Maternal exposure to air pollutants, PCSK9 levels, fetal growth and gestational age - An Italian cohort

Environ Int. 2021 Apr:149:106163. doi: 10.1016/j.envint.2020.106163. Epub 2021 Feb 5.


Objective: Exposure to airborne pollutants during pregnancy appears to be associated with uterine growth restriction and adverse neonatal outcome. Proprotein convertase subtilisin/kexin type (PCSK9), the key modulator of low-density lipoprotein (LDL) metabolism, increases following particulate matter (PM10) exposure. Because maternal cholesterol is required for fetal growth, PCSK9 levels could be used to evaluate the potential impact of airborne pollutants on fetal growth.

Design: A cohort of 134 healthy women during early pregnancy (11-12 weeks of gestational age) was studied.

Results: A significant association between circulating PCSK9 levels and three tested air pollutants (PM10, PM2.5, nitric oxide (NO2)) was found. Of importance, gestational age at birth was reduced by approximately 1 week for each 100 ng/mL rise in circulating PCSK9 levels, an effect that became more significant at the highest quartile of PM2.5 (with a 1.8 week advance in delivery date for every 100 ng/mL rise in circulating PCSK9; p for interaction = 0.026). This finding was supported by an elevation of the odds ratio for urgent cesarean delivery for each 100 ng/mL rise in PCSK9 (2.99, 95% CI, 1.22-6.57), similar trends being obtained for PM10 and NO2.

Conclusions: The association between exposure to air pollutants during pregnancy and elevation in PCSK9 advances our understanding of the unforeseen influences of environmental exposure in terms of pregnancy associated disorders.

Keywords: Air pollutants; Fetal growth; Gestational age; PCSK9; Particulate matter (PM(10) and PM(2.5)).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Air Pollutants* / analysis
  • Air Pollutants* / toxicity
  • Female
  • Fetal Development
  • Gestational Age
  • Humans
  • Italy
  • Maternal Exposure / adverse effects
  • Pregnancy
  • Proprotein Convertase 9*


  • Air Pollutants
  • PCSK9 protein, human
  • Proprotein Convertase 9