Estimation of stillbirths attributable to ambient fine particles in 137 countries

Tao Xue (), Mingkun Tong, Jiajianghui Li, Ruohan Wang, Tianjia Guan, Jiwei Li, Pengfei Li, Hengyi Liu, Hong Lu, Yanshun Li and Tong Zhu
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Tao Xue: Peking University Health Science Centre
Mingkun Tong: Peking University Health Science Centre
Jiajianghui Li: Peking University Health Science Centre
Ruohan Wang: Peking University Health Science Centre
Tianjia Guan: Chinese Academy of Medical Sciences & Peking Union Medical College
Jiwei Li: Zhejiang University
Pengfei Li: Peking University Health Science Centre
Hengyi Liu: Peking University Health Science Centre
Hong Lu: Peking University Health Science Centre
Yanshun Li: Washington University in St. Louis
Tong Zhu: Peking University

Nature Communications, 2022, vol. 13, issue 1, 1-9

Abstract: Abstract Gestational exposure to ambient fine particles (PM2.5) increases the risk of stillbirth, but the related disease burden is unknown, particularly in low- and middle-income countries (LMICs). We combine state-of-the-art estimates on stillbirths, and multiple exposure–response functions obtained from previous meta-analyses or derived by a self-matched case-control study in 54 LMICs. 13,870 stillbirths and 32,449 livebirths are extracted from 113 geocoded surveys from the Demographic and Health Surveys. Each stillbirth is compared to livebirth(s) of the same mother using a conditional logit regression. We find that 10-µg/m3 increase of PM2.5 is associated with an 11.0% (95% confidence interval [CI] 6.4, 15.7) increase in the risk of stillbirth, and the association is significantly enhanced by maternal age. Based on age-specific nonlinear PM2.5–stillbirth curves, we evaluate the PM2.5-related stillbirths in 137 countries. In 2015, of 2.09 (95% CI: 1.98, 2.20) million stillbirths, 0.83 (0.54, 1.08) million or 39.7% (26.1, 50.8) are attributable to PM2.5 exposure exceeding the reference level of 10 μg/m3. In LMICs, preventing pregnant women from being exposed to PM2.5 can improve maternal health.

Date: 2022
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DOI: 10.1038/s41467-022-34250-4

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