Air Pollution and Pregnancy Outcome in New York City

描述(由申请人提供)：我们建议研究纽约市空气污染与妊娠结局之间的关系，以帮助确定两者之间是否存在因果联系，重点关注颗粒性空气污染对早产和胎儿生长减少的影响。越来越多的证据表明，美国城市地区目前经历的颗粒物空气污染水平可能会对怀孕过程和结局产生不利影响，这将具有重要的临床和公共卫生意义。这项拟议的研究将把为纽约市社区空气调查(NYCCAS)收集的数据与出生记录结合起来，这些记录与2007-2009历年约30万名纽约市居民的出院数据有关。基于对纽约市150个地点的严格设计的调查，NYCCAS开发了全面的、经过验证的模型，以估计整个城市的环境细颗粒物(PM2.5)空气污染水平及其来源成分，以及其他潜在的相关污染物。从纽约市卫生和精神卫生部门获得的出生记录，包括分配暴露的地理编码住所，将与医院出院数据联系起来，以对感兴趣的妊娠结局、早产、胎儿生长和妊娠高血压综合征(一个关键决定因素)进行精细分类。社会经济状况指标(SES)和其他潜在的混杂因素在个人层面上可从出生证明(教育、吸烟状况)和医院出院数据(保险覆盖范围)获得，在总体层面上可用于居住地普查(SES指数)。有了这些信息，我们将评估PM2.5及其成分是否与早产、出生体重减轻和妊娠高血压相关。有了这些数据资源，我们将能够通过评估颗粒物成分和来源的作用，根据严重程度和临床表现检查早产的亚组，以及确定怀孕期间观察到不良反应的关键时间窗口，来克服过去研究的主要局限性。通过这些努力，我们将能够大幅提高我们对空气污染和妊娠结局之间假设因果联系的理解，解决一个具有重大公共卫生和监管重要性的问题。 公共卫生相关性：我们建议研究空气污染对纽约市居民怀孕健康的影响，重点关注胎儿生长和早产，这两个因素是婴儿死亡率的主要决定因素，并对终身健康造成影响。解决空气污染是否损害胎儿发育的问题具有至关重要的公共卫生和监管重要性，我们有机会为回答这个问题做出重大贡献。

DESCRIPTION (provided by applicant): We propose to examine the relationship between air pollution and pregnancy outcome in New York City (NYC) to help determine whether there is a causal link, focusing on the effect of particulate air pollution on preterm birth and reduced fetal growth. There is increasing evidence that levels of particulate air pollution currently experienced in urban areas of the U.S. may have adverse effects on the course and outcome of pregnancy, which would be of great clinical and public health significance. The proposed study will integrate data collected for the New York City Community Air Survey (NYCCAS) with birth records linked to hospital discharge data for approximately 300,000 NYC residents who delivered in calendar years 2007-2009. Based on a rigorously designed survey of 150 locations in NYC, the NYCCAS has developed comprehensive, validated models to estimate levels of ambient fine particulate matter (PM2.5) air pollution and its source constituents, as well as other potentially correlated pollutants throughout the city. Birth records obtained from the NYC Department of Health and Mental Hygiene, including geocoded residence for assigning exposure, will be linked to hospital discharge data for refined classification of the pregnancy outcomes of interest, preterm birth, fetal growth, and pregnancy-induced hypertension, a key determinant. Indicators of socioeconomic status (SES) and other potential confounders are available at the individual level from birth certificates (education, smoking status) and hospital discharge data (insurance coverage), and on an aggregate level for the Census Tract of residence (indices of SES). With this information, we will assess whether PM2.5 and its constituents are related to risk of preterm birth, reduced birthweight, and pregnancy-induced hypertension. With these data resources, we will be able to overcome major limitations of past studies by evaluating the role of particulate constituents and sources, examining subsets of preterm birth based on severity and clinical presentation, and identifying critical time windows during pregnancy when adverse effects are observed. Through these efforts, we will be able to substantially advance our understanding of the hypothesized causal link between air pollution and pregnancy outcome, addressing a question of substantial public health and regulatory importance. PUBLIC HEALTH RELEVANCE: We propose to examine the impact of air pollution on the health of pregnancy in NYC residents, focusing on fetal growth and preterm birth, leading determinants of infant mortality with lifelong health consequences. Resolving the question of whether air pollution harms fetal development is of vital public health and regulatory importance and we have the opportunity to make a substantial contribution to answering that question.