Exposure to fine particle matter, nitrogen dioxide and benzene during pregnancy and cognitive and psychomotor developments in children at 15 months of age

Causal Effects of Prenatal Exposure to PM2.5 on Child Development and the Role of Unobserved Confounding

Prenatal exposure to airborne particles is a potential risk factor for infant neuropsychological development. This issue is usually explored by regression analysis under the implicit assumption that all relevant confounders are accounted for. Our aim is to estimate the causal effect of prenatal exposure to high concentrations of airborne particles with a diameter < 2.5 µm (PM2.5) on children’s psychomotor and mental scores in a birth cohort from Gipuzkoa (Spain), and investigate the robustness of the results to possible unobserved confounding. We adopted the propensity score matching approach and performed sensitivity analyses comparing the actual effect estimates with those obtained after adjusting for unobserved confounders simulated to have different strengths. On average, mental and psychomotor scores decreased of −2.47 (90% CI: −7.22; 2.28) and −3.18 (90% CI: −7.61; 1.25) points when the prenatal exposure was ≥17 μg/m³ (median). These estimates were robust to the presence of unmeasured confounders having strength similar to that of the observed ones. The plausibility of having omitted a confounder strong enough to drive the estimates to zero was poor. The sensitivity analyses conferred solidity to our findings, despite the large sampling variability. This kind of sensitivity analysis should be routinely implemented in observational studies, especially in exploring new relationships.

Protective Effect of Breastfeeding on the Adverse Health Effects Induced by Air Pollution: Current Evidence and Possible Mechanisms

Air pollution is a major social, economic, and health problem around the world. Children are particularly susceptible to the negative effects of air pollution due to their immaturity and excessive growth and development. The aims of this narrative review were to: (1) summarize evidence about the protective effects of breastfeeding on the adverse health effects of air pollution exposure, (2) define and describe the potential mechanisms underlying the protective effects of breastfeeding, and (3) examine the potential effects of air pollution on breastmilk composition and lactation. A literature search was conducted using electronic databases. Existing evidence suggests that breastfeeding has a protective effect on adverse outcomes of indoor and outdoor air pollution exposure in respiratory (infections, lung function, asthma symptoms) and immune (allergic, nervous and cardiovascular) systems, as well as under-five mortality in both developing and developed countries. However, some studies reported no protective effect of breastfeeding or even negative effects of breastfeeding for under-five mortality. Several possible mechanisms of the breastfeeding protective effect were proposed, including the beneficial influence of breastfeeding on immune, respiratory, and nervous systems, which are related to the immunomodulatory, anti-inflammatory, anti-oxidant, and neuroprotective properties of breastmilk. Breastmilk components responsible for its protective effect against air pollutants exposure may be long chain polyunsaturated fatty acids (LC PUFA), antioxidant vitamins, carotenoids, flavonoids, immunoglobins, and cytokines, some of which have concentrations that are diet-dependent. However, maternal exposure to air pollution is related to increased breastmilk concentrations of pollutants (e.g., Polycyclic aromatic hydrocarbons (PAHs) or heavy metals in particulate matter (PM)). Nonetheless, environmental studies have confirmed that breastmilk’s protective effects outweigh its potential health risk to the infant. Mothers should be encouraged and supported to breastfeed their infants due to its unique health benefits, as well as its limited ecological footprint, which is associated with decreased waste production and the emission of pollutants.

Prenatal air pollution and childhood IQ: Preliminary evidence of effect modification by folate

OBJECTIVES

Animal studies suggest that air pollution is neurotoxic to a developing fetus, but evidence in humans is limited. We tested the hypothesis that higher air pollution is associated with lower child IQ and that effects vary by maternal and child characteristics, including prenatal nutrition.

METHODS

We used prospective data collected from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood study. Outdoor pollutant exposure during pregnancy was predicted at geocoded home addresses using a validated national universal kriging model that combines ground-based monitoring data with an extensive database of land-use covariates. Distance to nearest major roadway was also used as a proxy for traffic-related pollution. Our primary outcome was full-scale IQ measured at age 4-6. In regression models, we adjusted for multiple determinants of child neurodevelopment and assessed interactions between air pollutants and child sex, race, socioeconomic status, reported nutrition, and maternal plasma folate in second trimester.

