Over the last decade or so, a large number of studies have investigated the possible adverse effects of ambient air pollution on birth outcomes. We reviewed these studies, which were identified by a systematic search of the main scientific databases. Virtually all reviewed studies were population based, with information on exposure to air pollution derived from routine monitoring sources. Overall, there is evidence implicating air pollution in adverse effects on different birth outcomes, but the strength of the evidence differs between outcomes. The evidence is sufficient to infer a causal relationship between particulate air pollution and respiratory deaths in the postneonatal period. For air pollution and birth weight the evidence suggests causality, but further studies are needed to confirm an effect and its size and to clarify the most vulnerable period of pregnancy and the role of different pollutants. For preterm births and intrauterine growth retardation (IUGR) the evidence as yet is insufficient to infer causality, but the available evidence justifies further studies. Molecular epidemiologic studies suggest possible biologic mechanisms for the effect on birth weight, premature birth, and IUGR and support the view that the relation between pollution and these birth outcomes is genuine. For birth defects, the evidence base so far is insufficient to draw conclusions. In terms of exposure to specific pollutants, particulates seem the most important for infant deaths, and the effect on IUGR seems linked to polycyclic aromatic hydrocarbons, but the existing evidence does not allow precise identification of the different pollutants or the timing of exposure that can result in adverse pregnancy outcomes.

Laboratory of Genetic Ecotoxicology Institute of Experimental Medicine Academy of Sciences and Health Institute of Central Bohemia Prague Czech Republic

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Adriaanse HP, Knottnerus JA, Delgado LR, Cox HH, Essed GGM. Smoking in Dutch women and birth weight. Patient Educ Couns. 1996;28:25–30. PubMed

Alderman BW, Baron AE, Saviz DA. Maternal exposure to neighborhood carbon monoxide and risk of low infant birth weight. Public Health Rep. 1987;102:410–414. PubMed PMC

Axelrod D, Davis DL, Hajek RA, Jones LA. It’s time to rethink dose: the case for combining cancer, and birth and developmental defects [Editorial] Environ Health Perspect. 2001;109:A246–A249. PubMed PMC

Barker DJP. The fetal and infant origins of disease. Eur J Clin Invest. 1995;25:457–463. PubMed

Binková B, Cerna M, Pastorkova A, Jelinek R, Benes I, Novak J, et al. Biological activities of organic compounds adsorbed onto ambient air particles: comparison between the cities of Teplice and Prague during the summer and winter seasons 2000–2001. Mutat Res. 2003;525:43–59. PubMed

Binková B, Vesely D, Veselá D, Jelínek R, Šrám RJ. Genotoxicity and embryotoxicity of urban air particulate matter collected during winter and summer period in two different districts of the Czech Republic. Mutat Res. 1999;440:45–58. PubMed

Bobak M. Outdoor pollution, low birth weight, and prematurity. Environ Health Perspect. 2000;108:173–176. PubMed PMC

Bobak M, Leon DA. Air pollution and infant mortality in the Czech Republic, 1986–88. Lancet. 1992;310:1010–1014. PubMed

Bobak M, Leon DA. The effect of air pollution on infant mortality appears specific for respiratory causes in the postneonatal period. Epidemiology. 1999a;10:666–670. PubMed

Bobak M, Leon DA. Pregnancy outcomes and outdoor air pollution: an ecological study in districts of the Czech Republic. Occup Environ Med. 1999b;56:539–543. PubMed PMC

Bobak M, Richards M, Wadsworth M. Air pollution and birth weight in Britain in 1946. Epidemiology. 2001;12:358–359. PubMed

Boy E, Bruce N, Delgado H. Birth weight and exposure to kitchen wood smoke during pregnancy in rural Guatemala. Environ Health Perspect. 2002;110:109–114. PubMed PMC

Brunekreef B, Holgate ST. Air pollution and health. Lancet. 2002;360:1233–1242. PubMed

Bui QQ, Tran MB, West WL. A comparative study of the reproductive effects of methadone and benzo[a]pyrene in the pregnant and pseudopregnant rat. Toxicology. 1986;42:195–204. PubMed

Calabrese EJ. 1986. Age and Susceptibility to Toxic Substances. New York:Wiley & Sons.

