Nitrogen dioxide exposure during pregnancy and risk of spontaneous abortion: a case-control study in China

J Matern Fetal Neonatal Med. 2022 Oct;35(19):3700-3706. doi: 10.1080/14767058.2020.1837772. Epub 2020 Oct 27.


Background: Evidence on the relationship between prenatal exposure to NO2 and CO and spontaneous abortion (SAB) is insufficient. We investigated whether there is an association between maternal exposure to nitrogen dioxide (NO2) and carbon monoxide (CO) before and during pregnancy and SAB.

Methods: We conducted a case-control study using medical records of 2445 pregnant women who admitted for abortion prior to 20 weeks of gestational age from January 2014 to December 2019 at a tertiary-care hospital in Shanghai, China. Of the 2445 participants, 1075 were SAB cases and 1370 were healthy controls (underwent elective abortions). Maternal exposure to NO2 and CO before and during pregnancy was estimated using daily air pollution concentration data. Multivariable logistic regression models were constructed to quantify the relationships between maternal exposure to NO2 or CO and the risk of SAB while controlling for potential confounders.

Results: NO2 exposure levels during pregnancy were significantly higher in SAB cases than in healthy controls (42.26 vs. 40.67, p < .01). NO2 exposure during pregnancy was positively associated with the risk of SAB. An interquartile range (16 μg/m3) increase in NO2 exposure was associated with 68% increase in the odds of SAB (OR = 1.68, 95% CI, 1.28, 2.21). Analyses of associations by quartile of NO2 exposure showed that elevated NO2 exposure during pregnancy was associated with increased odds of SAB in linear dose-response manners. Compared with the lowest quartile of NO2 exposure, the odds of SAB in the fourth quartile of NO2 exposure increased 61% (OR = 1.61, 95% CI, 1.03-2.53). No associations of CO exposure with SAB risk were observed.

Conclusions: Our study suggested that exposure to NO2 during early pregnancy was associated with increased risk of SAB. Further studies are needed to confirm our results and explore the potential biological mechanism underlying these associations.

Keywords: Spontaneous abortion; air pollution; carbon monoxide; case-control study; nitrogen dioxide.

MeSH terms

  • Abortion, Spontaneous* / chemically induced
  • Abortion, Spontaneous* / epidemiology
  • Air Pollutants* / adverse effects
  • Air Pollutants* / analysis
  • Case-Control Studies
  • China / epidemiology
  • Female
  • Humans
  • Maternal Exposure / adverse effects
  • Nitrogen Dioxide / adverse effects
  • Nitrogen Dioxide / analysis
  • Particulate Matter
  • Pregnancy


  • Air Pollutants
  • Particulate Matter
  • Nitrogen Dioxide