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Exposure to Chemical Components of Fine Particulate Matter and Ozone Journal of Exposure Science & Environmental Epidemiology https://doi.org/10.1038/s41370-021-00299-4 ARTICLE Exposure to chemical components of fine particulate matter and ozone, and placenta-mediated pregnancy complications in Tokyo: a register-based study 1 2 3 4 4 4 Takehiro Michikawa ● Seiichi Morokuma ● Shin Yamazaki ● Akinori Takami ● Seiji Sugata ● Ayako Yoshino ● 1 5 6 6 5 3 1 Yuki Takeda ● Kazushige Nakahara ● Shinji Saito ● Junya Hoshi ● Kiyoko Kato ● Hiroshi Nitta ● Yuji Nishiwaki Received: 12 August 2020 / Revised: 1 January 2021 / Accepted: 21 January 2021 © The Author(s) 2021. This article is published with open access Abstract Background Maternal exposure to fine particulate matter (PM2.5) was associated with pregnancy complications. However, we still lack comprehensive evidence regarding which specific chemical components of PM2.5 are more harmful for maternal and foetal health. Objective We focused on exposure over the first trimester (0–13 weeks of gestation), which includes the early placentation period, and investigated whether PM2.5 and its components were associated with placenta-mediated pregnancy complications 1234567890();,: 1234567890();,: (combined outcome of small for gestational age, preeclampsia, placental abruption, and stillbirth). Methods From 2013 to 2015, we obtained information, from the Japan Perinatal Registry Network database, on 83,454 2 women who delivered singleton infants within 23 Tokyo wards (≈627 km ). Using daily filter sampling of PM2.5 at one monitoring location, we analysed carbon and ion components, and assigned the first trimester average of the respective pollutant concentrations to each woman. Results The ORs of placenta-mediated pregnancy complications were 1.14 (95% CI = 1.08–1.22) per 0.51 μg/m3 (inter- quartile range) increase of organic carbon and 1.11 (1.03–1.18) per 0.06 μg/m3 increase of sodium. Organic carbon was also associated with four individual complications. There was no association between ozone and outcome. Significance There were specific components of PM2.5 that have adverse effects on maternal and foetal health. Keywords Particulate matter ● Chemical component ● Placenta-mediated pregnancy complications ● Placentation Supplementary information The online version contains Introduction supplementary material available at https://doi.org/10.1038/s41370- 021-00299-4. Exposure to fine particulate matter (PM2.5) in the ambient * Takehiro Michikawa atmosphere has adverse health effects across all generations [email protected] [1]. Women of reproductive age are not exceptions. There is evidence that exposure to PM during pregnancy is asso- 1 Department of Environmental and Occupational Health, School of 2.5 Medicine, Toho University, Ota-ku, Tokyo, Japan ciated with obstetric complications that threaten the health of pregnant mothers, such as hypertensive disorders of 2 Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan pregnancy (including preeclampsia) and placental abruption [2–5]. In addition, maternal exposure to PM appears to 3 Centre for Health and Environmental Risk Research, National 2.5 Institute for Environmental Studies, Tsukuba, Ibaraki, Japan have harmful effects on the next generation; for example, PM exposure during pregnancy was associated with 4 Centre for Regional Environmental Research, National Institute 2.5 for Environmental Studies, Tsukuba, Ibaraki, Japan foetal growth restriction that resulted in the birth of small for gestational age (SGA) children [6, 7], and was linked to 5 Department of Obstetrics and Gynaecology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, the occurrence of stillbirths [8]. Although the accumulating Japan findings suggest that total PM2.5 (general mixture) fl 6 Tokyo Metropolitan Research Institute for Environmental in uences maternal and foetal health, we still lack com- Protection, Koto-ku, Tokyo, Japan prehensive evidence regarding which specific chemical T. Michikawa et al. components of PM2.5 are more harmful for their health [9]. registry (mainly university hospitals and local general Thus, understanding the association between individual hospitals) managed by the Japan Society of Obstetrics and PM2.5 components and perinatal health may provide infor- Gynaecology. Details of the database are described else- mation of value to policy making for environmental health. where [17]. The database included roughly two-fifths of the The placenta is a temporal organ, and normal placentation total births in the study area for the study period. The data is absolutely essential for foetal development and growth, are routinely input by attending physicians via a standar- while also contributing to maternal health [10]. Conversely, dised electronic form, and checked with respect to uniform abnormal placentation during the first trimester is related to coding specifications and diagnostic criteria for complica- adverse maternal and foetal conditions called placenta- tions by the Perinatal Committee of the Society [18]. We mediated pregnancy complications, including SGA, pre- used anonymised information on maternal age, height, eclampsia, placental abruption, and stillbirth [11–13]. As weight, parity, gestational age, smoking habits and alcohol aforementioned, each of these four complications has been drinking, infertility treatment, medical history, diagnoses of reported to be individually associated with maternal expo- obstetric complications, such as preeclampsia and placental sure to PM2.5 [2, 5–8]. Therefore, in the present study, we abruption, mode of delivery, neonatal records, and the focused on PM2.5 exposure over the first trimester, which is hospital at which the woman delivered. an important period of placentation, and investigated the From the 89,417 births including multiple births, we association with placenta-mediated pregnancy complica- firstly restricted to 85,496 singleton births (85,496 women). tions, with the aim of elucidating the relationship between Then, we excluded 254 women without information on (at PM2.5 exposure and placental toxicity, and seeking a least one of) age at delivery, infant sex, and parity, and 132 pathogenic foundation common to individual complications. women who delivered infants born after 42 weeks of In light of the fact that PM2.5 may be a common risk factor gestation. In Japan, some women return to their hometown for four individual complications, few studies have exam- near term and deliver at a hospital near their parents’ home ined the association between PM2.5 exposure and placenta- (known as ‘satogaeri’ in Japanese). Therefore, as such mediated pregnancy complications as a composite outcome. women may not have resided in our target area during early Also, it seems likely that ozone is a risk factor for placenta- pregnancy, we also excluded them (n = 1656) to avoid mediated pregnancy complications, because the potential exposure misclassification during the first trimester. In the maternal and foetal health effects of ozone exposure were end, 83,454 women (22–41 weeks of gestation) were indicated [14]. included in the analysis. The study protocol was approved In sum, the aim of this study was to investigate the by the Ethics Committee of Faculty of Medicine, Toho association between first-trimester exposure to specific University [A18049_A20024]. PM2.5 chemical components and ozone, and placenta- mediated pregnancy complications in Tokyo, one of the Measurement of fine particulate matter and its world’s major cities. chemical components We obtained air pollutant data, including the daily mean Methods concentrations of total PM2.5 and the maximum 8-h mean concentrations of ozone, measured at an urban back- Study area and participants ground monitoring station (Harumi monitoring station, 35.4°N, 139.5°E) (Fig. S1) near the monitoring point of Our study area included 23 Tokyo wards located on the east PM2.5 chemical components, from the Japan National side of Tokyo, with a total land area of roughly 627 square Institute for Environmental Studies’ atmospheric envir- kilometres. The population of the 23 wards was about onment database. The β-ray absorption method was used 9,272,000 as of 1 October 2015 [15]. Tokyo has a humid for PM2.5 measurement, and the ultraviolet absorption subtropical climate, and the annual average temperature is method was used for ozone measurement. Since there are around 16 °C. The average annual urban background con- several urban background monitoring stations in the study 3 centrations of PM2.5 in the study area (e.g., 16.9 μg/m in area, we confirmed that the PM2.5 and ozone concentra- 2014) is higher than the nationwide background con- tions at the Harumi station were strongly correlated with 3 centrations of PM2.5 (e.g., 14.7 μg/m in 2014) [16]. those at the other stations (Pearson’s correlation coeffi- We collected data on all the live births and stillbirths cients >0.9), and thus considered that the background after 22 weeks of gestation at 39 cooperating hospitals concentrations of PM2.5 and ozone were spatially homo- within the study area, from January 2013 to December 2015 geneous within our target area. Finally, we obtained (a total of 89,417 births), which were extracted from the the daily mean ambient temperatures from the Japan Japan Perinatal Registry Network database, a hospital-based Meteorological Agency. Exposure to chemical components of fine particulate matter and ozone, and placenta-mediated pregnancy. From April 2013 to the end of the
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