Carpenter DO, Arcaro K, Spink DC. Understanding the human health effects of chemical mixtures. Environ Health Perspect. 2002;110(suppl 1):25–42. PubMed PMC

Chen L, Yang W, Jennison BL, Goodrich A, Omaye ST. Air pollution and birth weight in northern Nevada, 1991–1999. Inhal Toxicol. 2002;14:141–157. PubMed

Collins JJ, Kasap HS, Holland WW. Environmental factors in child mortality in England and Wales. Am J Epidemiol. 1971;93:10–22. PubMed

Dejmek J, Selevan SG, Beneš I, Solansky I, Šrám RJ. Fetal growth and parental exposure to particulate matter during gestation. Environ Health Perspect. 1999;107:475–480. PubMed PMC

Dejmek J, Selevan SG, Beneš I, Šrám RJ. Impact of selected air pollutants on the prevalence of low birth weight and prematurity [Abstract] Epidemiology. 1996;7:S26.

Dejmek J, Solansky I, Beneš I, Leníček J, Šrám RJ. The impact of polycyclic aromatic hydrocarbons and fine particles on pregnancy outcome. Environ Health Perspect. 2000;108:1159–1164. PubMed PMC

Dockery DW, Pope CA., III Acute respiratory effects of particulate air pollution. Annu Rev Public Health. 1994;15:107–132. PubMed

Dockery DW, Pope CA, III, Xu X, Spengler JD, Ware JH, Fay ME, et al. The association between air pollution and mortality in six U.S. cities. N Engl J Med. 1993;329:1753–1759. PubMed

Dolk H, Pattenden S, Vrijheid M, Thakrar B, Armstrong B. Perinatal and infant mortality and low birth weight among residents near cokeworks in Great Britain. Arch Environ Health. 2000;55:26–30. PubMed

Glinianaia SV, Rankin J, Bell R, Pless-Mulloli, Howel D. Particulate air pollution and fetal health. A systematic review of the epidemiologic evidence. Epidemiology. 2004;15:36–45. PubMed

Gouveia N, Bremner SA, Novaes HM. Association between ambient air pollution and birth weight in Sao Paulo, Brazil. J Epidemiol Community Health. 2004;58(1):11–17. PubMed PMC

Guyda HJ. Metabolic effects of growth factors and polycyclic aromatic hydrocarbons on cultured human placental cells of early and late gestation. J Clin Endocrinol Metab. 1991;72:718–723. PubMed

Ha EH, Hong YC, Lee BE, Woo BH, Schwartz J, Christiani DC. Is air pollution a risk factor for low birth weight in Seoul? Epidemiology. 2001;12:643–648. PubMed

Ha EH, Lee JT, Kim H, Hong YC, Lee BE, Park HS, et al. Infant susceptibility of mortality to air pollution in Seoul, South Korea. Pediatrics. 2003;111:284–290. PubMed

Heinrich J, Hoelscher B, Wjst M, Ritz B, Cyrys J, Wichmann H. Respiratory diseases and allergies in two polluted areas in East Germany. Environ Health Perspect. 1999;107:53–62. PubMed PMC

Künzli N, Kaiser R, Medina S, Studnicka M, Chanel O, Fillinger P, et al. Public-health impact of outdoor and traffic-related air pollution: a European assessment. Lancet. 2000;356:795–801. PubMed

Lave LB, Seskin EP. 1977. Air Pollution and Human Health. Baltimore, MD:Johns Hopkins University Press.

Lin MC, Chiu HF, Yu HS, Tsai SS, Cheng BH, Wu TN, et al. Increased risk of preterm delivery in areas with air pollution from a petroleum refinery plant in Taiwan. J Toxicol Environ Health. 2001a;64:637–644. PubMed

Lin MC, Yu HS, Tsai SS, Cheng BH, Hsu TY, Wu TN, et al. Adverse pregnancy outcome in a petrochemical polluted area in Taiwan. J Toxicol Environ Health. 2001b;63:565–574. PubMed

Liu S, Krewski D, Shi Y, Chen Y, Burnett RT. Association between gaseous ambient air pollutants and adverse pregnancy outcomes in Vancouver, Canada. Environ Health Perspect. 2003;111:1773–1778. PubMed PMC

