Prenatal Ambient Air Pollutant Mixture Exposure and Early School-age Lung Function

Hsiao Hsien Leon Hsu, Ander Wilson, Joel Schwartz, Itai Kloog, Robert O. Wright, Brent A. Coull, Rosalind J. Wright

Research output: Contribution to journalArticlepeer-review


Introduction: Research linking prenatal ambient air pollution with childhood lung function has largely considered one pollutant at a time. Real-life exposure is to mixtures of pollutants and their chemical components; not considering joint effects/effect modification by co-exposures contributes to misleading results. Methods: Analyses included 198 mother-child dyads recruited from two hospitals and affiliated community health centers in Boston, Massachusetts, USA. Daily prenatal pollutant exposures were estimated using satellite-based hybrid chemical-transport models, including nitrogen dioxide(NO2), ozone(O3), and fine particle constituents (elemental carbon [EC], organic carbon [OC], nitrate [NO3-], sulfate [SO42-], and ammonium [NH4+]). Spirometry was performed at age 6.99 ± 0.89 years; forced expiratory volume in 1s (FEV1), forced vital capacity (FVC), and forced mid-expiratory flow (FEF25-75) z-scores accounted for age, sex, height, and race/ethnicity. We examined associations between weekly-averaged prenatal pollution mixture levels and outcomes using Bayesian Kernel Machine Regression-Distributed Lag Models (BKMR-DLMs) to identify susceptibility windows for each component and estimate a potentially complex mixture exposure-response relationship including nonlinear effects and interactions among exposures. We also performed linear regression models using time-weighted-mixture component levels derived by BKMR-DLMs adjusting for maternal age, education, perinatal smoking, and temperature. Results: Most mothers were Hispanic (63%) or Black (21%) with ≤12 years of education (67%). BKMR-DLMs identified a significant effect for O3exposure at 18-22 weeks gestation predicting lower FEV1/FVC. Linear regression identified significant associations for O3,NH4+, and OC with decreased FEV1/FVC, FEV1, and FEF25-75, respectively. There was no evidence of interactions among pollutants. Conclusions: In this multi-pollutant model, prenatal O3, OC, and NH4+were most strongly associated with reduced early childhood lung function.

Original languageEnglish
Pages (from-to)E249
JournalEnvironmental Epidemiology
Issue number2
StatePublished - 4 Apr 2023
Externally publishedYes


  • Lung function
  • Mixture
  • Multi-pollutant
  • Prenatal exposure
  • spirometry

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health
  • Pollution
  • Health, Toxicology and Mutagenesis
  • Epidemiology
  • Global and Planetary Change


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