California Department of Public Health logo: three likenesses of people colored blue, green, and orange  
Last Edited: 9/30/2010

Prematurity and Growth Retardation: Environmental Factors

To what extent should we think about prematurity and growth retardation as environmental diseases?

Given that prematurity and growth retardation are relatively easy to measure in a population, we are able to explore what substances in the environment may influence these outcomes.  In general, we are unable to determine why individual infants may be born prematurely or grow insufficiently.  What we can do, however, is examine patterns among groups of people to generate hypotheses about why the events occur.


Back to top


Behavioral and occupational exposures

Environmental exposures that are related to personal behaviors or occupations are sometimes the easiest to study.  We therefore know that children born to women exposed to tobacco smoke during pregnancy are at higher risk for both prematurity and growth retardation.1, 2  Workplace exposures (for both fathers and mothers) to substances such as lead3, 4 or welding fumesare also associated with adverse outcomes.


Back to top


Monitoring people and their surroundings

One method that researchers use to investigate environmental influences on prematurity and growth retardation is to collect samples from the mother’s surroundings (e.g. air samples) or from the mother herself (e.g. blood samples) and examine them for evidence of exposure.  In this way, scientists have observed patterns between these conditions and exposure to:

  • Lead3
  • Particulate matter of the type arising from motor vehicle traffic (PM2.5)6
  • Polycyclic Aromatic Hydrocarbons, which arise from diesel fuel combustion7-11
  • Pesticides such as diazinon and propoxur,12, 13 chlorpyrifos,10 and DDT14
  • Polychlorinated biphenyls (PCBs)15 (see Longecker,16 however, for a study with negative findings on PCBs)

Back to top


Studies based on where people live

The most common approach used by scientists, however, is to infer exposures based on where people live during their pregnancy.  The advantage of this approach is that maternal addresses are frequently recorded in birth records, so very large groups of people can be studied for very little cost.  This kind of study has greater limitations, however, since people frequently move residences or spend substantial time away from home during pregnancy.  Simple residential proximity to sources of pollution, such as hazardous waste landfills17 or traffic18-22 is consistently associated with prematurity and growth retardation. 

A related question—what particular substances in air pollution could be contributing to prematurity and growth retardation—is much more difficult to answer.  Pollutants nearly always occur in combinations, so it is rarely known whether the compound under study is responsible for the pattern or whether it is a separate substance that may or may not have been measured.  A study located in one city or country will involve different mixtures of pollutants than another, and the populations in question may not be vulnerable in the same way.

For all of these reasons, answers about specific pollutants are still a ways off.  Judging by a large number of recent studies,6, 18, 23-43 the pollutants one could subjectively say are most frequently found to have positive associations with prematurity and growth retardation include:

Back to top


1. Fantuzzi G, Vaccaro V, Aggazzotti G, et al. Exposure to active and passive smoking during pregnancy and small for gestational age at term. Journal of Maternal-Fetal and Neonatal Medicine. 2008;21(9):643-647.
2. Wigle D, Arbuckle T, Turner M, et al. Epidemiologic evidence of relationships between reproductive and child health outcomes and environmental chemical contaminants. Journal of Toxicology and Environmental Health, Part B. 2008;11:373-517.
3. Jelliffe-Pawlowski L, Miles S, Courtney J, Materna B, Charlton V. Effect of magnitude and timing of maternal pregnancy blood lead (Pb) levels on birth outcomes. Journal of Perinatology. 2006;26:154-162.
4. Lin S, Hwang S-A, Marshall E, Marion D. Does Paternal Occupational Lead Exposure Increase the Risks of Low Birth Weight or Prematurity. American Journal of Epidemiology. 1998;148(2):173-181.
5. Quansah R, Jaakkola J. Paternal and maternal exposure to welding fumes and metal dusts or fumes and adverse pregnancy outcomes. International Archives of Occupational and Environmental Health. 2008;[epub ahead of print].
6. Jedrychowski W, Brendkowska I, Flak E, et al. Estimating risk for altered fetal growth resulting from exposure to fine particles during pregnancy:  An epidemiologic prospective cohort study in Poland. Environmental Health Perspectives. 2004;112:1398-1402.
7. Choi H, Jedrychowski W, Spengler J, et al. International studies of prenatal exposure to polycyclic aromatic hydrocarbons and fetal growth. Environmental Health Perspectives. 2006;114:1744-1750.
8. Choi H, Rauh V, Garfinkel R, Tu Y, Perera F. Prenatal exposure to airborne polycyclic aromatic hydrocarbons and risk of intrauterine growth restriction. Environmental Health Perspectives. 2008;116:658-665.
9. Perera F, Raugh V, Whyatt R, et al. Molecular evidence of an interaction between prenatal environmental exposures and birth outcomes in a multiethnic population. Environmental Health Perspectives. 2004;112:626-630.
10. Perera F, Rauh V, Tsai W, et al. Effects of transplacental exposure to environmental pollutants on birth outcomes in a multiethnic population. Environmental Health Perspectives. 2003;111:201-205.
11. Perera F, Tang D, Rauh V, et al. Relationships among polycyclic aromatic hydrocarbon-DNA adducts, proximity to the World Trade Center, and effects on fetal growth. Environmental Health Perspectives. 2005;113:1062-1067.
12. Whyatt R, Camann D, Perera F, et al. Biomarkers in assessing residential insecticide exposures during pregnancy and effects on fetal growth. Toxicology and Applied Pharmacology. 2005;206:246-254.
13. Whyatt R, Rauh V, Barr D, et al. Prenatal insecticide exposures and birth weight and length among an urban minority cohort. Environmental Health Perspectives. 2004;112:1125-1132.
14. Longnecker M, Klebanoff M, Zhou H, Brock J. Association between Maternal Serum Concentration of the DDT Metabolite DDE and Preterm and Small-for-gestational-age Babies at Birth. Lancet. 2001;358:110-114.
15. Rylander L, Stromberg U, Dyremark E, Ostman C, Nilsson-Ehle P, Hagmar L. Polychlorinated Biphenyl in Blood Plasma among Swedish Female Fish Consumers in Relation to Low Birthweight. American Journal of Epidemiology. 1998;147(5):493-502.
16. Longnecker M, Klebanoff M, Brock J, Guo X. Maternal levels of plychlorinated biphenyls in relation to preterm and small-for-gestational-age birth. Epidemiology. 2005;16:641-647.
17. Berry M, Bove F. Birth Weight Reduction Associated with Residence near a Hazardous Waste Landfill. Environmental Health Perspectives. 1997;105:856-861.
18. Brauer M, Lencar C, Tamburic L, Koehoorn M, Demers P, Karr C. A cohort study of traffic-related air pollution impacts on birth outcomes. Environmental Health Perspectives. 2008;116:680-686.
19. Généreux M, Auger N, Goneau M, Daniel M. Neighbourhood socioeconomic status, maternal education and adverse birth outcomes among mothers living near highways. Journal of Epidemiology and Community Health. 2008;622:695-700.
20. Ponce N, Hoggatt K, Wilhelm M, Ritz B. Preterm birth:  The interaction of traffic-related air pollution with economic hardship in Los Angeles. American Journal of Epidemiology. 2005;162:140-148.
21. Slama R, Morgenstern V, Cyrys J, et al. Traffic-related atmospheric pollutants levels during pregnancy and offspring's term birth weight:  a study relying on a land-use regression exposure model. Environmental Health Perspectives. 2007;115:1283-1291.
