Gestational fine particulate matter exposure and perinatal outcomes in the ECHO cohort: Associations across pregnancy windows

Adaeze W Nzegwu; Aisha S Dickerson; Kristin Miller; Adam Szpiro; Alison E Hipwell; Amy J Elliot; Amy M Padula; Anne L Dunlop; Anne P Starling; Assiamira Ferrara; Carrie V Breton; Christine T Loftus; Cindy T McEvoy; Dana Dabelea; Daphne Koinis-Mitchell; Donghai Liang; Emily Oken; Emily S Barrett; Heather Volk; James E Gern; Joseph B Stanford; Julie B Herbstman; Jun Wu; Kristen Lyall; Leonardo Trasande; Leslie D Leve; Margaret R Karagas; Nicolò Pini; Rosalind J Wright; Ruby H N Nguyen; Susan L Schantz; Thomas G O'Connor; Sheela Sathyanarayana; Catherine J Karr; Daniel A Enquobahrie; ECHO Cohort Consortium

doi:10.1016/j.envres.2025.123587

Gestational fine particulate matter exposure and perinatal outcomes in the ECHO cohort: Associations across pregnancy windows

Environ Res. 2026 Mar 1:292:123587. doi: 10.1016/j.envres.2025.123587. Epub 2025 Dec 22.

Authors

Adaeze W Nzegwu¹, Aisha S Dickerson², Kristin Miller³, Adam Szpiro⁴, Alison E Hipwell⁵, Amy J Elliot⁶, Amy M Padula⁷, Anne L Dunlop⁸, Anne P Starling⁹, Assiamira Ferrara¹⁰, Carrie V Breton¹¹, Christine T Loftus¹², Cindy T McEvoy¹³, Dana Dabelea¹⁴, Daphne Koinis-Mitchell¹⁵, Donghai Liang¹⁶, Emily Oken¹⁷, Emily S Barrett¹⁸, Heather Volk¹⁹, James E Gern²⁰, Joseph B Stanford²¹, Julie B Herbstman²², Jun Wu²³, Kristen Lyall²⁴, Leonardo Trasande²⁵, Leslie D Leve²⁶, Margaret R Karagas²⁷, Nicolò Pini²⁸, Rosalind J Wright²⁹, Ruby H N Nguyen³⁰, Susan L Schantz³¹, Thomas G O'Connor³², Sheela Sathyanarayana³³, Catherine J Karr¹², Daniel A Enquobahrie³; ECHO Cohort Consortium

Affiliations

¹ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: awosu1@jhu.edu.
² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
³ Department of Epidemiology, University of Washington, Seattle, WA, USA.
⁴ Department of Biostatistics, University of Washington, Seattle, WA, USA.
⁵ Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
⁶ Avera Research Institute, Sioux Falls, SD, USA.
⁷ Department of Obstetrics, Gynecology and Reproductive Sciences, Program for Reproductive Health and the Environment, University of California, San Francisco, San Francisco, CA, USA.
⁸ Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.
⁹ Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Colorado School of Public Health, Aurora, CO, USA.
¹⁰ Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
¹¹ Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
¹² Department of Environmental and Occupational Sciences, University of Washington, Seattle, WA, USA.
¹³ Department of Pediatrics, Papé Pediatric Research Institute, Oregon Health and Science University, Portland, OR, USA.
¹⁴ Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Colorado School of Public Health, Aurora, CO, USA.
¹⁵ Departments of Pediatrics and Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA.
¹⁶ Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA.
¹⁷ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
¹⁸ Department of Biostatistics and Epidemiology, Rutgers School of Public Health, and Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA.
¹⁹ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
²⁰ Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
²¹ Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA.
²² Department of Environmental Health Sciences, Columbia Mailman School of Public Health, New York, NY, USA.
²³ Department of Environmental and Occupational Health, University of California, Irvine, Irvine, CA, USA.
²⁴ AJ Drexel Autism Institute, Drexel University School of Public Health, Philadelphia, PA, USA.
²⁵ Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA.
²⁶ Department of Counseling Psychology and Human Services, College of Education, University of Oregon, Eugene, OR, USA.
²⁷ Department of Epidemiology, Geisel School of Medicine, Dartmouth University, Hanover, NH, USA.
²⁸ Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.
²⁹ Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
³⁰ Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA.
³¹ Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA.
³² Departments of Psychiatry, Neuroscience, Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA.
³³ Department of Pediatrics, University of Washington and Seattle Children's Research Institute, Seattle, WA, USA.

PMID: 41443492
DOI: 10.1016/j.envres.2025.123587

Abstract

Evidence is inconsistent regarding which windows of PM_2.5 exposure are critical for adverse perinatal outcomes. We investigated associations between timing of gestational PM_2.5 exposure and perinatal outcomes. Participants included 19,108 mother-infant dyads from 51 sites of the Environmental influences on Child Health Outcomes (ECHO) cohort. Repeated measures of PM_2.5 exposure were included based on high-resolution spatiotemporal models for trimesters 1-3, early first trimester (≤14 days), and late first trimester (70-92 days). We estimated associations of PM_2.5 exposure (per 5 μg/m³ increase) and continuous outcomes (gestational age at birth [GA] and birthweight for gestational age z-scores [BWZs]) using generalized estimating equation (GEE) models for linear regression. Poisson regression via GEE was used to estimate risk ratios (RRs) of PM_2.5 exposure (per 5 μg/m³ increase) with binary outcomes (preterm birth [PTB], <37 completed weeks of gestation), and term small for gestational age [SGA], <10th percentile). We explored effect modification by participants' characteristics. In fully adjusted models, early 1st trimester PM_2.5 exposure was associated with lower BWZ (β = -0.03, 95 % CI -0.06, -0.001); association with term SGA was RR = 1.06, 95 % CI 0.99, 1.13. Results were mostly null for other windows of gestational exposure. When stratified by sex, early pregnancy PM_2.5 exposure and lower BWZ associations were observed among females, but not males. Suggestive evidence indicates that associations of PM_2.5 exposure with GA, PTB risk, and term SGA risk may vary by maternal race and ethnicity. Our results suggest that policies and practices that reduce the risks of PM_2.5 exposure, particularly in pre-conception and early pregnancy, may improve perinatal outcomes.

Keywords: Birth weight; Environmental pollutants; Gestational age; Infant; Particulate matter; Pregnancy; Premature birth.

MeSH terms

Adult
Air Pollutants* / adverse effects
Birth Weight
Cohort Studies
Female
Gestational Age
Humans
Infant, Newborn
Infant, Small for Gestational Age
Male
Maternal Exposure* / adverse effects
Particulate Matter* / adverse effects
Particulate Matter* / analysis
Pregnancy
Pregnancy Outcome / epidemiology
Pregnancy Trimesters
Premature Birth / epidemiology
Young Adult

Substances

Particulate Matter
Air Pollutants