RESULTS

In our analytic sample (N = 1005) full-scale IQ averaged 2.5 points (95% CI: 0.1, 4.8) lower per 5 μg/m³ higher prenatal PM₁₀, while no associations with nitrogen dioxide or road proximity were observed. Associations between PM₁₀ and IQ were modified by maternal plasma folate (p_interaction = 0.07). In the lowest folate quartile, IQ decreased 6.8 points (95% CI: 1.4, 12.3) per 5-unit increase in PM₁₀; no associations were observed in higher quartiles.

CONCLUSIONS

Our findings strengthen evidence that air pollution impairs fetal neurodevelopment and suggest a potentially important role of maternal folate in modifying these effects.

Are mothers less likely to breastfeed in harsh environments? Physical environmental quality and breastfeeding in the Born in Bradford study

We use the United Kingdom's Born in Bradford study to investigate whether women in lower quality environments are less likely to breastfeed. We use measures of physical environmental quality (water disinfectant by-products [DBPs], air pollution, passive cigarette smoke, and household condition) alongside socio-economic indicators, to explore in detail how different exposures influence breastfeeding. Drawing on evolutionary life history theory, we predict that lower environmental quality will be associated with lower odds of initiating, and higher hazards of stopping, breastfeeding. As low physical environmental quality may increase the risk of adverse birth outcomes, which may in turn affect breastfeeding chances, we also test for mediation by gestational age, birthweight, head circumference, and abdominal circumference. Our sample is composed of mothers who gave birth at the Bradford Royal Infirmary in West Yorkshire between March 2007 and December 2010 for whom breastfeeding initiation data was available. Analyses were stratified by the two largest ethnic groups: White British (n = 3,951) and Pakistani-origin (n = 4,411) mothers. After controlling for socio-economic position, Pakistani-origin mothers had lower chances of initiating and higher chances of stopping breastfeeding with increased water DBP exposure (e.g., OR for 0.03-0.61 vs. <0.02 μg/day dibromochloromethane exposure 0.70 [0.58-0.83], HR 1.16 [0.99-1.36]), greater air pollution exposure predicted lower chances of initiation for both ethnic groups (e.g., OR for 10 μg/m³ increase in nitrogen dioxide 0.81 [0.66-0.99] for White British mothers and 0.79 [0.67-0.94] for Pakistani-origin mothers) but also a reduced hazard of stopping breastfeeding for White British mothers (HR 0.65 [0.52-0.80]), and exposure to household damp/mould predicted higher chances of breastfeeding initiation amongst White British mothers (OR 1.66 [1.11-2.47]). We found no evidence that physical environmental quality effects on breastfeeding were mediated through birth outcomes amongst Pakistani-origin mothers and only weak evidence (p < 0.10) amongst White British mothers (exposure to passive cigarette smoke was associated with having lower birthweight infants who were in turn less likely to be breastfed whereas greater air pollution exposure was associated with longer gestations and in turn reduced hazards of stopping breastfeeding). Overall, our findings suggest that there is differential susceptibility to environmental exposures according to ethnicity. Although the water DBP results for Pakistani-origin mothers and air pollution-initiation results for both ethnic groups support our hypothesis that mothers exhibit reduced breastfeeding in poorer quality environments, several physical environmental quality indicators showed null or positive associations with breastfeeding outcomes. We consider physiological explanations for our findings and their implications for life history theory and public health policy.

Residential exposure to green space and early childhood neurodevelopment

BACKGROUND

A few studies reported that exposure to high levels of residential surrounding green spaces was associated with better cognitive development in primary school children. However, no studies have been conducted to examine such association in early childhood.

OBJECTIVES

We investigated the association between residential exposure to green space and early childhood neurodevelopment, and further explored the mediation effects of traffic-related air pollution and maternal physical activity on this association.

METHODS

We enrolled 1312 pregnant women between January 2012 and October 2015 and their children were followed up until an age of 2 years. We measured residential exposure to green space by calculating averaged normalized difference vegetation index (NDVI) within a 300 meter buffer area surrounding residential address at birth. The neurodevelopment, which included mental development index (MDI) and psychomotor development index (PDI), was assessed using Bayley Scales of Infant Development for each child at about 24 months. The associations of residential exposure to NDVI with early childhood MDI score and PDI score were evaluated using multiple linear regression models. The mediation effects of traffic-related air pollution and maternal physical activities on those associations were estimated by causal mediation analyses.