Loomis D, Castillejos M, Gold RG, McDonnell W, Borja-Aburto VH. Air pollution and infant mortality in Mexico City. Epidemiology. 1999;10:118–123. PubMed

MacKenzie KM, Angevine DM. Infertility in mice exposed in utero to benzo(a)pyrene. Biol Reprod. 1981;24:183–191. PubMed

Maisonet M, Bush TJ, Correa A, Jaakkola JJK. Relation between ambient air pollution and low birth weight in the northeastern United States. Environ Health Perspect. 2001;109(suppl 3):351–356. PubMed PMC

Maisonet M, Correa A, Misra D, Jaakkola JJK. A review of the literature on the effects of ambient air pollution on fetal growth. Environ Res. 2004;95:106–115. PubMed

Misra DP, Nguyen RH. Environmental tobacco smoke and low birth weight: a hazard in the workplace? Environ Health Perspect. 1999;107(suppl 6):897–904. PubMed PMC

Nicol CJ, Harrison ML, Laposa RR, Gimelshtein IL, Wells PG. A teratologic suppressor role for p53 in benzo[a]pyrene-treated transgenic p53-deficient mice. Nat Genet. 1995;10:181–187. PubMed

Osmond C, Baker DJP. Fetal, infant and childhood growth are predictors of coronary heart disease, diabetes, and hypertension in adult men and women. Environ Health Perspect. 2000;18:545–553. PubMed PMC

Penna MLF, Duchiade MP. Air pollution and infant mortality from pneumonia in the Rio de Janeiro metropolitan area. Bull Pan Am Health Organ. 1991;25:47–54. PubMed

Pereira LA, Loomis D, Conceicao GMS, Braga ALF, Arcas RM, Kishi HS, et al. Association between air pollution and intrauterine mortality in Sao Paulo, Brazil. Environ Health Perspect. 1998;106:325–329. PubMed PMC

Perera FP, Hemminki K, Jedrychowski W, Whyatt R, Campbell U, Hsu Y, et al. In utero DNA damage from environmental pollution is associated with somatic gene mutation in newborns. Cancer Epidemiol Biomarkers Prev. 2002;11:1134–1137. PubMed

Perera FP, Jedrychowski W, Rauh V, Whyatt RM. Molecular epidemiologic research on the effect of environmental pollutants on the fetus. Environ Health Perspect. 1999;107:451–460. PubMed PMC

Perera FP, Rauh V, Tsai WY, Kinney P, Camann D, Barr D, et al. Effects of transplacental exposure to environmental pollutants on birth outcomes in a multiethnic population. Environ Health Perspect. 2003;111:201–205. PubMed PMC

Perera FP, Whyatt RM, Jedrychowski W, Rauh V, Manchester D, Santella RM, et al. Recent developments in molecular epidemiology. A study of the environmental polycyclic aromatic hydrocarbons on birth outcomes in Poland. Am J Epidemiol. 1998;147:309–314. PubMed

Pope CA, Burnett RT, Thun MJ, Calle MJ, Krewski D, Ito K, et al. Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. JAMA. 2002;287:1132–1141. PubMed PMC

Rigdon RH, Rennels EG. Effect of feeding benzpyrene on reproduction in the rat. Experientia. 1964;20:224–226. PubMed

Ritz B, Yu F. The effect of ambient carbon monoxide on low birth weight among children born in Southern California between 1989 and 1993. Environ Health Perspect. 1999;107:17–25. PubMed PMC

Ritz B, Yu F, Chapa G, Fruin S. Effect of air pollution on preterm birth among children born in Southern California between 1989 and 1993. Epidemiology. 2000;5:502–511. PubMed

Ritz B, Yu F, Fruin S, Chapa G, Shaw GM, Harris JA. Ambient air pollution and risk of birth defects in Southern California. Am J Epidemiol. 2002;155:17–24. PubMed

Rogers JF, Thompson SJ, Addy CL, McKeown RE, Cowen DJ, Decoufle P. Association of very low birth weight with exposures to environmental sulfur dioxide and total suspended particulates. Am J Epidemiol. 2000;151:602–613. PubMed

Saldiva PHN, Pope CA, III, Schwartz J, Dockery DW, Lichtenfels AJF, Salge JM, et al. Air pollution and mortality in elderly people: a time series study in São Paulo, Brazil. Arch Environ Health. 1995;50:159–163. PubMed

