Examining Joint Effects of Air Pollution Exposure and Social Determinants of Health in Defining "At-Risk" Populations Under the Clean Air Act: Susceptibility of Pregnant Women to Hypertensive Disorders of Pregnancy

被引：42

作者：

Koman, Patricia D. ^{[1
]}

Hogan, Kelly A. ^{[1
,2
,3
]}

Sampson, Natalie ^{[4
]}

Mandell, Rebecca ^{[5
]}

Coombe, Chris M. ^{[6
]}

Tetteh, Myra M. ^{[6
]}

Hill-Ashford, Yolanda R. ^{[7
]}

Wilkins, Donele ^{[8
]}

Zlatnik, Marya G. ^{[9
]}

Loch-Caruso, Rita ^{[10
,11
,12
]}

Schulz, Amy J. ^{[6
,13
,14
]}

Woodruff, Tracey J. ^{[15
,16
,17
]}

机构：

[1] Univ Michigan, Sch Publ Hlth, Dept Environm Hlth Sci, Ann Arbor, MI 48109 USA

[2] Mayo Clin, Dept Biochem & Mol Biol, Rochester, MN USA

[3] Mayo Clin, Robert & Arlene Kogod Ctr Aging, Rochester, MN USA

[4] Univ Michigan Dearborn, Dept Hlth & Human Serv, Dearborn, MI USA

[5] Arbor Res Collaborat Hlth, Ann Arbor, MI USA

[6] Univ Michigan, Sch Publ Hlth, Dept Hlth Behav & Hlth Educ, Ann Arbor, MI 48109 USA

[7] Detroit Hlth Dept, Family & Community Hlth, Detroit, MI USA

[8] Green Door Initiat, Detroit, MI USA

[9] Univ Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, Maternal Fetal Med, San Francisco, CA USA

[10] Univ Michigan, Sch Publ Hlth, Dept Environm Hlth Sci, Toxicol, Ann Arbor, MI 48109 USA

[11] Michigan Ctr Lifestage Environm Exposures & Dis, Ann Arbor, MI USA

[12] Environm Toxicol & Epidemiol Program, Ann Arbor, MI USA

[13] Univ Michigan, Sch Publ Hlth, Ctr Res Ethn Culture & Hlth, Ann Arbor, MI 48109 USA

[14] Univ Michigan, Sch Publ Hlth, Community Engagement Core, Michigan Ctr Lifestage Environm Exposures & Dis, Ann Arbor, MI 48109 USA

[15] Univ Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA USA

[16] Philip R Lee Inst Hlth Policy Studies, San Francisco, CA USA

[17] Program Reprod Hlth & Environm, San Francisco, CA USA

来源：

WORLD MEDICAL & HEALTH POLICY | 2018年 / 10卷 / 01期

关键词：

air pollution; cardiovascular disease; pregnancy;

D O I：

10.1002/wmh3.257

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

Pregnant women are uniquely susceptible to adverse effects of air pollution exposure due to vulnerabilities and health consequences during pregnancy (e.g., hypertensive disorders of pregnancy [HDP]) compared to the general population. Because the Clean Air Act (CAA) creates a duty to protect at-risk groups, the regulatory assessment of at-risk populations has both policy and scientific foundations. Previously, pregnant women have not been specially protected in establishing the margin of safety for the ozone and particulate matter (PM) standards. Due to physiological changes, pregnant women can be at greater risk of adverse effects of air pollution and should be considered an at-risk population. Women with preexisting conditions, women experiencing poverty, and groups that suffer systematic discrimination may be particularly susceptible to cardiac effects of air pollutants during pregnancy. We rigorously reviewed 11 studies of over 1.3 million pregnant women in the United States to characterize the relationship between ozone or PM exposure and HDP. Findings were generally mixed, with a few studies reporting a joint association between ozone or PM and social determinants or pre-existing chronic health conditions related to HDP. Adequate evidence associates exposure to PM with an adverse effect of HDP among pregnant women not evident among non-gravid populations.

引用

页码：7 / 54

页数：48