RESULTS

Exposure to higher levels of residential surrounding green spaces was associated with increased early childhood PDI score (adjusted changes for one SD increment of NDVI: 3.28 (95% CI: 2.15, 4.41)) and MDI score (adjusted changes for one SD increment of NDVI: 1.97 (95% CI: 0.63, 3.30). These associations were more pronounced in children of mothers whose pre-pregnancy BMI were lower than 24 kg/m². Further mediation analyses indicated that reduced levels of traffic-related air pollution explained 13.6% to 28.0% of the association between exposure to green space and early childhood PDI score.

CONCLUSION

Exposure to higher levels of residential surrounding green spaces was associated with better early childhood neurodevelopment. The association between exposure to green space and early childhood psychomotor development might be partly explained by reduced levels of traffic-related air pollution.

Prenatal exposure to PM2.5 and NO2 and sex-dependent infant cognitive and motor development

BACKGROUND

Prenatal exposure to air pollutants including particulate matter (<2.5 μm of diameter,PM_2.5)and nitrogen dioxide (NO₂) has been identified as a potential risk factor for neuropsychological developmental and mental health disorders.

OBJECTIVE

This study aimed to analyze the associations between prenatal PM_2.5 and NO₂ exposure and cognitive functions in children at 4-6 years of age, including sex differences, and the modification effect of the duration predominant breastfeeding these associations.

DESIGN

This study was conducted as part of the INMA project, a population-based birth cohort study in Spain (n = 1119). Each of the pregnant mothers was assigned a prenatal exposure to PM_2.5 and NO₂ for their whole pregnancy based on their place of residence. At the 4-6 year-old follow-up, infants' neuropsychological development was assessed using McCarthy scales: Verbal, Perceptive-Manipulative, Numeric, General Cognitive, Memory and Motor (gross and fine). Between 6 and 14 months of age, information concerning breastfeeding was gathered with a questionnaire. Regression analyses were performed to estimate the associations between exposure and outcomes, accounting for potential confounders. The analyses were stratified by child sex and breastfeeding duration.

RESULTS

The majority of coefficients for the different cognitive domains were negative either for PM_2.5 and NO₂, though none was statistically significant. After stratifying by sex, the associations become even more negative for boys, with some of the associations becoming statistically significant (memory both for PM_2.5 and NO₂), and global cognition and verbal for NO₂. Duration of predominant breastfeeding was not found to have a modifying effect.

CONCLUSIONS

These findings suggest a sex-dependent effects on neuropsychological development at 4-6 years of age, with a greater vulnerability in boys, specifically in domains related to memory, verbal and general cognition. No modifying effect was observed for duration of predominant breastfeeding.

Towards a fuller assessment of benefits to children's health of reducing air pollution and mitigating climate change due to fossil fuel combustion

BACKGROUND

Fossil fuel combustion by-products, including particulate matter (PM_2.5), polycyclic aromatic hydrocarbons (PAH), nitrogen dioxide (NO₂) and carbon dioxide (CO₂), are a significant threat to children's health and equality. Various policies to reduce emissions have been implemented to reduce air pollution and mitigate climate change, with sizeable estimated health and economic benefits. However, only a few adverse outcomes in children have been considered, resulting in an undercounting of the benefits to this vulnerable population.

OBJECTIVES

Our goal was to expand the suite of child health outcomes addressed by programs to assess health and economic benefits, such as the Environmental Protection Agency (EPA) Benefits Mapping and Analysis Program (BenMAP), by identifying concentration-response (C-R) functions for six outcomes related to PM_2.5, NO₂, PAH, and/or PM₁₀: preterm birth (PTB), low birthweight (LBW), autism, attention deficit hyperactivity disorder, IQ reduction, and the development of childhood asthma.

METHODS

We conducted a systematic review of the literature published between January 1, 2000 and April 30, 2018 to identify relevant peer-reviewed case-control and cohort studies and meta-analyses. In some cases meta-analyses were available that provided reliable C-R functions and we assessed their consistency with subsequent studies. Otherwise, we reviewed all eligible studies published between our search dates.

RESULTS

For each pollutant and health outcome, we present the characteristics of each selected study. We distinguish between C-R functions for endpoints having a causal or likely relationship (PTB, LBW, autism, asthma development) with the pollutants for incorporation into primary analyses and endpoints having a suggestive causal relationship with the pollutants (IQ reduction, ADHD) for secondary analyses.

