Making an
Impact Fact
by Fact
Promoting Good Prenatal Health:
Air Pollution and Pregnancy
Information for Prenatal
Health Care Providers —
With tips for patients on preventing and reducing
exposure to air pollution
Recent literature suggests that exposure to air pollution during pregnancy can
cause adverse birth outcomes and health problems for the mother and child.
Some pollutants of concern are secondhand smoke,
carbon monoxide, fumes from paint and household
cleaners, particulate matter, and ozone.1-2-3-4-6-6
Women of child-bearing age, pregnant women, new
mothers, families, and their health care providers
should be aware of the potential hazards of outdoor
and indoor air pollution to developing fetuses and
small children. Research shows that prenatal exposure
to pollutants can increase the risk of preterm delivery
and low birth weight (LBW; less than 2,500 grams,
or 5.5 pounds), which are public health challenges in
the United States, as they contribute significantly to
infant mortality and developmental disabilities.78-9This
fact sheet identifies some common environmental
exposures and provides simple steps that health care
providers can recommend to pregnant women and
new mothers to avoid exposure.
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Healthier Environments, Healthier
Sources-
Of Air Pollution and Risks Associated with Exposure
for Preventing
Exposure to Tobacco Smoke
• Pregnant women should not smoke.
• Pregnant women should avoid public
places where smoking is allowed.
• Pregnant women should make their
homes and cars smoke-free.
Tobacco Smoke
It is well documented that maternal smoking during
pregnancy is associated with poor fetal development.10- "•12-13
However, exposure to secondhand smoke during pregnancy
might also result in a higher risk of poor fetal development
(i.e., reduced birth weight and birth length), reduced lung
function, respiratory illnesses (e.g., asthma), and cognitive
deficits (e.g., impaired speech, language skills, and
intelligence).2-3-14-16
Secondhand smoke, also known as environmental tobacco
smoke (ETS), contains more than 4,000 compounds, of
which at least 250 have been found to be toxic to human
health.16 Some of these chemicals can cross the placenta to
the developing fetus and increase the risk of adverse birth
outcomes.14 Children exposed to secondhand smoke after
birth are more likely to suffer serious health problems such
as asthma, lower respiratory tract infections, ear infections or
Sudden Infant Death Syndrome (SIDS).2-3-14-16
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Babies, Healthier World.
Carbon Monoxide
Carbon monoxide (CO) is often referred to as a silent killer. CO
is a toxic gas that is difficult to detect because it is colorless,
odorless, tasteless, and does not irritate the skin.17
Malfunctioning or improperly used fuel-burning appliances
and idling automobiles in enclosed spaces are responsible
for hundreds of unintentional CO-related deaths every year.18
Indoor sources of CO include back-drafting from woodstoves
and gas water heaters, gas stoves, the improper use of
generators in enclosed spaces such as homes, cigarette
smoke, and unvented gas and kerosene space heaters.17 CO
reduces the capacity of a mother's blood to carry oxygen
(02), complicating delivery of 02 to the developing fetus.19-20
Epidemiological and animal toxicological studies suggest that
long-term exposure to ambient CO, especially during the first
trimester, may increase risk for preterm birth, reduced fetal
growth, and certain birth defects such as cardiac birth defects
and otoacoustic deficits.19-21-22The severity of CO poisoning for
the fetus depends on the amount and length of exposure, as
well as gestational age at the time of exposure.23
In situations of suspected CO poisoning, if a pregnant woman
experiences very mild symptoms, or no symptoms at all,
generally it is unlikely her fetus is at significant risk. However,
detecting CO poisoning in pregnant women can be more
difficult because symptoms mirror conditions that normally
appear in pregnancy (nausea, vomiting, and tiredness).23
Symptoms of high exposure to CO are serious and potentially
life-threatening, and include mental confusion, lack of muscular
coordination, and loss of consciousness.
**Anyone who exhibits symptoms that could be related to CO
exposure should be taken to an emergency room immediately. The
source of the CO should be identified and the problem corrected to
prevent further exposure.18
II PS for Preventing
CO Exposure
• Install carbon monoxide alarms that
are Nationally Recognized Testing
Laboratory (NRTL) approved (such as
Underwriters Laboratories Inc.) outside
all sleeping rooms.
• Have fuel-burning appliances, furnace
flues, and chimneys checked at the
beginning of every heating season by
a trained professional to ensure proper
working order.
