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，目前美国城市地区的颗粒物空气污染水平可能对怀孕的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。拟议的研究将把纽约市社区航空调查（NYCCAS）收集的数据与2007-2009日历年分娩的约30万纽约市居民的出生记录与出院数据相结合。基于对纽约市150个地点进行的严格设计的调查，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）空气污染及其来源成分的水平，以及其他潜在的相关污染物。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住所，将与医院出院数据相关联，以对感兴趣的妊娠结局、早产、胎儿生长和妊娠高血压（一个关键决定因素）进行精确分类。社会经济地位（SES）和其他潜在混杂因素的指标可从个人层面的出生证明（教育、吸烟状况）和出院数据（保险覆盖范围）获得，并可从居住人口普查区的总体水平（SES指数）获得。有了这些信息，我们将评估PM2.5及其成分是否与早产、出生体重降低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亚群，以及确定孕期观察到不良反应的关键时间窗，来克服过去研究的主要局限性。通过这些努力，我们将能够大大提高我们对空气污染与妊娠结局之间假定的因果关系的理解，解决一个具有重大公共卫生和监管重要性的问题。

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.