CONCLUSION

We have identified C-R functions for a number of adverse health outcomes in children associated with air pollutants largely from fossil fuel combustion. Their incorporation into expanded assessments of health benefits of clean air and climate mitigation policies will provide an important incentive for preventive action.

Nanosized carbon black exposure induces neural injury: effects on nicotinamide adenine dinucleotide phosphate oxidases and endoplasmic reticulum stress

Carbon black in ambient air is believed to be the cause of many diseases; however, its potential neural toxicity and the underlying mechanisms remain poorly understood. The present study is to evaluate the toxic effects of carbon black nanoparticles, Printex 90, on the neural cell line PC-12. The study revealed that Printex 90 treatment significantly decreased cell viability, accompanied by an enormous increase in reactive oxygen species generation and a decrease in ATP. Additionally, NOX2 and NOX4, 4-hydroxynonenal, endoplasmic reticulum (ER) stress marker proteins (IRE-1α, ATF-6, GRP78, PERK and the downstream target protein CHOP) and antioxidative enzymes (glutathione and superoxide dismutase) were evaluated. It showed that Printex 90 significantly upregulated 4-hydroxynonenal, NOX2 and NOX4 expression, and the levels, or activity, of glutathione and superoxide dismutase, were markedly reduced. For the ER stress-associated proteins, Printex 90 induced a significant increase of IRE-1α, ATF-6, GRP78, p-PERK and CHOP expression. Collectively, these results demonstrate that NOX and ER stress are involved in Printex 90-mediated neural damage. Therefore, decreased ER stress and NOX-derived reactive oxygen species generation may provide compensatory protective effects and attenuate Printex 90-induced neural injury.

Metabolomics analysis explores the rescue to neurobehavioral disorder induced by maternal PM2.5 exposure in mice

Reproductive epidemiological studies have suggested associations between perinatal exposure to fine particulate matter (PM_2.5) and adverse birth outcomes. To explore the effects of early prenatal exposure to PM_2.5 on subsequent generations, pregnant mice were exposed to PM_2.5 or filtered clean air in whole body dynamic exposure chambers for 14 consecutive days from gestation day (GD) 1.5 to GD15.5. Neurobehavioral tests showed that spontaneous locomotion and exploratory behaviors in the offspring were significantly enhanced in the open field test. Meanwhile, metabolomics analysis suggested activation of dopamine pathway while inhibition of glycine pathway in murine brains. Administration of the DRD4 antagonist, clozapine; or supplementation of glycine receptor agonist, taurine, to mice offspring attenuated the locomotor hyperactivities to levels indistinguishable from controls. These data provide strong evidence that maternal exposure to air pollution might increase the risk for neural disorders in the offspring during critical periods of brain development.

Effects of neonatal inhalation exposure to ultrafine carbon particles on pathology and behavioral outcomes in C57BL/6J mice

Background

Recent epidemiological studies indicate early-life exposure to air pollution is associated with adverse neurodevelopmental outcomes. Previous studies investigating neonatal exposure to ambient fine and ultrafine particles have shown sex specific inflammation-linked pathological changes and protracted learning deficits. A potential contributor to the adverse phenotypes from developmental exposure to particulate matter observed in previous studies may be elemental carbon, a well-known contributor to pollution particulate. The present study is an evaluation of pathological and protracted behavioral alterations in adulthood following subacute neonatal exposure to ultrafine elemental carbon. C57BL/6J mice were exposed to ultrafine elemental carbon at 50 μg/m³ from postnatal days 4–7 and 10–13 for 4 h/day. Behavioral outcomes measured were locomotor activity, novel object recognition (short-term memory), elevated plus maze (anxiety-like behavior), fixed interval (FI) schedule of food reward (learning, timing) and differential reinforcement of low rate (DRL) schedule of food reward (impulsivity, inability to inhibit responding). Neuropathology was assessed by measures of inflammation (glial fibrillary-acidic protein), myelin basic protein expression in the corpus callosum, and lateral ventricle area.

Results

Twenty-four hours following the final exposure day, no significant differences in anogenital distance, body weight or central nervous system pathological markers were observed in offspring of either sex. Nor were significant changes observed in novel object recognition, elevated plus maze performance, FI, or DRL schedule-controlled behavior in either females or males.

