Association Between Hypertensive Disorders in Pregnancy and Particulate Matter in the Contiguous United States, 1999–2004Novelty and Significance
Hypertensive disorders in pregnancy harm both maternal and infant health and have been linked to ambient particulate matter. However, existing studies are restricted to a local scale and remain inconsistent. A large-scale study is required to enrich the epidemiological evidence and explore the potential sources of the inconsistency. Making use of US birth certificates (1999–2004), and monitoring data from the environmental protection agency air quality networks, we associated hypertensive disorders in pregnancy with maternal exposure to fine particles or coarse particles using logistic regression analysis after adjusting for many covariates among >5 million subjects in the contiguous United States. Additional analyses were conducted to examine variations in the associations according to (1) census divisions; (2) individual-level factors; (3) a socioeconomic indicator, county-level poverty; and (4) the concentration of ambient particles. The results indicated that hypertensive disorders in pregnancy were robustly linked to maternal exposure to fine particles with an adjusted odds ratio of 1.10 (95% confidence intervals, 1.08–1.12) per 5 μg/m3 increment in terms of the entire pregnancy mean. Stronger associations were found among white mothers. There were also considerable variations in the association by census division or poverty level among counties. Nonlinear analysis indicated a sublinear dose-response function with a threshold concentration of 9 μg/m3. Based on the national study, we calculated the population attributable fractions and found that 8.1% (6.8%–9.4%) of hypertensive disorder cases were attributable to an entire pregnancy exposure of fine particles. These findings can help policymakers to plan related interventions.
- Received February 22, 2018.
- Revision received March 21, 2018.
- Accepted April 26, 2018.
- © 2018 American Heart Association, Inc.