# Air Pollution Exposure and Risk for Cerebral Palsy - A Statewide Study

> **NIH NIH R21** · YALE UNIVERSITY · 2024 · $238,995

## Abstract

PROJECT SUMMARY/ABSTRACT
Cerebral palsy (CP) is the most common life-long neuromotor
physical mobility. CP affects about1 in 345 newborns each year
 condition that permanently affects children's
in the United States. The etiology of CP is
complex and multifactorial. We know that CP is caused by lesions occurring in the developing brain, but what
risk factors trigger the developing brain damage remain largely unknown. Newborn asphyxia at delivery only
presents in less than 10% of cases. While ambient/household environmental risk factors for CP have long been
suspected and discussed, few studies have been conducted to evaluate environmental exposure effects on CP
development. Recently, a seasonal pattern of CP occurrence was observed in our California study, where air
pollution exposure was suspected to play an important role. Air pollution is one of the most widespread
environmental pollutants, and the literature has consistently suggested maternal exposure to ambient air
pollution during pregnancy can affect major perinatal predictors of CP, including maternal preeclampsia, preterm
birth, and Apgar scores. Moreover, emerging research shows air pollution affects cognitive, neurobehavioral,
and motor function deficits in childhood, as well as increases the risk for white matter injury and thinning of the
cerebral cortex in the developing brain which are highly relevant to CP etiology. The collective set of scientific
evidence points toward a need to thoroughly examine whether air pollution exposure poses a risk to CP
development. Our proposed study is novel and will be the first and largest population-based study of CP and air
pollution to date. We will use records from the California Department of Developmental Services (DDS) to identify
children who were born during 2000-2015 and diagnosed with CP in California. We expect to identify ~10,000
CP cases and we will utilize a case-cohort design and select 20% of births in California during the study period
(N=~1.6M births) as the population controls. We will apply a sibling-matched analysis to triangulate the main
results. We will utilize a newly developed land-use-regression (LUR) model with a high temporal (daily) and
spatial resolution (100m X 100m) to estimate gestational exposures to three major ambient air pollutants (PM2.5,
NO2, and O3), study the associations between maternal pregnancy exposures and CP risk using single and multi-
pollutant analyses, and explore the critical time window of exposure. Moreover, we will perform causal mediation
analyses to examine to what extent the racial/social disparities of CP in California may be explained by
environmental disparities in exposure to air pollution, and whether a specific pregnancy complication or adverse
birth outcome mediates the association between air pollution exposures and CP risk. Findings from this project
will advance our knowledge of suspected environmental risk factors of CP, and possibly inform risk identification
and primary prev...

## Key facts

- **NIH application ID:** 10993240
- **Project number:** 1R21ES035485-01A1
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** Zeyan Liew
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $238,995
- **Award type:** 1
- **Project period:** 2024-07-10 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10993240

## Citation

> US National Institutes of Health, RePORTER application 10993240, Air Pollution Exposure and Risk for Cerebral Palsy - A Statewide Study (1R21ES035485-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10993240. Licensed CC0.

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