Research, NICHD, Bethesda, MD. Electronic address:

Purpose: In this case-crossover study, we investigated the odds of having a labor/delivery with cardiovascular event (i.e., ischemic heart disease, stroke, heart failure, cardiac arrest/failure, and other or unspecified cardiovascular events) associated with acute exposure to common air pollutants.

Methods: We selected 680 women with singleton pregnancy and cardiovascular events at labor/delivery from 12 U.S. clinical sites (2002-2008). Exposures to six criteria air pollutants, six particulate constituents, and 26 air toxics were obtained using modified Community Multiscale Air Quality models. Conditional logistic regression models calculated the odds ratio (OR) and 95% confidence intervals (CI) comparing exposures during the day of delivery, the week before delivery, and each of the days of the week before delivery to two control periods before and after.

Results: An interquartile range increase in particulate matter (PM) ≤2.5 microns and nitric oxide exposures during the week before delivery was associated with an 11% (OR 1.11, 95% CI: 1.01-1.23) and 21% (OR 1.21, 95% CI: 1.04-1.42) increased cardiovascular events odds, respectively. These pollutants, sulfur dioxide, carbon monoxide, PM ≤ 10 microns, and some PM constituents showed associations with event odds for days 0, 1, 5, and 6 before delivery. Inverse associations were observed for O and some PM constituents as well as air toxics.

Conclusions: Cardiovascular events at labor/delivery merit more attention in relation to air pollution.
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http://dx.doi.org/10.1016/j.annepidem.2017.05.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5533083PMC
June 2017

Ambient Air Pollution and Risk of Gestational Hypertension.

Am J Epidemiol 2017 Aug;186(3):334-343

Air pollution has been linked to hypertension in the general population, but data on gestational hypertension (GH) are limited. We investigated criteria air pollutants and air toxics during the period before conception and in early gestation in relation to GH risk in the Consortium on Safe Labor/Air Quality and Reproductive Health Study (United States, 2002-2008). Modified Community Multi-scale Air Quality models estimated air pollution exposures for 6,074 singleton pregnancies in which GH was present and 199,980 normotensive pregnancies. Generalized estimating equations estimated relative risks per interquartile-range increment for pollutants and high exposure (≥75th percentile) for air toxics after adjustment for major risk factors. For an interquartile-range increment, GH risk was significantly increased by 18% for sulfur dioxide during the 3 months before conception and, during gestational weeks 1-20, 17% for nitrogen oxides, 10% for particulate matter with an aerodynamic diameter <2.5 μm, 7% for particulate matter with an aerodynamic diameter <10 μm, and 22% for sulfur dioxide. High exposures to several polycyclic aromatic hydrocarbons before conception and during the first trimester were significantly associated with 8%-20% higher risk of GH. Further, preconceptional exposures to several volatile organic compounds were significantly associated with 11%-19% higher risk. Our findings suggest that early exposures to criteria air pollutants, particularly from transport emissions, and high exposure to several air toxics before conception may increase GH risk.
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http://dx.doi.org/10.1093/aje/kwx097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5860464PMC
August 2017

Ambient temperature and air quality in relation to small for gestational age and term low birthweight.

Environ Res 2017 05 1;155:394-400. Epub 2017 Mar 1.

Epidemiology Branch, Division of Intramural Population Health Research, NICHD, Bethesda, MD, USA. Electronic address:

Background: Exposures to extreme ambient temperature and air pollution are linked to adverse birth outcomes, but the associations with small for gestational age (SGA) and term low birthweight (tLBW) are unclear. We aimed to investigate exposures to site-specific temperature extremes and selected criteria air pollutants in relation to SGA and tLBW.

Methods: We linked medical records of 220,572 singleton births (2002-2008) from 12 US sites to local temperature estimated by the Weather Research and Forecasting model, and air pollution estimated by modified Community Multiscale Air Quality models. Exposures to hot (>95th percentile) and cold (<5th percentile) were defined using site-specific distributions of daily temperature over three-month preconception, each trimester, and whole-pregnancy. Average concentrations of five criteria air pollutants and six fine particulate matter constituents were also calculated for these pregnancy windows. Poisson regression with generalized estimating equations calculated the relative risks (RR) and 95% confidence intervals for SGA (weight <10th percentile conditional on gestational age and sex) and tLBW (≥37 weeks and <2500g) associated with an interquartile range increment of air pollutants, and cold or hot compared to mild (5-95th percentile) temperature. Models were adjusted for maternal demographics, lifestyle, and clinical factors, season, and site.