22. Wilhelm M, Ritz B. Residential Proximity to Traffic and Adverse Birth Outcomes in Los Angeles County, California, 1994-1996. Environmental Health Perspectives. 2003;111(2):207-216.
23. Bell M, Ebisu K, Belanger K. Ambient air pollution and low birth weight in Connecticut and Massachusetts. Environmental Health Perspectives. 2007;115:1118-1125.
24. Bobak M. Outdoor Air Pollution, Low Birthweight, and Prematurity. Environmental Health Perspectives. 2000;108:173-176.
25. Dejmek J, Selevan S, Benes I, Solansky I, Sram R. Fetal Growth and Maternal Exposure to Particulate Matter During Pregnancy. Environmental Health Perspectives. 1999;107:475-480.
26. Dugandzic R, Dodds L, Stieb D, Smith-Doiron M. The association between low level exposures to ambient air pollution and term low birth weight:  a retrospective cohort study. Environmental Health. 2006;5:3-10.
27. Gouveia N, Bremner S, Novaes H. Association between ambient air pollution and birth weight in São Paulo, Brazil. Journal of Epidemiology and Community Health. 2003;58:11-17.
28. Hansen C, Barnett A, Pritchard G. The effect of ambient air pollution during early pregnancy on fetal ultrasonic measurements during mid-pregnancy. Environmental Health Perspectives. 2008;116:362-369.
29. Hansen C, Neller A, Williams G, Simpson R. Low levels of ambient air pollution during pregnancy and fetal growth among term neonates in Brisbane, Australia. Environmental Research. 2007;103:383-389.
30. Huynh M, Woodruff T, Parker J, Schoendorf K. Relationships between air pollution and preterm birth in California. Paediatric and Perinatal Epidemiology. 2006;20:454-461.
31. Leem J-H, Kaplan B, Shim Y, et al. Exposures to air pollutants during pregnancy and preterm delivery. Environmental Health Perspectives. 2006;114:905-910.
32. Lin C-M, Li C-Y, Yang G-Y, Mao I-F. Association between maternal exposure to elevated ambient sulfur dioxide during pregnancy and term low birth weight. Environmental Research. 2004;96:41-50.
33. Liu S, Krewski D, Shi Y, Chen Y, Burnett R. Association between gaseous ambient air pollutants and adverse pregnancy outcomes in Vancouver, Canada. Environmental Health Perspectives. 2003;111:1773-1778.
34. Liu S, Krewski D, Shi Y, Chen Y, Burnett R. Association between maternal exposure to ambient air pollutants during pregnancy and fetal growth restriction. Journal of Exposure Science and Environmental Epidemiology. 2007;17:426-432.
35. Maisonet M, Bush T, Correa A, Jaakkola J. Relation between ambient air pollution and low birth weight in the Northeastern United States. Environmental Health Perspectives. 2001;109 (suppl 3):351-356.
36. Mannes T, Jalaludin B, Morgan G, Lincoln D, Sheppeard V, Corbett S. Impact of ambient air pollution on birth weight in Sydney, Australia. Occupational and Environmental Medicine. 2005;62:524-530.
37. Parker J, Woodruff T. Influences of study design and location on the relationship between particulate matter air pollution and birthweight. Paediatric and Perinatal Epidemiology. 2008;22:214-227.
38. Parker J, Woodruff T, Basu R, Schoendorf K. Air pollution and birth weight among term infants in California. Pediatrics. 2005;115(1):121-128.
39. Ritz B, Wilhelm M, Hoggatt K, Ghosh J. Ambient air pollution and preterm birth in the Environment and Pregnancy Outcomes Study at the University of California, Los Angeles. American Journal of Epidemiology. 2007;166:1045-1052.
40. Ritz B, Yu F. The Effect of Ambient Carbon Monoxide on Low Birth Weight Among Children Born in Southern California Between 1989 and 1993. Environmental Health Perspectives. 1999;107:17-25.
41. Salam M, Millstein J, Li Y-F, Lurmann F, Margolis H, Gilliland F. Birth outcomes and prenatal exposure to ozone, carbon monoxide, and particulate matter:  results from the Children's Health Study. Environmental Health Perspectives. 2005;113:1638-1644.
42. Wang X, Ding H, Ryan L, Xu X. Association Between Air Pollution and Low Birth Weight: A Community-based Study. Environmental Health Perspectives. 1997;105:514-520.
43. Wilhelm M, Ritz B. Local variations in CO and particulate air pollution and adverse birth outcomes in Los Angeles County, California, USA. Environmental Health Perspectives. 2005;113:1212-1221.