Conclusion

The limited effect of neonatal exposure to ultrafine elemental carbon suggests this component of air pollution is not a substantial contributor to the behavioral alterations and neuropathology previously observed in response to ambient pollution particulate exposures. Rather, other more reactive constituent species, organic and/or inorganic, gas-phase components, or combinations of constituents may be involved. Defining these neurotoxic components is critical to the formulation of better animal models, more focused mechanistic assessments, and potential regulatory policies for air pollution.

Electronic supplementary material

The online version of this article (10.1186/s12989-019-0293-5) contains supplementary material, which is available to authorized users.

Born to be Wise: a population registry data linkage protocol to assess the impact of modifiable early-life environmental exposures on the health and development of children

INTRODUCTION

Deficiencies in childhood development is a major global issue and inequalities are large. The influence of environmental exposures on childhood development is currently insufficiently explored. This project will analyse the impact of various modifiable early life environmental exposures on different dimensions of childhood development.

METHODS

Born to be Wise will study a Canadian cohort of approximately 34 000 children who have completed an early development test at the age of 5. Land use regression models of air pollution and spatially defined noise models will be linked to geocoded data on early development to analyse any harmful effects of these exposures. The potentially beneficial effect on early development of early life exposure to natural environments, as measured by fine-grained remote sensing data and various land use indexes, will also be explored. The project will use data linkages and analyse overall and age-specific impact, including variability depending on cumulative exposure by assigning time-weighted exposure estimates and by studying subsamples who have changed residence and exposure. Potentially moderating effects of natural environments on air pollution or noise exposures will be studied by mediation analyses. A matched case-control design will be applied to study moderating effects of natural environments on the association between low socioeconomic status and early development. The main statistical approach will be mixed effects models, applying a specific software to deal with multilevel random effects of nested data. Extensive confounding control will be achieved by including data on a range of detailed health and sociodemographic variables.

ETHICS AND DISSEMINATION

The study protocol has been ethically approved by the Behavioural Research Ethics Board at the University of British Columbia. The findings will be published in peer-reviewed journals and presented at scholarly conferences. Through stakeholder engagement, the results will also reach policy and a broader audience.

Neurodevelopmental toxicity induced by maternal PM2.5 exposure and protective effects of quercetin and Vitamin C

Epidemiological studies show that maternal exposure to PM_2.5 affects the neurodevelopment of the offspring, especially the neurocognitive function. However, no relevant experimental researches have been published on toxic mechanism and diet intervention. We evaluated the effects of exposure to different doses of PM_2.5 on the behavioral development of offspring via a PM_2.5 exposure model established by intratracheal instillation, explored its mechanism and the protective effects of quercetin and VC intervention, and focused on the protein expression of CREB/BDNF signaling pathway. Specifically, Exposure to PM_2.5 during gestation and lactation period caused maternal oxidative stress. Maternal exposure to PM_2.5 changed postnatal open-field behaviors in both gender, impaired spatial learning and memory in the female offspring, increased the level of IL-1β, IL-6, down-regulated p-CREB/CREB, BDNF, TrkB, p-CaMKII/CaMKII, p-CaMKIV/CaMKIV, up-regulated p-Akt/Akt and p-ERK1/2/ERK1/2 in the offspring. In addition, maternal supplementation with quercetin ameliorate the maternal oxidative stress, improved progeny inflammatory response, regulated BDNF, TrkB, p-Akt/Akt, p-ERK1/2/ERK1/2 in female offspring, regulated TrkB, p-CREB/CREB and p-Akt/Akt in male offspring. Maternal supplementation with VC increased the levels of CAT in maternal mice, up-regulated BDNF in female offspring, regulated p-CREB/CREB and p-ERK1/2/ERK1/2 in male offspring. Our findings indicate that PM2.5 exposure during pregnancy and lactation could impair behavioral development of offspring. Quercetin shows more protective effects than VC. The mechanism of neurodevelopmental toxicity induced by PM_2.5 may be related to oxidative stress, inflammatory response and modulation of the CREB/BDNF signaling pathway.