• Don't use gas ovens or burners to heat a
home, not even for a short time.
• Don't use charcoal grills indoors, even in
a fireplace.
• Don't use any gasoline-powered engines
(mowers, weed trimmers, snow
blowers, chain saws, small engines, or
generators) in enclosed spaces.
• Don't idle cars in the garage.
• Don't ignore symptoms (nausea,
vomiting, and tiredness) when around a
CO source, especially if more than one
person is feeling them. You could lose
consciousness and even die if you do
nothing.
• Go to the emergency room if
CO poisoning is suspected.
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Healthier Environments, Healthier
for Reducing
Exposure to Particle
Pollution and Ozone
• Check local news media for air quality
forecasts and plan outdoor activities for
days when particle and ozone levels are
lower. EPA's Air Quality Index (AQI) is a
tool that state and local agencies use to
issue public reports of actual levels of
particles, ground-level ozone, and other
common air pollutants.
• When the AQI indicates poor air quality,
reduce activity time or substitute another
activity that requires less energy. For
example, walk rather than jog.
• Don't exercise near high-traffic roads,
where particle levels are generally
higher.
• Protect yourself from exposure to
particulate matter in wood smoke.
- Burn only clean, seasoned wood, not
trash or plastics.
- If you have a woodstove purchased
before 1992, upgrade to either an
EPA-certified wood or pellet stove, or
other cleaner burning heater.
- Maintain your stove annually.
- Consider upgrading your outdoor
wood-fired boiler to a new
EPA-qualified model.
Particle Pollution
Particle pollution, also known as particulate matter or PM,
is the generic term for a broad class of chemically and
physically diverse substances that exist as discrete particles
(liquid droplets or solids) over a wide range of sizes. Particles
originate from a variety of anthropogenic stationary and
mobile sources as well as from natural sources. Particles
may be emitted directly, or formed in the atmosphere by
transformations of gaseous emissions such as sulfur oxides
(SOX), nitrogen oxides (NOX), and volatile organic compounds
(VOCs).The chemical and physical properties of PM vary
greatly with time, region, meteorology, and source category,
thus complicating the assessment of health and welfare
effects.24-26 Size directly determines a particle's potential
for causing health problems, with the smaller particles,
those 10 micrometers in diameter or less (PM10 and PM25),
being more dangerous. These small particles can enter the
respiratory system and penetrate deep into the lungs, with
possible serious health effects.24-26
Research suggests that exposure to ambient levels of particle
pollution may increase the risk for adverse cardiovascular
and/or respiratory health effects.26 Some research has linked
particle exposure to a greater risk of low birth weight (LBW)
and infant mortality, especially due to respiratory causes
during the postnatal period. However, outcomes are highly
variable based on the size of particles, duration of exposure,
and time during pregnancy when the mother is exposed.26
The risk of being affected by particle pollution and ground-level
ozone increases with the difficulty and duration of outdoor
activities, and with increased pollution levels in the area.
Ozone
Ozone is a gas composed of three oxygen atoms (03).
"Good" ozone is a naturally formed layer in the stratosphere
that helps protect life on Earth from the sun's rays. "Bad"
ozone exists at ground level and can be harmful to health.
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Babies, Healthier World.
Ground-level ozone is created by chemical reactions of tailpipe
exhaust, gasoline vapors, industrial emissions, chemical
solvents, and natural sources. Joined with particulate matter
and acted on by sunlight and heat, ozone creates "smog."26
Ozone can be present in indoor air as well. Ozone generators,
personal air purifiers, "pure-air" generators and "super
oxygen" purifiers are devices that emit ozone gas into the
indoor air at levels that can irritate airways and exacerbate
existing respiratory conditions. Evidence shows that at
concentrations that do not exceed public health standards,
ozone is ineffective at removing indoor air contaminants or
biological pollutants such as mold from the air.27
Exposure to ozone has been linked to LBW babies.
