The relationship between air pollutants and maternal socioeconomic factors on preterm birth in California urban counties

J Expo Sci Environ Epidemiol. 2021 May;31(3):503-513. doi: 10.1038/s41370-021-00323-7. Epub 2021 Apr 15.


Background: Preterm birth is the leading cause of perinatal morbidity and mortality in the U.S. and disparities among racial and ethnic groups persist. While etiologies of preterm birth have not been fully elucidated, it is probable that environmental and social factors play a role.

Objective: We hypothesized that there is an interactive association between exposure to fine particulate matter (PM2.5) or ozone (O3) and neighborhood socioeconomic factors that increase the risk of preterm birth.

Methods: We conducted a retrospective study using geocoded birth certificate data between 2007 and 2011, daily ambient air quality data on PM2.5 and O3, and American Community Survey (2007-2011 5-year estimates) data to assess census tract-level socioeconomic factors in California urban counties.

Results: Our study found a small positive association between maternal exposures to PM2.5 and O3 and preterm birth that varied by gestational exposure period. In mixed-effects models, we found an increase in the risk of preterm birth for a one-unit change in PM2.5 averaged across the entire pregnancy (AOR = 1.02, 95% CI: 1.01, 1.02) and O3 during 3-months pre-pregnancy (AOR = 1.03, 95% CI: 1.02, 1.04). Interaction between census tract-level factors and air pollutants showed an increase in the risk of preterm birth among mothers living in higher socioeconomic areas, though, a fixed cohort bias sensitivity analysis showed these associations were not significant.

Significance: These findings substantiate previous studies that showed associations between air pollution and preterm birth, even as pollution levels have decreased. This study has important implications for policy decisions and may help inform research on potential mechanisms of preterm birth.

Keywords: Air pollution; Ozone; PM2.5; Preterm birth; Socioeconomic status.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Air Pollutants* / adverse effects
  • Air Pollutants* / analysis
  • Air Pollution* / adverse effects
  • Air Pollution* / analysis
  • California / epidemiology
  • Female
  • Humans
  • Infant, Newborn
  • Maternal Exposure / adverse effects
  • Particulate Matter / adverse effects
  • Particulate Matter / analysis
  • Pregnancy
  • Premature Birth* / chemically induced
  • Premature Birth* / epidemiology
  • Retrospective Studies
  • Socioeconomic Factors


  • Air Pollutants
  • Particulate Matter