Air Pollution and Pregnancy Outcome in New York City

描述（由申请人提供）：我们建议检查纽约市（NYC）的空气污染与妊娠结局之间的关系，以帮助确定是否存在因果关系，重点关注颗粒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空气污染水平可能对妊娠过程和结果产生不利影响，这将具有重大的临床和公共卫生意义。拟议的研究将整合为纽约市社区空气调查（NYCCAS）收集的数据，以及与2007-2009日历年分娩的约30万纽约市居民的出院数据相关的出生记录。基于对纽约市150个地点的严格设计调查，NYCCAS开发了全面、有效的模型来估计环境细颗粒物（PM2.5）空气污染水平及其来源成分，以及整个城市的其他潜在相关污染物。从纽约市卫生和心理卫生部获得的出生记录，包括用于分配暴露的地理编码居住地，将与医院出院数据相关联，以便对感兴趣的妊娠结局，早产，胎儿生长和妊娠高血压进行精细分类，这是一个关键决定因素。社会经济地位（SES）和其他潜在混杂因素的指标可以从出生证明（教育，吸烟状况）和出院数据（保险范围）中获得，并在人口普查居住区（SES指数）的总体水平上获得。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的风险有关。有了这些数据资源，我们将能够通过评估颗粒成分和来源的作用，根据严重程度和临床表现检查早产子集，并确定妊娠期间观察到不良反应的关键时间窗，克服过去研究的主要局限性。通过这些努力，我们将能够大大推进我们对空气污染和妊娠结局之间假设因果关系的理解，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，这是婴儿死亡率的主要决定因素，并对终身健康产生影响。解决空气污染是否会损害胎儿发育的问题对公共卫生和监管至关重要，我们有机会为回答这个问题做出实质性贡献。

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.