Wildfire Smoke Exposure in Pregnancy and Risk of Structural Birth Defects

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Project Summary Climate change continues to result in increased exposure to wildfires in California (CA) and around the world with smoke reaching far more populations than in recent years. There is increased concern for the health effects of these fires, especially for pregnant people and their developing embryos/fetuses. Birth defects are the leading cause of infant mortality in the US. In the US, 3-5% of all births, i.e., more than 100,000 babies/year, are born with a major birth defect. Few studies have been conducted to examine the relationship between wildfire smoke and birth defects, and none have included study populations with detailed wildfire smoke exposure metrics. None have included large population-based studies with thorough case ascertainment. We propose to compile a unique group of datasets of fire occurrence, air quality monitoring and modeling, meteorology and housing characteristics of the maternal residence during critical periods of pregnancy for mothers of children with and without birth defects in the National Birth Defects Prevention Study (NBDPS) and Birth Defects Study To Evaluate Pregnancy exposureS (BD-STEPS) Study, observational, population-based, case-control studies, between 2000-2018 in California. Cases had at least one of 22 major birth defects of the heart, brain and spine, eye, ear, face and mouth, gut, or muscles and bones. Detailed residential history and covariate data are available from extensive interviews of participants about their pregnancy experience and general health, and medication use during pregnancy. Specifically, we aim to estimate the risk of 22 major structural birth defects in relation to wildfire smoke exposures (fire burned area within 20 and 50km, smoke frequencies, fire-sourced PM2.5 and ozone, and polycyclic aromatic hydrocarbons) at the maternal residence in early pregnancy during defect-specific periods of development. Additionally, we will investigate whether the relationship (or lack thereof) between wildfire smoke exposure and birth defects is modified by neighborhood socioeconomic status, psychosocial stress or housing factors. With geocoded residential history, physician determined case ascertainment, extensive covariate collection, housing characteristics and exhaustive air pollution and fire measurement and modeling, our study will have the most precise exposure assessment and case ascertainment to date in a highly exposed region of CA. The findings have the potential to inform targeted clinical and public health interventions designed to reduce exposures to pregnant people.