• air pollution;
  • fine particulates;
  • carbon monoxide;
  • preterm birth


Air pollution from vehicular emissions and other combustion sources is related to cardiovascular and respiratory outcomes. However, few studies have investigated the relationship between air pollution and preterm birth, a primary cause of infant mortality and morbidity. This analysis examined the effect of fine particulate matter (PM2.5) and carbon monoxide (CO) on preterm birth in a matched case–control study. PM2.5 and CO monitoring data from the California Air Resources Board were linked to California birth certificate data for singletons born in 1999–2000. Each birth was mapped to the closest PM monitor within 5 miles of the home address. County-level CO measures were utilised to increase sample size and maintain a representative population. After exclusion of implausible birthweight–gestation combinations, preterm birth was defined as birth occurring between 24 and 36 weeks’ gestation. Each of the 10 673 preterm cases was matched to three controls of term (39–44 weeks) gestation with a similar date of last menstrual period. Based on the case’s gestational age, CO and PM2.5 exposures were calculated for total pregnancy, first month of pregnancy, and last 2 weeks of pregnancy. Exposures were divided into quartiles; the lowest quartile was the reference. Because of the matched design, conditional logistic regression was used to adjust for maternal race/ethnicity, age, parity, marital status and education.

High total pregnancy PM2.5 exposure was associated with a small effect on preterm birth, after adjustment for maternal factors (adjusted odds ratio [AOR] = 1.15, [95% CI 1.07, 1.24]). The odds ratio did not change after adjustment for CO. Results were similar for PM2.5 exposure during the first month of pregnancy (AOR = 1.21, 95% CI [1.12, 1.30]) and the last 2 weeks of pregnancy (AOR = 1.17, 95% CI [1.09, 1.27]). Conversely, CO exposure at any time during pregnancy was not associated with preterm birth (AORs from 0.95 to 1.00). Maternal exposure to PM2.5, but not CO, is associated with preterm birth. This analysis did not show differences by timing of exposure, although more detailed examination may be needed.