Associations of air pollution exposures in preconception and pregnancy with birth outcomes and infant neurocognitive development: Analysis of the Complex Lipids in Mothers and Babies (CLIMB) prospective cohort in Chongqing, China

Objectives: To investigate the associations of traffic-related air pollution exposures in early pregnancy with birth outcomes and infant neurocognitive development.
Design: Cohort study.
Setting: Eligible women attended six visits in the maternity clinics of two centres, the First Affiliated Hospital of Chongqing Medical University and Chongqing Health Centre for Women and Children.
Participants: Women who were between 20 and 40 years of age and were at 11-14 weeks gestation with a singleton pregnancy were eligible for participation. Women were excluded if they had a history of premature delivery before 32 weeks of gestation, maternal milk allergy or aversion or severe lactose intolerance. 1273 pregnant women enrolled in 2015-2016 and 1174 live births were included in this analysis.
Exposures: Air pollution concentrations at their home addresses, including particulate matter with diameter ≤2.5 μm (PM 2.5) and nitrogen dioxide (NO 2), during pre-conception and each trimester period were estimated using land-use regression models.
Outcome measures: Birth outcomes (ie, birth weight, birth length, preterm birth, low birth weight, large for gestational age and small for gestational age (SGA) status) and neurodevelopment outcomes measured by the Chinese version of Bayley Scales of Infant Development.
Results: An association between SGA and per-IQR increases in NO 2 was found in the first trimester (OR: 1.57, 95% CI: 1.06 to 2.32) and during the whole pregnancy (OR: 1.33, 99% CI: 1.01 to 1.75). Both PM 2.5 and NO 2 exposure in the 90 days prior to conception were associated with lower Psychomotor Development Index scores (β: -6.15, 95% CI: -8.84 to -3.46; β: -2.83, 95% CI: -4.27 to -1.39, respectively). Increased NO 2 exposure was associated with an increased risk of psychomotor development delay during different trimesters of pregnancy.
Conclusions: Increased exposures to NO 2 during pregnancy were associated with increased risks of SGA and psychomotor development delay, while increased exposures to both PM 2.5 and NO 2 pre-conception were associated with adverse psychomotor development outcomes at 12 months of age.
Trial registration number: ChiCTR-IOR-16007700.