Researchers at the University of Southern California found
that women who breathe air heavily polluted with ozone are
at particular risk for having babies afflicted with intrauterine
growth retardation (IUGR), meaning they fall below the
15th percentile of expected size. The association was even
stronger for ozone exposure over the second and third
trimesters.6
Animal studies contribute to the understanding of the role
of ozone in LBW. Pregnant rats were found particularly
vulnerable to lung inflammation from ozone. Researchers
suspect that lung inflammation initiates a biochemical
response that may harm the placenta.26-28-29
Paint Fumes
When preparing the house for the new baby, be aware that
exposure to paint fumes can be hazardous to the health of
the mother and developing fetus. There are two general types
of household paints, oil-based and water-based. Oil-based
(alkyd) paint is often used on the exterior of houses because
it dries very hard and withstands harsh weather for a long
time. Water-based (latex) paint generally emits fewer chemical
II PS for Preventing
Exposure to Paint Fumes
• Pregnant women and children should
avoid exposure to paint fumes and limit
their time in freshly painted rooms.
• Creating a nursery can involve exposure
to hazardous substances. Before using
any product, always read the label first
for instructions and safety information.
• Open the windows and doors fully in
any room that is being painted or has
recently been painted.
- Put a box fan in the window directing
the air and fumes outdoors. Keep the
fan on while painting and for about
48 hours afterward.
- If the room does not have a window,
use a fan to circulate and exhaust air
away from the work area. Keep
doors open.
• Do not paint indoors with paint labeled
"for exterior use only."
• Ask a local paint dealer whether they
carry low-VOC or zero-VOC paint.
Due to environmental regulations and
consumer demand, there are now
several low-VOC and zero-VOC paints on
the market. Currently, low- and zero-
VOC paints as marketed may still emit
VOCs of concern, and efforts should be
taken to properly ventilate the room,
and keep exposures to a minimum.
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Healthier Environments, Healthier
for Reducing
Exposure to Cleaning
Products
• Never mix cleaning products, as the
fumes can be hazardous or deadly! For
example, mixing chlorine bleach and
ammonia can generate very harmful
chloramine gas.
• Pregnant women should only use
cleaning products in well-ventilated
areas, wearing protective gloves.
• Consider using alternative cleaners.
Baking soda can be used to scrub
greasy pots, pans and ovens; and
vinegar and water to clean countertops
and other surfaces.
• Look for the Design for the Environment
(DfE) logo on safer cleaning products.
- The DfE logo on a product means
that EPA scientists have screened
each ingredient for potential human
health and environmental effects,
and that based on currently available
information, the product contains
only those ingredients that pose the
least concern among chemicals in
their class.
vapors, often called volatile organic compounds (VOCs), than
alkyd paint, but may still contain some hazardous chemicals
such as ethylene glycol ethers and biocides (e.g., mercury
or formaldehyde). VOCs are emitted as a gas from various
solids or liquids, including most paints, and can cause adverse
health effects, especially with extended duration or frequency
of exposure to fumes.4-30-31
Short-term exposure to solvents from alkyd paints can be
significantly higher than from latex paints.4 Headaches,
nausea, dizziness, and fatigue are typical symptoms of paint
fume inhalation and can be worse with acute, higher level
exposure.4-31 Pregnant women should avoid alkyd paint, and
limit the use of latex paint in order to reduce exposure to
potentially harmful vapors in both home and occupational
settings.
Cleaning Products
Exposure to fumes from some cleaning products during
pregnancy can pose risks when used in the home and in the
workplace.
Common cleaning products contain a range of ingredients
including solvents, strong acids and bases, and fragrances.
Some of these ingredients pose health concerns, others can
be bad for the environment, and some of them can release
toxic fumes either individually, or if mixed together.6-32-33
Phthalates can be carriers for fragrance in glass cleaners,
deodorizers, laundry detergents, and fabric softeners. Some
phthalate compounds can be associated with potential
adverse effects in male children, reduced sperm count in
adult men, and increased allergic symptoms and asthma in
children.34
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Babies, Healthier World.
