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Program on Reproductive
Health and the Environment1
Air Pollution and Reproductive Health
(Photo source: http://weekspregnanttips.com)
Tracey J. Woodruff, PhD, MPHBritish Columbia Lung Association’s Annual Air Quality &
Health Workshop
February 10, 2016
Program on Reproductive
Health and the Environment
2
Program on Reproductive
Health and the Environment
Development and Periods of Susceptibility
Fertilized Egg
EmbryoFetus
InfantChild
Teenager
3
Program on Reproductive
Health and the Environment
Preterm Birth and Low Birthweight
4
Program on Reproductive
Health and the Environment
5
Pregnancy outcomes
• Immediate
– “low birthweight”
– Preterm delivery
– Birth defects
• Short term
– Infant death
– Childhood cancer
– Neurodevelopmental outcomes
• Long term
– Heart disease
– Diabetes
Program on Reproductive
Health and the Environment
Air pollution monitors
6
Program on Reproductive
Health and the Environment7
1999
1.03 (0.95 – 1.11)
Suspended Particles
Program on Reproductive
Health and the Environment
8
Preterm birth during steel mill closure –Utah Valley
Parker, Mendola, Woodruff
Epidemiology 2008
Geneva Steel, Utah
Valley, 1989 (PM10 =
150 mg/m3)
3
3.5
4
4.5
5
5.5
6
6.5
7
7.5
8
Jan-
85
May-
85
Sep-
85
Jan-
86
May-
86
Sep-
86
Jan-
87
May-
87
Sep-
87
Jan-
88
May-
88
Sep-
88
Jan-
89
First Month of Pregnancy
Perc
en
t P
rete
rm
Outside Utah Valley
Utah Valley
- Steel Mill Closed -
2008
Program on Reproductive
Health and the Environment
9
Traffic-related Air Pollution and Fetal Weight/Placental Weight in Mice
Rocha e Silva et al. F&S 2008
Clean Air Clean AirDirty Air
Dirty Air
2008
Program on Reproductive
Health and the Environment10Increased Odds of Low Birthweight PM10
Increased
Odds of
Preterm Birth
PM10
2012
Program on Reproductive
Health and the Environment
~ 3 million births from
PM2.5 - OR = 1.10; 95% CI: 1.03, 1.18
10-μg/m3 increase
2013
Program on Reproductive
Health and the Environment12
2015
20 ug/m3 increase in PM2.5 -> 18 g (95% CI: –32 g, 3 g),
decreases in birth weight among term births..’.
Program on Reproductive
Health and the Environment
13
LBW & Preterm
• Effects are small but exposure ubiquitous and high in certain areas
– For LBW ~ 30 grams reduction in BW for 10 ug/m3 increase in particulate matter air pollution in CA
• ETS (20-30 grams) (Windham et al. 1999)
• Other pollutants may play role
– Studies typically find at least one pollutant associated, not always the same one
• Variable critical window
1.03 (0.95 – 1.11)
(about 50 ug/m3 increase
suspended particles)
1999 2013PM2.5 - OR = 1.10; 95% CI:
1.03, 1.18
10-μg/m3 increase
14 years
Program on Reproductive
Health and the Environment
Program on Reproductive
Health and the Environment
I. Reproductive Health Professionals
• Influential allies
• Can intervene
early in
children’s health
• Pregnancy – a
teachable
moment
Program on Reproductive
Health and the Environment
2013
Linda C. Giudice, MD, PhD, President American Society for Reproductive Medicine and Jeanne C. Conry, MD, PhD, President, American Congress of Obstetricians and Gynecologists – October 2013, Washington, DC
Program on Reproductive
Health and the Environment
Program on Reproductive
Health and the Environment
Program on Reproductive
Health and the Environment
Recommendation 1: Advocate
for policies to prevent exposure
to toxic environmental
chemicals
Recommendation 2:
Work to ensure a healthy
food system for all
Recommendation 3:
Make environmental health
part of health care
Recommendation 4:
Champion environmental
justice
Program on Reproductive
Health and the Environment
Program on Reproductive
Health and the Environment
- Pregnancy should be
considered a time of
vulnerability to air pollution- Ex. EPA’s Endangerment Finding
for greenhouse gases affects on
public health “the very young” as
among the most vulnerable groups
to climate-related health effects.
Air pollution effects are a
concern of all reproductive
health professionals
We need to continue to
implement approaches to
shorten time from science to
decision.
Linda C. Giudice, MD, PhD, President American Society for
Reproductive Medicine and Jeanne C. Conry, MD, PhD, President,
American Congress of Obstetricians and Gynecologists – October 2013,
Washington, DC
Program on Reproductive
Health and the Environment
Program on Reproductive
Health and the Environment23
$2 trillion dollars by 2020
Recent Past (1990 – 2008)
Program on Reproductive
Health and the Environment
PRHEMission: To create a healthier environment for human reproduction and development
by advancing scientificinquiry, clinical care, andhealth policies that
prevent exposures toharmful chemicals in
our environment
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