An exposure-response meta-analysis of ambient PM2.5 during pregnancy and preeclampsia
- DOI
- Language of the publication
- English
- Date
- 2022-02-09
- Type
- Article
- Author(s)
- Gogna, Priyanka
- Villeneuve, Paul J.
- Borghese, Michael M.
- King, Will D.
- Publisher
- ScienceDirect
Abstract
Relationships between PM2.5 exposure and preeclampsia have been the focus of four recent systematic reviews and meta-analyses. We expand on knowledge gaps in these reviews by characterizing the shape of the exposure-outcome relationship, and by assessing the heterogeneity in these associations by study characteristics. Studies of PM2.5 and preeclampsia were identified from reviews, and confounder-adjusted estimates were extracted. Estimates were derived using a random-effects model. Potential non-linearity was evaluated using a one-stage dose-response meta-analysis. Contrary to previous meta-analyses reporting stronger relationships, the overall adjusted relative risk (RR) for a 10 μg/m3 average increase in PM2.5 during pregnancy and preeclampsia was modest and not statistically significant (RR: 1.07, 95% CI: 0.99–1.15). This was mainly attributable to inclusion/exclusion decisions for studies made during this review. In addition, there was no evidence of non-linearity, and no important sub-group differences by characteristics such as region, exposure assessment, participant exclusions, and early versus late-onset preeclampsia. Overall, our analysis suggests a modest relationship between ambient PM2.5 and preeclampsia. We provide details on inclusion and exclusion decisions that were lacking in previous studies, and report novel investigations of non-linearity and heterogeneity.
Plain language summary
Health Canada helps to protect the health of Canadians by assessing and managing the risks associated with exposure to environmental exposures, including air pollution. Air pollution is most commonly assessed by measuring fine particulate matter (PM2.5). Preeclampsia is a complication in pregnancy and is related to hypertension in pregnancy. The relationship between PM2.5 exposure and preeclampsia have been the focus of four recent reviews. These reviews consistently reported that PM2.5 exposure was associated with a higher risk of developing preeclampsia. However, there were gaps in each of these reviews This paper expands on knowledge gaps from these reviews. Health Canada, working with external partners, characterized the shape of the exposure-outcome relationship and look at sub-groups based on region, exposure assessment method, participant exclusions, and early versus late-onset preeclampsia. Contrary to previous meta-analyses reporting a stronger relationship, in this paper the effect of exposure to PM2.5 during pregnancy and preeclampsia was modest and not statistically significant. This difference was mainly attributed this difference to the inclusion/exclusion decisions between this review and previous reviews. In addition, there was no evidence of non-linearity in the relationship, and no important sub-group differences by study characteristics evaluated. Contradicting evidence from four systematic reviews, this updated analysis suggests a modest relationship between ambient PM2.5 exposure and preeclampsia. The paper provides details on inclusion and exclusion decisions that were lacking in previous investigations, and report novel investigations of non-linearity and heterogeneity. The study demonstrates the importance of scrutinizing inclusion and exclusion decisions when compiling results from different studies. This study can help Health Canada to more precisely understand the deleterious effects of air pollution on preeclampsia, a major pregnancy complication.
Subject
- Health,
- Health and safety