Abstract
In many previous studies for the relationship between air pollution and birth outcome, the exposure was based on the data for environmental monitoring site. We reviewed the epidemiologic studies that evaluated the health effects of air pollution on birth outcome such as low birth weight and preterm births. We identified the air pollution exposure during pregnancy was related with low birth weight and preterm birth, although there are differences between studies for the critical period of vulnerability. also suggests that the indoor and personal exposure to VOCs during pregnancy may contribute the adverse pregnancy outcomes. The biological mechanisms whereby air pollution might influence health of fetus are not clearly established. Controlling for potential confounders and valid assessment of exposure are the problem remained in these epidemiologic studies. In the future, more studies are need to investigate the effect of air pollution on preterm birth or stillbirths, considering the various exposure period, and the biological mechanism. also results should be taken into account for future advisories and evaluation of environmental policy.
Figures and Tables
Figure 1
Relatianshiop between maternal CO, NO2, SO2, TSP exposure and Birth weight in the first trimester
Reference: Epidemiology 2001;12(6):643-648.

Figure 2
Relationship between 7th month PM10 exposure and log of hazard ratio
Reference: J Prev Med Pub Health 2004;37(4):300-305.

Figure 3
Scatter plots of correlation among a 72-hr indoor, outdoor and personal VOC exposure concentration (µg/m3)

Table 1
Relative Risks and 95% confidence intervals for adverse birth outcomes by average ambient PM10 concentration (per 10µg/m3) for first, second and third trimester periods

*Analyzed by multiple logistic regression in SAS
†Adjusted for infant gender, infant order, maternal age and educational level, paternal educational level and season
‡Adjusted for infant gender, infant order, maternal age and educational level, paternal education, season, alcohol drinking, maternal body mass index(BMI) and weight just before delivery
References
1. Saldiva PH, Pope CA 3rd, Schwartz J, Dockery DW, Lichtenfels AJ, Salge JM, Barone I, Bohm GM. Air pollution and mortality in elderly people: a time-series study in Sao Paulo, Brazil. Arch Environ Health. 1995. 50:159–163.


2. Pope CA 3rd. Epidemiology of fine particulate air pollution and human health: biologic mechanisms and whos at risk? Environ Health Perspect. 2000. 108:Suppl 4. 713–723.


3. Liu S, Krewski D, Shi Y, Chen Y, Burnett RT. Association between gaseous ambient air pollutants and adverse pregnancy outcomes in Vancouver, Canada. Environ Health Perspect. 2003. 111:1773–1178.


4. Bobak M, Leon DA. Pregnancy outcomes and outdoor air pollution: an ecological study in districts of the Czech Republic1986-8. Occup Environ Med. 1999. 56:539–543.


5. Lin MC, Yu HS, Tsai SS, Cheng BH, Hsu TY, Wu TN, Yang CY. Adverse pregnancy outcome in a petrochemical polluted area in Taiwan. J Toxicol Environ Health A. 2001. 63:565–574.


6. Oliveira LM, Stein N, Sanseverino MT, Vargas VM, Fachel JM, Schuler L. Reproductive outcomes in an area adjacent to a petrochemical plant in southern Brazil. Rev Saude Publica. 2002. 36:81–87.


7. Ritz B, Yu F, Chapa G, Fruin S. Effect of air pollution on preterm birth among children born in Southern California between 1989 and 1993. Epidemiology. 2000. 11:502–511.


9. Committee of Environmental Health. Citizens institute for environmental studies, A sound body in a sound environment. 2004.
10. Xu X, Ding H, Wang X. Acute effects of total suspended particles and sulfur dioxides on preterm delivery: a community-based cohort study. Arch Environ Health. 1995. 50:407–415.


11. Ritz B, Yu F. The effect of ambient carbon monoxide on low birth weight among children born in southern California between 1989 and 1993. Environ Health Perspect. 1999. 107:17–25.


12. Bobak M. Outdoor air pollution, low birth weight, and prematurity. Environ Health Perspect. 2000. 108:173–176.


13. Landgren O. Environmental pollution and delivery outcome in southern Sweden: a study with central registries. Acta Paediatr. 1996. 85:1361–1364.


14. Williams L, Spence A, Tideman SC. Implication of the observed effect of air pollution on birth weight. Soc Biol. 1997. 24:1–9.
15. Gouveia N, Fletcher T. Time series analysis of air pollution and mortality: effects by cause, age and socioeconomic status. J Epidemiol Community Health. 2000. 54:750–755.


16. Maisonet M, Bush TJ, Correa A, Jaakkola JJK. Relation between ambient air pollution and low birth weight in the Northeastern United States. Environmen Health Perspect. 2001. 109:Suppl 3. S351–S356.


17. World Health Organization Occupational and Environmental Health Team. Guidelines for air quality. 2000. Geneva: WHO.
18. Longo LD. Carbon monoxide: effects on oxygenation of the fetus in utters. Science. 1976. 194:523–525.


19. Hutter CD, Blair ME. Carbon monoxide--does fetal exposure cause sudden infant death syndrome? Med Hypotheses. 1996. 46:1–4.
20. Ha EH, Hong YC, Lee BE, Woo BH, Schwartz J, Christiani DC. Is air pollution a risk factor for low birth weight in Seoul? Epidemiology. 2001. 12:643–648.


21. Lee BE, Ha EH, Park HS, Kim YJ, Hong YC, Kim H, Lee JT. Exposure to air pollution during different gestational phases contributes to risks of low birth weight. Hum Reprod. 2003. 18:638–643.


22. Kim BM, Ha EH, Lee BE, Sec JH, Park HS, Kim YJ, Lee JT, Hong YC. Exposure to pm2.5 and VOCs of the pregnat women in SBC(Seoul birth & development cohort). 2006. In : 18th Conference of the International Society for Environmental Epidemiology Poster Discussion; 9:2-6; Paris.
23. Lee BE, Kim BM, Ha EH, Sec JH, Park HS, Kim YJ, Kim OJ, Lee JT, Hong YC. A Prospective birth cohort study on the effect of personal, indoor, and outdoor VOCs of pregnancy outcome. 2006. In : 18th Conference of the International Society for Environmental Epidemiology Poster Discussion; 9:2-6; Paris.