2023

Author(s): Xue T, Li J, Tong M, Fan X, Li P, Wang R, Li Y, Zheng Y, Li J, Guan T, Zhu T

Due to global warming, an increased number of open fires is becoming a major contributor to PM(2.5) pollution and thus a threat to public health. However, the burden of stillbirths attributable to fire-sourced PM(2.5) is unknown. In low- and middle-income countries (LMICs), there is a co-occurrence of high baseline stillbirth rates and frequent firestorms, which may lead to a geographic disparity. Across 54 LMICs, we conducted a self-matched case-control study, making stillbirths comparable to the corresponding livebirths in terms of time-invariant characteristics (e.g., genetics) and duration of gestational exposure. We established a joint-exposure-response function (JERF) by simultaneously associating stillbirth with fire- and non-fire-sourced PM(2.5) concentrations, which were estimated by fusing multi-source data, such as chemical transport model simulations and satellite observations. During 2000-2014, 35,590 pregnancies were selected from multiple Demographic and Health Surveys. In each mother, a case of stillbirth was compared to her livebirth(s) based on gestational exposure to fire-sourced PM(2.5). We further applied the JERF to assess stillbirths attributable to fire-sourced PM(2.5) in 136 non-Western countries. The disparity was evaluated using the Gini index. The risk of stillbirth increased by 17.4% (95% confidence interval [CI]: 1.6-35.7%) per 10 μg/m(3) increase in fire-sourced PM(2.5). In 2014, referring to a minimum-risk exposure level of 10 μg/m(3), total and fire-sourced PM(2.5) contributed to 922,860 (95% CI: 578,451-1,183,720) and 49,951 (95% CI: 3,634-92,629) stillbirths, of which 10% were clustered within the 6.4% and 0.6% highest-exposure pregnancies, respectively. The Gini index of stillbirths attributable to fire-sourced PM(2.5) was 0.65, much higher than for total PM(2.5) (0.28). Protecting pregnant women against PM(2.5) exposure during wildfires is critical to avoid stillbirths, as the burden of fire-associated stillbirths leads to a geographic disparity in maternal health.

DOI: https://dx.doi.org/10.1016/j.envpol.2023.122170