Air Pollution and Pregnancy Loss

项目摘要 流产是美国最常见的妊娠并发症，发生率为15%-20% 临床公认的怀孕。它对父母双方都有毁灭性的影响，焦虑和 母亲的抑郁症状，甚至创伤后应激障碍，在事件发生后持续一年。 因此，确定可改变的妊娠丢失危险因素具有重要的公共卫生意义。环境空气 污染是孕期并发症的一个日益明显的危险因素。尽管有一些证据 存在将空气污染与妊娠丢失联系在一起的情况，需要通过医疗手段确定妊娠丢失事件 记录是全面评估这一协会的一大障碍。就建议的工作而言，我们会聘请 一种新的方法，它使用活产识别的受孕时间变化的结果度量 系列化设计克服了所有现有研究的这一主要局限。为此，我们将使用关于所有 1997年至2017年在丹麦记录的活产婴儿，并将这些与高度时空结合在一起 解决了来自经过充分验证的模型的空气污染预测。具体地说，我们将(1)调查这种联系 在颗粒物空气污染暴露(空气污染混合的指标)和交通之间- 相关的空气污染，环境空气污染的一种成分，被发现对怀孕特别有害 并发症和妊娠丢失；(2)确定易损性的关键窗口；(3)开发新的 评估同时加入多个修饰剂的潜在效果修改的方法 妊娠期间高分辨率的时变暴露；以及(4)确定母亲和邻居的水平 效果修饰剂，因此，最容易受到空气污染影响的亚群。我们的发现可以 为有针对性的法规和政策、制定公共卫生信息和有针对性的干预措施提供大量信息。

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.