Results: Compared to mild temperature, cold exposure during trimester 2 [RR: 1.21 (1.05-1.38)], trimester 3 [RR: 1.18 (1.03-1.36)], and whole-pregnancy [RR: 2.57 (2.27-2.91)]; and hot exposure during trimester 3 [RR: 1.31 (1.15-1.50)] and whole-pregnancy [RR: 2.49 (2.20-2.83)] increased tLBW risk. No consistent association was observed between temperature and SGA. Air pollutant analyses were generally null but preconception elemental carbon was associated with a 4% increase in SGA while dust particles increased tLBW by 10%. Particulate matter ≤10µm in the second trimester and whole pregnancy also appeared related to tLBW.

Conclusions: Our findings suggest prenatal exposures to extreme ambient temperature relative to usual environment may increase tLBW risk. Given concerns related to climate change, these findings merit further investigation.
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http://dx.doi.org/10.1016/j.envres.2017.02.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5402474PMC
May 2017

Invited Commentary: Ambient Environment and the Risk of Preterm Birth.

Am J Epidemiol 2017 02;185(4):259-261

Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive Room 3119, Bethesda, USA.

Preterm birth is a common adverse birth outcome known to be associated with increased infant mortality, and it often results in a higher burden of offspring morbidity in both the short and long terms. The potential for environmental factors, particularly air pollution and meteorological parameters, to increase preterm birth risk has received significant attention worldwide, but the findings are generally inconsistent, with variations in study designs and methods across populations and geographic locations. In the current issue of the Journal, Giorgis-Allemand et al. (Am J Epidemiol. 2017;185(4):247-258) take the field a step further than most prior investigations of the ambient environment. They examined the associations of ambient air pollution and meteorological factors with preterm risk among 13 cohorts across 11 European countries. No association with air pollution was observed, but associations with increased preterm birth risk were found for both increased atmospheric pressure and ambient temperature exposures during the first trimester. The study is notable in attempting to address several important issues that challenge the field, including exposure misclassification and defining critical windows of exposure. Their comprehensive evaluation of ambient exposures is to be commended.
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http://dx.doi.org/10.1093/aje/kww138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5860257PMC
February 2017

Ozone and hypertensive disorders of pregnancy in Florida: Identifying critical windows of exposure.

Environ Res 2017 Feb 8;153:120-125. Epub 2016 Dec 8.

Department of Epidemiology & Biostatistics, School of Public Health, Texas A&M University, College Station, TX, USA. Electronic address:

Introduction: Ozone (O) has been linked to hypertensive disorders of pregnancy (HDP). However, inconsistent results have been reported, and no study has examined the critical exposure windows during pregnancy.

Materials And Methods: We used Florida birth vital statistics records to investigate the association between HDP and O exposure among 655,529 pregnancies with conception dates between 2005 and 2007. Individual O exposure was assessed at mothers' home address at the time of delivery using the Hierarchical Bayesian space-time statistical model. We examined the association during three predefined exposure windows including trimester 1, trimester 2, and trimesters 1&2, as well as in each week of the first two trimesters using distributed lag models.

Results: Pregnancies with HDP had a higher mean exposure to O (39.07 in trimester 1, 39.02 in trimester 2, and 39.06 in trimesters 1&2, unit: ppb) than those without HDP (38.65 in trimester 1, 38.57 in trimester 2, and 38.61 in trimesters 1&2, unit: ppb). In the adjusted logistic regression model, increased odds of HDP were observed for each 5 ppb increase in O (OR=1.04, 95% CI: 1.03, 1.06; OR=1.03, 95% CI: 1.02, 1.04; OR=1.07, 95% CI: 1.05, 1.08). In the distributed lag models, elevated odds of HDP were observed with increased O exposure during the 1st to 24th weeks of gestation, with higher odds during early pregnancy.

Conclusions: O exposure during pregnancy is related to increased odds of HDP, and early pregnancy appears to be a potentially critical window of exposure.
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http://dx.doi.org/10.1016/j.envres.2016.12.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5222744PMC
February 2017

Smartphone-assisted spatial data collection improves geographic information quality: pilot study using a birth records dataset.