Salihu HM, Shumpert MN, Aliyu MH, Alexander MR, Kirby RS, Alexander GR. Stillbirths and infant deaths associated with maternal smoking among mothers aged ≥ 40 years: a population study. Am J Perinatol. 2004;21:121–9. PubMed

Schwartz J, Dockery DW, Neas LM, Wypij D, Ware JH, Spengler JD, et al. Acute effects of summer air pollution on respiratory symptom reporting in children. Am J Respir Crit Care Med. 1994;150:1234–1242. PubMed

Schwartz J, Marcus A. Mortality and air pollution in London: a time series analysis. Am J Epidemiol. 1990;131:185–194. PubMed

Sprague HA, Hagstrom R. The Nashville Air Pollution Study: mortality multiple regression. Arch Environ Health. 1969;18:503–507. PubMed

Šrám RJ. Impact of air pollution on reproductive health [Editorial] Environ Health Perspect. 1999;107:A542–A543. PubMed PMC

Šrám RJ, Binková B. Molecular epidemiology studies on occupational and environmental exposure to mutagens and carcinogens, 1997–1999. Environ Health Perspect. 2000;108:57–69. PubMed PMC

Šrám RJ, Binková B, Rössner P, Rubeš J, Topinka J, Dejmek J. Adverse reproductive outcomes from exposure to environmental mutagens. Mutat Res. 1999;428:203–215. PubMed

Topinka J, Binková B, Mračková G, Stávková Z, Beneš I, Dejmek J, et al. DNA adducts in human placenta as related to air pollution and to GSTM1 genotype. Mutat Res. 1997a;390:59–68. PubMed

Topinka J, Binková B, Mračková G, Stávková Z, Peterka V, Beneš I, et al. Influence of GSTM1 and NAT2 genotypes on placental DNA adducts in an environmentally exposed population. Environ Mol Mutagen. 1997b;30:184–195. PubMed

Vassilev ZP, Robson MG, Klotz JB. Association of polycyclic organic matter in outdoor air with decreased birth weight: a pilot cross-sectional analysis. J Toxicol Environ Health. 2001a;64:595–605. PubMed

Vassilev ZP, Robson MG, Klotz JB. Outdoor exposure to airborne polycyclic organic matter and adverse reproductive outcomes: a pilot study. Am J Ind Med. 2001b;40:255–262. PubMed

Wang X, Ding H, Ryan L, Xu X. Association between air pollution and low birth weight: a community-based study. Environ Health Perspect. 1997;105:514–520. PubMed PMC

Whyatt RM, Jedrychowski W, Hemminki K, Santella RM, Tsai WY, Yang K, et al. Biomarkers of polycyclic aromatic hydrocarbon-DNA damage and cigarette smoke exposure in paired maternal and newborn blood samples as a measure of differential susceptibility. Cancer Epidemiol Biomarkers Prev. 2001;10:581–588. PubMed

Whyatt RM, Santella RM, Jedrychowski W, Garte SJ, Bell DA, Ottman R, et al. Relationship between ambient air pollution and DNA damage in Polish mothers and newborns. Environ Health Perspect. 1998;106:821–826. PubMed PMC

Wilhelm M, Ritz B. Residential proximity to traffic and adverse birth outcomes in Los Angeles County, California, 1994–1996. Environ Health Perspect. 2003;111:207–216. PubMed PMC

Windham GC, Eaton A, Hopkins B. Evidence for an association between environmental tobacco smoke exposure and birthweight: a meta-analysis and new data. Paediatr Perinat Epidemiol. 1999;13:35–57. PubMed

Woodruff T, Grillo J, Schoendorf KC. The relationship between selected causes of postnatal infant mortality and particulate air pollution in the United States. Environ Health Perspect. 1997;105:608–612. PubMed PMC

Xu X, Ding H, Wang X. Acute effects of total suspended particles and sulfur dioxides on preterm delivery; a community-based cohort study. Arch Environ Health. 1995;50:407–415. PubMed

Zhang L, Connor EE, Chegini N, Shiverick KT. Modulation by benzo[a]pyrene of epidermal growth factor receptors, cell proliferation, and secretion of human chorionic gonadotropin in human placental lines. Biochem Pharmacol. 1995;50:1171–1180. PubMed

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