Maternal exposure to fine particulate matter over the first trimester and umbilical cord insertion abnormalities

Int J Epidemiol. 2022 Feb 18;51(1):191-201. doi: 10.1093/ije/dyab192.


Background: Our hypothesis was that exposure to fine particulate matter (PM2.5) is related to abnormal cord insertion, which is categorized as a form of placental implantation abnormality. We investigated the association between exposure to total PM2.5 and its chemical components over the first trimester and abnormal cord insertion, which contributes to the occurrence of adverse birth outcomes.

Methods: From the Japan Perinatal Registry Network database, we used data on 83 708 women who delivered singleton births at 39 cooperating hospitals in 23 Tokyo wards (2013-2015). We collected PM2.5 on a filter and measured daily concentrations of carbon and ion components. Then, we calculated the average concentrations over the first trimester (0-13 weeks of gestation) for each woman. A multilevel logistic-regression model with the hospital as a random effect was used to estimate the odds ratios (ORs) of abnormal cord insertion.

Results: Among the 83 708 women (mean age at delivery = 33.7 years), the frequency of abnormal cord insertion was 4.5%, the median concentration [interquartile range (IQR)] of total PM2.5 was 16.1 (3.61) μg/m3 and the OR per IQR for total PM2.5 was 1.14 (95% confidence interval = 1.06-1.23). In the total PM2.5-adjusted models, total carbon, organic carbon, nitrate, ammonium and chloride were positively associated with abnormal insertion. Organic carbon was consistently, and nitrate tended to be, associated with specific types of abnormal insertion (marginal or velamentous cord insertion).

Conclusions: Exposure to total PM2.5 and some of its components over the first trimester increased the likelihood of abnormal cord insertion.

Keywords: Abnormal cord insertion; fine particle; implantation; nitrate; organic carbon; pregnancy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Air Pollutants* / analysis
  • Air Pollutants* / toxicity
  • Air Pollution* / analysis
  • Air Pollution* / statistics & numerical data
  • Female
  • Humans
  • Maternal Exposure / statistics & numerical data
  • Particulate Matter / analysis
  • Particulate Matter / toxicity
  • Placenta
  • Pregnancy
  • Pregnancy Trimester, First
  • Umbilical Cord / chemistry


  • Air Pollutants
  • Particulate Matter