Geospat Health 2016 11 23;11(3):482. Epub 2016 Nov 23.

Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX.

It is well known that the conventional, automated geocoding method based on self-reported residential addresses has many issues. We developed a smartphone-assisted aerial image-based method, which uses the Google Maps application programming interface as a spatial data collection tool during the birth registration process. In this pilot study, we have tested whether the smartphone-assisted method provides more accurate geographic information than the automated geocoding method in the scenario when both methods can get the address geocodes. We randomly selected 100 well-geocoded addresses among women who gave birth in Alachua county, Florida in 2012. We compared geocodes generated from three geocoding methods: i) the smartphone-assisted aerial image-based method; ii) the conventional, automated geocoding method; and iii) the global positioning system (GPS). We used the GPS data as the reference method. The automated geocoding method yielded positional errors larger than 100 m among 29.3% of addresses, while all addresses geocoded by the smartphoneassisted method had errors less than 100 m. The positional errors of the automated geocoding method were greater for apartment/condominiums compared with other dwellings and also for rural addresses compared with urban ones. We conclude that the smartphone-assisted method is a promising method for perspective spatial data collection by improving positional accuracy.
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http://dx.doi.org/10.4081/gh.2016.482DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800510PMC
November 2016

Ambient Temperature and Early Delivery of Singleton Pregnancies.

Environ Health Perspect 2017 03 31;125(3):453-459. Epub 2016 Aug 31.

Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland, USA.

Background: Extreme temperature is associated with adverse birth outcomes but it is unclear whether it increases early delivery risk.

Objectives: We aimed to determine the association between ambient temperature and early delivery.

Methods: Medical records from 223,375 singleton deliveries from 12 U.S. sites were linked to local ambient temperature. Exposure to hot (> 90th percentile) or cold (< 10th percentile) using site-specific and window-specific temperature distributions were defined for 3-months preconception, 7-week periods during the first two trimesters, 1 week preceding delivery, and whole pregnancy. Poisson regression with generalized estimating equations calculated the relative risk (RR) and 95% confidence interval for early deliveries associated with hot/cold exposures, adjusting for conception month, humidity, site, sex, maternal demographics, parity, insurance, prepregnancy body mass index, pregnancy complications, and smoking or drinking during pregnancy. Acute temperature associations were estimated separately for warm (May-September) and cold season (October-April) in a case-crossover analysis using conditional logistic regression.

Results: Compared with mild temperature (10-90th percentile), exposure to hot or cold during weeks 1-7 increased risk for early preterm (< 34 weeks) [RR: 1.11 (95% CI: 1.01, 1.21); RR: 1.20 (95% CI: 1.11, 1.30)], late preterm (34-36 weeks) [RR: 1.09 (95% CI: 1.04, 1.15)], and early term (37-38 weeks) [RR: 1.04 (95% CI: 1.02, 1.07); RR: 1.03 (95% CI: 1.00, 1.05)] delivery. Findings were similar for hot exposures during weeks 15-21. Examining deliveries at each week from 23 through 38, whole-pregnancy hot exposures increased delivery risk by 6-21% at weeks 34 and 36-38. In the case-crossover analysis, a 5°F increase during the week preceding delivery was associated with 12-16% higher and 4-5% lower early delivery risk during warm and cold season, respectively.

Conclusions: Both acute and chronic ambient temperature extremes may affect early delivery risk. Citation: Ha S, Liu D, Zhu Y, Kim SS, Sherman S, Mendola P. 2017. Ambient temperature and early delivery of singleton pregnancies. Environ Health Perspect 125:453-459; http://dx.doi.org/10.1289/EHP97.
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http://dx.doi.org/10.1289/EHP97DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5332199PMC
March 2017

A Review of Epidemiological Research on Adverse Neurological Effects of Exposure to Ambient Air Pollution.

Front Public Health 2016 5;4:157. Epub 2016 Aug 5.

Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M Health Science Center , College Station, TX , USA.

