Air Pollution and Pregnancy Loss

项目摘要 流产是美国最常见的妊娠并发症，占所有妊娠并发症的15-20%。 临床上公认的怀孕。它对父母双方都有毁灭性的影响，焦虑加剧， 母亲的抑郁症状，甚至创伤后应激障碍，持续长达一年的事件后。 因此，确定可改变的流产风险因素具有重大的公共卫生意义。环境空气 污染是一个越来越被认识到的妊娠并发症风险因素。尽管有证据表明 存在将空气污染与妊娠丢失联系起来的情况，需要通过医疗手段来识别妊娠丢失事件。 记录是全面评估这种联系的一大障碍。对于拟议的工作，我们将雇用 一种新的方法，使用活产识别概念的结果度量， 系列设计，以克服所有现有研究的这一主要局限性。为此，我们将使用所有 丹麦在1997年至2017年期间记录的活产，并将这些与高度时空 从经过充分验证的模型中解决空气污染预测问题。具体而言，我们将（1）调查关联 在颗粒物空气污染暴露（空气污染混合物的指标）和交通之间- 相关的空气污染，环境空气污染的一个组成部分，发现对怀孕特别有毒 并发症和流产;（2）确定脆弱性的关键窗口;（3）开发新的 一种评估多种改性剂同时对潜在效应进行改性的方法， 妊娠期高分辨随时间变化的暴露;（4）确定母亲和邻居水平 影响调节剂，因此，最容易受到空气污染影响的亚群。我们的研究结果可以 为有针对性的法规和政策提供大量信息，精心制作公共卫生信息和有针对性的干预措施。

Project Summary Miscarriage is the most common pregnancy complication in the United States, occurring in 15-20% of all clinically recognized pregnancies. It has devastating impacts on both parents, with elevated anxiety and depressive symptoms in the mother, and even post-traumatic stress disorder, lasting up to a year post-event. Identification of modifiable risk factors of pregnancy loss, thus, is of great public health importance. Ambient air pollution is an increasingly recognizable risk factor for pregnancy complications. Although some evidence exists linking air pollution to pregnancy loss, the need to identify pregnancy loss events through medical records is a large hurdle in comprehensively assessing this association. For the proposed work, we will employ a novel approach that uses the outcome metric of live birth-identified conceptions in a variation of the time series design to overcome this major limitation of all existing studies. To this end, we will use information on all live births recorded in Denmark between 1997 and 2017, and couple these with highly spatio-temporally resolved air pollution predictions from well-validated models. Specifically, we will (1) investigate the association between both particulate matter air pollution exposures, an indicator of the mixture of air pollution, and traffic- related air pollution, a component of ambient air pollution found to be especially toxic for pregnancy complications, and pregnancy loss; (2) identify the critical windows of vulnerability; (3) develop novel methodology to assess potential effect modification by multiple modifiers simultaneously while incorporating the highly resolved time-varying exposures during gestation; and (4) identify maternal- and neighborhood-level effect modifiers, and therefore, the most susceptible subpopulations to air pollution impacts. Our findings can greatly inform targeted regulations and policies, crafting of public health messages, and targeted interventions.