Additional Resources
Environmental Protection Agency
• Office of Children's Health Protection www.epa.gov/children
• Air Quality Index: www.airnow.gov
• Indoor air quality: www.epa.gov/iaq - Burn Wise Program: www.epa.gov/burnwise
• National Ambient Air Quality Standards (NAAQS): www.epa.gov/air/criteria.html
• Particle pollution and your health: www.epa.gov/oar/particlepollution/pdfs/pm-color.pdf
• Protect your family and yourself from CO poisoning: www.epa.gov/iaq/pubs/coftsht.html
• Six common air pollutants: www.epa.gov/air/urbanair/6poll.html
• Consumer Product Safety Commission: www.cpsc.gov
• Learn about chemicals around your house: www.epa.gov/kidshometour
• Find safer products that bear EPAs DfE logo: www.epa.gov/dfe
• Smoke-free homes: www.epa.gov/smokefree
Pediatric Environmental Health Specialty Units (PEHSU)
• Children's environmental health experts: www.pehsu.net
Centers for Disease Control and Prevention
• CO poisoning: www.cdc.gov/co/faqs.htm
• Indoor air quality information: www.cdc.gov/nceh/airpollution/indoor_air.htm
U.S. Department of Health and Human Services
• Office on Women's Health www.womenshealth.gov/owh
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References
1 Sram, R.J., Binkova, B., Dejmek, J., et al. (2005). Ambient air pollution
and pregnancy outcomes: a review of literature. Environmental Health
Perspectives, 113 (4): 378-382. Retrieved from: www.ehponline.org/
members/2005/6362/6362.pdf on May 28, 2009
2 Miller, R.L., Garfinkel, R., Morton, M., et al. (2004). Polycyclic aromatic
hydrocarbons, environmental tobacco smoke, and respiratory symptoms
in an inner-city birth cohort. Chest, 126: 1071-1078. Retrieved from: www.
chestjournal.org/content/126/4/1071.full.pdf+html on May 28, 2009.
3 Rauh, V.A., Whyatt, R.M., Garfinkel, R., et al. (2004). Developmental effects
of exposure to environmental tobacco smoke and material hardship among
inner-city children. Neurotoxicology and Teratology, 26(3): 373-85.
4 U.S. Environmental Protection Agency (EPA). (2000). Healthy Indoor Painting
Practices. EPA 744-F-00-011. Retrieved from:
www.epa.gov/oppt/exposure/pubs/inpaint5.pdfonApril 27, 2009.
6 EPA. (2007). Learn About Chemicals Around Your House: Kitchen and
Bathroom. Retrieved from: www.epa.gov/kidshometour/tour.
htm#view on December 31, 2008.
6 Salam, M.I, Millstein, J., Li ,Y, et al. (2005). Birth outcomes and prenatal
exposure to ozone, carbon monoxide, and particulate matter: results
from the children's health study. Environmental Health Perspectives,
113(111:1638-1644.
7 Lacasana, M., Esplugues, A. and F Ballester. (2005). Exposure to ambient
air pollution and prenatal and early childhood health effects. European Journal
of Epidemiology, 20:183-99.
8 U.S. Department of Health and Human Services, Centers for Disease
Control and Prevention (CDC). (2002). Infant mortality and low birth weight
among black and white infants—United States, 1980-2000. Morbidity and
Mortality Weekly Report, 51(271:589-592. Retrieved from: www.cdc.gov/
mmwr/preview/mmwrhtml/mm5127a1.htm on June 12, 2008.
9 Paneth, N.S. (1995). The problem of low birth weight. Future Child, 5(1):
19-34. Retrieved from: http://futureofchildren.org/futureofchildren/
publications/journals/article/index.xml?journalid=60&articleid=370
§ionid=2478 on June 12, 2008.
10 Jaakkola, J.J., Kosheleva, A.A., Katsnelson, B.A., et al. (2006). Prenatal and
postnatal tobacco smoke exposure and respiratory health in Russian children.
Respiratory Research, 7(1): 48. Retrieved from: www.princeton.edu/
futureofchildren/publications/joumals/article/index.xml?journalid=
60&articleid=370§ionid=2477&submit on June 12, 2008.
11 Werler, M. (1997).Teratogen update: smoking and reproductive
outcomes. Teratology, 55:382-88. Retrieved from: http://teratology.org/
updates/55pg382.pdf on June 12, 2008.
12 Bardy, A.H., Seppala.I, Lillsunde, R, et al. (1993). Objectively measured
tobacco exposure during pregnancy: neonatal effects and relation to maternal
smoking. British Journal of Obstetrics and Gyneco/ogy, 100(81:721-6.
13 Jaakkola, J.J. and M. Gissler. (2004). Maternal smoking in pregnancy, fetal
development, and childhood asthma. American Journal of Public Health,
94(1): 136-40. Retrieved from: www.ajph.org/cgi/reprint/94/1/136 on
May 28, 2009.
14 CDC, National Center for Chronic Disease Prevention and Health
Promotion, Office on Smoking and Health. (2006).The health consequences
of involuntary exposure to tobacco smoke: a report of the surgeon general.
Retrieved from: www.surgeongeneral.gov/library/secondhandsmoke
on June 12, 2008.
