# Air Pollution and Pregnancy Complications in Complex Urban Environments: Risks, Heterogeneity, and Mechanisms

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA-IRVINE · 2022 · $572,625

## Abstract

Pregnancy complications (e.g. gestational diabetes [GDM], gestational hypertension [GHTN], and pre-
eclampsia & eclampsia [PE/E] are major causes of perinatal morbidity and mortality. Studies have examined
associations of air pollution with pregnancy complications, but have major limitations, including 1) reliance on
birth certificates or billing/claims data where information may be missing or of questionable validity to ascertain
outcomes and co-morbidities; 2) limited consideration of effect confounding and/or modification by other
environmental factors; 3) air pollution exposure misclassification due to lack of residential address history; 4)
focus on individual air pollutants rather than air pollutant mixtures; 5) lack of focus on the heterogeneity of the
risk from air pollution by time and place of exposures, maternal conditions, other environmental factors, and
sub-types of outcomes; 6) lack of understanding of the mediation pathways linking maternal co-morbidity with
outcomes. We propose a 4-year study to address these limitations and advance knowledge of the impact of
air pollutant mixture on pregnancy complications. We will leverage state-of-the-art spatiotemporal air pollution
modeling and novel statistical methods that examine both individual and composite exposure profiles with a
longitudinal (pre-conception through postpartum) pregnancy cohort of ~400,000 singleton pregnancies in
2008-2018 that result in a live birth or fetal death after 20 weeks gestation that have prospectively-recorded
high quality clinical data and residential addresses from the electronic health record (EHR) of Kaiser
Permanente Southern California members in 8 southern California counties. Primary outcomes are GHTN,
PE/E, GDM. We will estimate individual-level air pollutant exposures (particulate matter and its composition
and traffic-related pollutants using sophisticated spatiotemporal models), weather (air temperature, relative
humidity, pressure), and built environment measures (greenness, walkability, noise, neighborhood resources)
based on prospectively-recorded maternal addresses. Covariates we will examine include maternal
comorbidities; history of previous pregnancies and outcomes; individual and contextual socioeconomic status
(SES) indicators; employment during pregnancy and job classification; self-reported physical activity and
smoking. Complementary statistical methods will be used to evaluate effects of exposure to a mixture of air
pollutants while accounting for co-exposure to weather, built environment, and SES. We will examine effect
modifications by SES, maternal factors, and other environmental exposures, and the potential mediating role of
maternal factors on associations between air pollution and the outcomes. We will elucidate risk of pregnancy
complications from air pollution exposure, heterogeneity of risk due to SES, maternal conditions, and other
environmental factors, potential underlying mechanisms, susceptible sub-populations, and ...

## Key facts

- **NIH application ID:** 10398024
- **Project number:** 5R01ES030353-04
- **Recipient organization:** UNIVERSITY OF CALIFORNIA-IRVINE
- **Principal Investigator:** Darios Getahun
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $572,625
- **Award type:** 5
- **Project period:** 2019-08-01 → 2025-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10398024

## Citation

> US National Institutes of Health, RePORTER application 10398024, Air Pollution and Pregnancy Complications in Complex Urban Environments: Risks, Heterogeneity, and Mechanisms (5R01ES030353-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10398024. Licensed CC0.

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