Impacts of gestational age uncertainty in estimating associations between preterm birth and ambient air pollution

Environmental Epidemiology
Benjamin E NealyHoward H Chang

Abstract

Previous epidemiologic studies utilizing birth records have shown heterogeneous associations between air pollution exposure during pregnancy and the risk of preterm birth (PTB, gestational age <37 weeks). Uncertainty in gestational age at birth may contribute to this heterogeneity. We first examined disagreement between clinical and last menstrual period-based (LMP) determination of PTB from individual-level birth certificate data for the 20-county Atlanta metropolitan area during 2002 to 2006. We then estimated associations between five trimester-averaged pollutant exposures and PTB, defined using various methods based on the clinical or LMP gestational age. Finally, using a multiple imputation approach, we incorporated uncertainty in gestational age to quantify the impact of this variability on associations between pollutant exposures and PTB. Odds ratios (OR) were most elevated when a more stringent definition of PTB was used. For example, defining PTB only when LMP and clinical diagnoses agree yielded an OR of 1.09 (95% confidence interval [CI] = 1.04, 1.14) per interquartile range increase in first trimester carbon monoxide exposure versus an OR of 1.04 (95% CI = 1.01, 1.08) when PTB was defined as either an LMP or clinica...Continue Reading

References

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