15 Herrmann, M., King, K. and M. Weitzman. (2008). Prenatal tobacco smoke
and postnatal secondhand smoke exposure and child neurodevelopment.
Current Opinion in Pediatrics, 20(21:184-90.
16 EPA. (2008). Health Effects of Exposure to Secondhand Smoke. Retrieved
from: www.epa.gov/smokefree/healtheffects.html on May 14, 2009.
17 EPA. (2006). Sources of indoor air pollution—carbon monoxide. Retrieved
from: www.epa.gov/iaq/co.htmlADefinition on May 19, 2009.
18 EPA. (2006). Protect your family and yourself from carbon monoxide
poisoning. Retrieved from: www.epa.gov/iaq/pubs/coftsht.html on
May 19, 2009.
19 EPA. (2009). Integrated Science Assessment for Carbon Monoxide (First
External Review Draft). EPA-600-R-09-019. Retrieved from: http://oaspub.
epa.gov/eims/eimscomm.getfile?p_download_id=487236on
May 18, 2009.
20 Di Cera, E., Doyle, M.L., et al. (1989). Carbon monoxide and oxygen binding
to human hemoglobin FO. Biochemistry, 28(6): 2631-2638.
21 Wilhelm, M. and B. Ritz. (2005). Local variations in CO and particulate air
pollution and adverse birth outcomes in Los Angeles County, California, USA.
Environmental Health Perspectives, 113(91:1212-1221. Retrieved from: www.
ehponline.org/members/2005/7751/7751.pdf on May 28, 2009.
22 Bell, M.L., Ebisu, K., and K. Belanger. (2007). Ambient Air Pollution and
Low Birth Weight in Connecticut and Massachusetts. Environmental Health
Perspectives, 115:1118-1125.
23 CDC. (2005). Hurricanes—special population. Effects on pregnant
women—carbon monoxide. Retrieved from: www.cdc.gov/ncbddd/
hurricanes/environmental.htm on May 19, 2009.
24 EPA. (2006). Particulate matter. Retrieved from: www.epa.gov/oar/
particlepollution on May 19, 2009.
25 EPA. National Center for Environmental Assessment-RTP Division (2008).
Integrated Science Assessment for Particulate Matter: First External Review
Draft. Retrieved from: http://cfpub.epa.gov/ncea/cfm/recordisplay.
cfm?deid=201805 on January 27, 2009.
26 EPA. (2003). Ozone: Good Up High, Bad Nearby. EPA-451/K-03-001.
Retrieved from: www.epa.gov/oar/oaqps/gooduphigh/ozone.pdf on
April 9, 2009.
27 EPA. (2009). Ozone Generators that are sold as air cleaners. Retrieved
from: www.epa.gov/iaq/pubs/ozonegen.html on May 20, 2009.
28 Acevedo, S., Bizarro, R, Fortoul.I, Lopez, I., Sanchez, I., and M. Ustarroz.
(2008). Ultrastructural alterations during embryonic rats' lung development
caused by ozone. Journal of Electron Microscopy, 57(11:19-23.
29 Gunnison, AF, Sobo, M., and PA. Weideman. (1992). Enhanced
inflammatory response to acute ozone exposure in rats during pregnancy and
lactation. Fundamental and Applied Toxicology, 19(41:607-12.
30 EPA. (2009). An Introduction to Indoor Air Quality: Volatile Organic
Compounds (VOCs). Retrieved from: www.epa.gov/iaq/voc.html on
December 10, 2009.
31 American Pregnancy Association. Pregnancy and Paint Exposure.
Retrieved from: www.americanpregnancy.org/pregnancyhealth/
paintexposure.html on December 31, 2008.
32 EPA. (2000). Read the Label First! Protect Your Household brochure. EPA
740-F-00-004. Retrieved from: www.epa.gov/pesticides/regulating/
labels/pdf/home.pdf on December 10, 2009.
33 National Institutes of Health. U.S. National Library of Medicine. (2009).
Medline Plus: Household Products. Retrieved from: www.nlm.nih.gov/
medlineplus/householdproducts.html#cat7 on December 10, 2009.
34 Hauser, R. and A.M. Calafat. (2005). Phthalates and Human Health.
Occupational and Environmental Medicine, 62: 806-818. Retrieved from:
http://oem.bmj.com/cgi/reprint/62/11/806 on January 9, 2009.
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