There is a growing body of epidemiological research reporting the neurological effects of ambient air pollution. We examined current evidence, identified the strengths and weaknesses of published epidemiological studies, and suggest future directions for research in this area. Studies were identified through a systematic search of online scientific databases, in addition to a manual search of the reference lists from the identified papers. Despite being a relatively new area of investigation, overall, there is mounting evidence implicating adverse effects of air pollution on neurobehavioral function in both adults and children. Further research is needed to expand our understanding of these relationships, including improvement in the accuracy of exposure assessments; focusing on specific toxicants and their relationships to specific health endpoints, such as neurodevelopmental disorders and neurodegenerative diseases; investigating the combined neurological effects of multiple air pollutants; and further exploration of genetic susceptibility for neurotoxicity of air pollution. In order to achieve these goals collaborative efforts are needed from multidisciplinary teams, including experts in toxicology, biostatistics, geographical science, epidemiology, and neurology.
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http://dx.doi.org/10.3389/fpubh.2016.00157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974252PMC
August 2016

The cold effects on circulatory inflammation, thrombosis and vasoconstriction in type 2 diabetic patients.

Sci Total Environ 2016 Oct 10;568:271-277. Epub 2016 Jun 10.

School of Public Health, Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai, China; Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP(3)), Fudan University, Shanghai, China. Electronic address:

Short-term associations between temperature variation and adverse cardiovascular outcomes have been well documented. However, it remains unclear whether these temperature-related cardiovascular effects are reflected in circulating biomarkers. We aimed to examine the associations between ambient temperature and circulating biomarkers of inflammation, coagulation and vasoconstriction. We collected 207 blood samples from a panel of 35 type 2 diabetes mellitus patients. Sixteen biomarkers of inflammation, coagulation and vasoconstriction were repeatedly measured over six follow-ups. The short-term associations between air temperature and these biomarkers were assessed by mixed-effect models with controls of demographic characteristics and main air pollutants. We found significant and acute effects of temperature on circulatory biomarkers occurred as early as 3h after exposure, peaked at 25-48h and lasted until 72h after exposure. For example, a 1°C decrease in the 25-48h average of air temperature was associated with 2.2%-15.1% increases in biomarkers of inflammation, 1.4%-24.5% of coagulation and 8.2% of vasoconstriction. Our results provided significant evidence that a temperature decline results in a response in biomarkers of inflammation, coagulation and vasoconstriction biomarkers, suggesting them to be the potential biologic mechanisms underlying the cardiovascular effects of temperature variation, and may have implications for disease prevention.
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http://dx.doi.org/10.1016/j.scitotenv.2016.06.030DOI Listing
October 2016

Potential selection bias associated with using geocoded birth records for epidemiologic research.

Ann Epidemiol 2016 Mar 4;26(3):204-11. Epub 2016 Feb 4.

Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M Health Science Center, College Station. Electronic address:

Purpose: There is an increasing use of geocoded birth registry data in environmental epidemiology research. Ungeocoded records are routinely excluded.

Methods: We used classification and regression tree analysis and logistic regression to investigate potential selection bias associated with this exclusion among all singleton Florida births in 2009 (n = 210,285).

Results: The rate of unsuccessful geocoding was 11.5% (n = 24,171). This ranged between 0% and 100% across zip codes. Living in a rural zip code was the strongest predictor of being ungeocoded. Other predictors for geocoding status varied with urbanity status. In urban areas, maternal race (adjusted odds ratio [aOR] ranging between 1.08 for Hispanic and 1.18 for black compared to white), maternal age [aOR: 1.16 (1.10-1.23) for ages 20-34 compared to <20], maternal nativity [aOR: 1.20 (1.15-1.25) for non-US versus US born], delivery at a birth center [aOR: 1.72 (1.49-2.00) compared to hospital delivery], multiparity [aOR: 0.91 (0.88-0.94)], maternal smoking [aOR: 0.82 (0.76-0.88)], and having nonprivate insurance [aOR: 1.25 (1.20-1.30) for Medicaid versus private insurance] were significantly associated with being ungeocoded. In rural areas, births delivered at birth center [aOR: 2.91 (1.80-4.73)] or home [aOR: 1.94 (1.28-2.95)] had increased odds compared to hospital births. The characteristics predictive of being ungeocoded were also significantly associated with adverse birth outcomes such as low birth weight and preterm delivery, and the association for maternal age was different when ungeocoded births were included and excluded.

Conclusions: Geocoding status is not random. Women with certain exposure-outcome characteristics may be more likely to be ungeocoded and excluded, indicating potential selection bias.
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http://dx.doi.org/10.1016/j.annepidem.2016.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4799779PMC
March 2016