The emerging risk of exposure to air pollution on cognitive decline and Alzheimer's disease - Evidence from epidemiological and animal studies

As incidence of Alzheimer's disease (AD) and other neurodegenerative diseases rise, there is increasing interest in environmental factors which may contribute to disease onset and progression. Air pollution has been known as a major health hazard for decades. While its effects on cardiopulmonary morbidity and mortality have been extensively studied, growing evidence has emerged that exposure to polluted air is associated with impaired cognitive functions at all ages and increased risk of AD and other dementias in later life; this association is particularly notable with traffic related pollutants such as nitrogen dioxide, nitrous oxide, black carbon, and small diameter airborne solids and liquids known as particulate matter. The exact mechanisms by which air pollutants mediate neurotoxicity in the central nervous system (CNS) and lead to cognitive decline and AD remain largely unknown. Studies using animal and cell culture models indicate that amyloid-beta processing, anti-oxidant defense, and inflammation are altered following the exposure to constituents of polluted air. In this review, we summarize recent evidence supporting exposure to air pollution as a risk for cognitive decline at all ages and AD at later lifetime. Additionally, we review the current body of work investigating the molecular mechanisms by which air pollutants mediate damage in the CNS. Understanding of the neurotoxic effects of air pollution and its constituents is still limited, and further studies will be essential to better understand the cellular and molecular mechanisms linking air pollution and cognitive decline.

Long-term exposure to ambient PM2.5 associated with fall-related injury in six low- and middle-income countries

Exposure to ambient air pollution has been linked with adverse health outcomes of the circulatory and nervous systems. Given that falls are closely related to circulatory and nervous health, we hypothesize that air pollution may adversely affect fall-related injury. We employed Wave 1 data from 36,662 participants aged ≥50 years in WHO's Study on Global AGEing and Adult Health in six low- and middle-income countries. Ambient annual concentration of PM_2.5 was estimated using satellite data. A three-level logistic regression model was applied to examine the long-term association between ambient PM_2.5 and the prevalence of fall-related injury, and associated disease burden, as well as the potential effect modification of consumption of fruit and vegetables. Ambient PM_2.5 was found to be significantly associated with the risk of fall-related injury. Each 10 μg/m³ increase corresponded to 18% (OR = 1.18, 95% CI: 1.09, 1.28) increase in fall-related injury after adjusting for various covariates. The association was relatively stronger among participants with lower consumption of fruit (OR = 1.22, 95% CI: 1.12, 1.33) than higher consumption (OR = 1.06, 95% CI: 0.92, 1.23), and among those with lower vegetable consumption (OR = 1.18, 95% CI: 1.08, 1.28) than higher consumption (OR = 1.08, 95% CI: 0.91, 1.27). Our study suggests that ambient PM_2.5 may be one risk factor for fall-related injury and that higher consumption of fruit and vegetables could alleviate this effect.

Outdoor and indoor air quality and cognitive ability in young children

BACKGROUND

This study examined outdoor and indoor air quality at ages 9 months and 3 years and their association with cognitive ability at age 3 in England and Wales.

METHOD

Data from 8198 Millennium Cohort Study children were analysed using multilevel regression. Outdoor air quality was assessed with mean annual estimates of nitrogen dioxide (NO₂) levels within a standard small area (ward). Indoor air quality was measured with parent-reports of damp or condensation in the home and exposure to secondhand smoke in the home. Cognitive ability was assessed with the British Ability Scales Naming Vocabulary subscale and the Bracken School Readiness Assessment.

RESULTS

In adjusted models, consistent exposure to high levels of NO₂ at age 9 months and age 3 years was associated with lower verbal ability at age 3 years. Damp/condensation and secondhand smoke in the home at either age or at both ages were correlated with lower school readiness at age 3 years. Exposures to damp/condensation at age 3 years or at both ages and secondhand smoke at either age or at both ages were associated with lower verbal ability at age 3 years.

CONCLUSION

Young children's exposures to indoor damp or condensation and secondhand smoke are likely to be detrimental for their cognitive outcomes. However, there do not appear to be any short-term effects of NO₂.

A critical review of developmental exposure to particulate matter, autism spectrum disorder, and attention deficit hyperactivity disorder

