Ambient air pollution, birth weight and preterm birth: a systematic review and meta-analysis

Environ Res. 2012 Aug:117:100-11. doi: 10.1016/j.envres.2012.05.007. Epub 2012 Jun 21.


Low birth weight and preterm birth have a substantial public health impact. Studies examining their association with outdoor air pollution were identified using searches of bibliographic databases and reference lists of relevant papers. Pooled estimates of effect were calculated, heterogeneity was quantified, meta-regression was conducted and publication bias was examined. Sixty-two studies met the inclusion criteria. The majority of studies reported reduced birth weight and increased odds of low birth weight in relation to exposure to carbon monoxide (CO), nitrogen dioxide (NO(2)) and particulate matter less than 10 and 2.5 microns (PM(10) and PM(2.5)). Effect estimates based on entire pregnancy exposure were generally largest. Pooled estimates of decrease in birth weight ranged from 11.4 g (95% confidence interval -6.9-29.7) per 1 ppm CO to 28.1g (11.5-44.8) per 20 ppb NO(2), and pooled odds ratios for low birth weight ranged from 1.05 (0.99-1.12) per 10 μg/m(3) PM(2.5) to 1.10 (1.05-1.15) per 20 μg/m(3) PM(10) based on entire pregnancy exposure. Fewer effect estimates were available for preterm birth and results were mixed. Pooled odds ratios based on 3rd trimester exposures were generally most precise, ranging from 1.04 (1.02-1.06) per 1 ppm CO to 1.06 (1.03-1.11) per 20 μg/m(3) PM(10). Results were less consistent for ozone and sulfur dioxide for all outcomes. Heterogeneity between studies varied widely between pollutants and outcomes, and meta-regression suggested that heterogeneity could be partially explained by methodological differences between studies. While there is a large evidence base which is indicative of associations between CO, NO(2), PM and pregnancy outcome, variation in effects by exposure period and sources of heterogeneity between studies should be further explored.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Air Pollutants / analysis*
  • Air Pollutants / toxicity*
  • Birth Weight / drug effects*
  • Carbon Monoxide / analysis
  • Carbon Monoxide / toxicity
  • Female
  • Humans
  • Nitrogen Dioxide / analysis
  • Nitrogen Dioxide / toxicity
  • Odds Ratio
  • Particulate Matter / analysis
  • Particulate Matter / toxicity
  • Pregnancy
  • Pregnancy Outcome
  • Premature Birth / chemically induced*
  • Premature Birth / epidemiology*
  • Regression Analysis


  • Air Pollutants
  • Particulate Matter
  • Carbon Monoxide
  • Nitrogen Dioxide