Autism spectrum disorder (ASD) and attention deficit (hyperactivity) disorder (ADD/ADHD) are key focuses of current health research due to their increasing prevalence. The objective of this systematic literature search and critical review was to evaluate whether the human epidemiologic data indicate a pattern of association between ASD or ADD/ADHD and developmental exposure to particulate matter (PM), with a focus on exposures encountered before the age of three. A MEDLINE and EMBASE search was conducted; following preliminary and full-text screening, 14 relevant articles were identified for review. Three of the 14 studies were prospective cohort studies evaluating exposure to PM₁₀; 11 studies had a case-control design. There was no consistent association between developmental PM exposure and ASD across the three of the cohort studies. Seven of the case-control studies examined the relationship between PM_2.5 and/or PM₁₀ and ASD; four examined the relationship between developmental diesel PM exposure and ASD. Overall, there was low external consistency in results among studies of PM_2.5/PM₁₀ and ASD, with some reporting high internal consistency without significant associations, others showing associations with high internal consistency for specific exposure windows only (e.g., third trimester), and still others showing high consistency for moderate to strong associations between PM and ASD. The majority of studies reporting significant results had low effect sizes in conjunction with small sample sizes. The four studies of diesel PM and ASD also had low external consistency of results. Only one study evaluated associations with ADD/ADHD, and it found no significant associations with PM₁₀. The inconsistent findings across studies of developmental exposure to PM and ASD may be attributed to differences in the study populations, exposure assessments, outcome assessments, or chance. Further research is needed to understand the underlying biological mechanisms that lead to ASD and ADD/ADHD and how PM might be involved in those mechanisms, if at all. High-quality epidemiologic studies are also needed to conclusively determine whether developmental PM exposure is a causal factor for ASD or ADD/ADHD, with focus on a well-developed exposure assessment.

Early-life exposure to air pollution and greater use of academic support services in childhood: a population-based cohort study of urban children

BACKGROUND

There is a growing literature showing associations between prenatal and early-life exposure to air pollution and children's neurodevelopment. However, it is unclear if decrements in neurodevelopment observed in epidemiologic research translate into observable functional outcomes in the broader pediatric population. The objective of this study was to examine the association between early-life exposures to common urban air toxics and the use of academic support services, such as early intervention and special education within a population-based cohort of urban children.

METHODS

Data for 201,559 children born between 1994 and 1998 in New York City were obtained through administrative data linkages between birth, early intervention and educational records. Use of academic support services was ascertained from birth through attendance in 3rd grade. Census tract at birth was used to assign estimates of annual average ambient concentrations of benzene, toluene, ethylbenzene and xylenes (BTEX) using the 1996 National Air Toxics Assessment. Discrete-time hazard models were fit to the data and adjusted for confounders including maternal, childhood and neighborhood factors.

RESULTS

Children with higher exposures to BTEX compounds were more likely to receive academic support services later in childhood. For example, the adjusted hazard ratio comparing children exposed to the highest decile of benzene to those with lower exposure was 1.09 (95% confidence interval 1.05, 1.13). Results were consistent across individual BTEX compounds, for exposure metrics which summarized exposure to all four BTEX pollutants and for multiple sensitivity analyses.

CONCLUSIONS

These findings suggest urban air pollution may affect children's neurodevelopment and educational trajectories. They also demonstrate the use of public health data systems to advance children's environmental health research.

Exposure to air pollution and cognitive functioning across the life course--A systematic literature review

OBJECTIVES

Air pollution is associated with increased risk of respiratory, cardiovascular and cerebrovascular disease, but its association with cognitive functioning and impairment is unclear. The aim of this systematic review was to examine whether a relationship exists between these variables across the life course.

METHODS

We searched Web of Knowledge, Pubmed, SciVerse Scopus, CINAHL, PsychInfo and Science Direct up to October 2015 to identify studies that investigated the association between air pollution and performance on neurocognitive tests.

RESULTS

Variations in exposure assessment and outcome measures make meta-analysis impossible. Thirty one studies published between 2006 and 2015, from the Americas (n=15), Asia (n=5) and Europe (n=11), met the criteria for inclusion. Many showed weak but quantified relationships between various air pollutants and cognitive function. Pollution exposure in utero has been associated with increased risk of neuro-developmental delay. Exposure in childhood has been inversely associated with neuro-developmental outcomes in younger children and with academic achievement and neurocognitive performance in older children. In older adults, air pollution has been associated with accelerated cognitive decline.

CONCLUSIONS

The evidence to date is coherent in that exposure to a range of largely traffic-related pollutants has been associated with quantifiable impairment of brain development in the young and cognitive decline in the elderly. There is insufficient evidence at present to comment on consistency, in view of the different indices of pollution and end-points measured, the limited number of studies, and the probability at this stage of publication bias. However, plausible toxicological mechanisms have been demonstrated and the evidence as a whole suggests that vehicular pollution, at least, contributes to cognitive impairment, adding to pressure on governments and individuals to continue to reduce air pollution.