{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T08:21:43Z","timestamp":1790670103576,"version":"4.1.0"},"reference-count":29,"publisher":"BMJ","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Occup Environ Med"],"published-print":{"date-parts":[[1999,8]]},"abstract":"<jats:p>OBJECTIVES: Outdoor air pollution has consistently been shown to predict mortality. The finding that this association is stronger in infants than in children or adults raises the question whether air pollution could also be related to pregnancy outcomes--such as birthweight and stillbirth. The association between outdoor air pollution and stillbirths and low birthweight in the Czech Republic, where air pollution was high, was examined. METHODS: An ecological study was conducted, with routinely collected data on stillbirths and low birthweight (&lt; 2500 g), air pollution (total suspended particulates, sulphur dioxide (SO2), and nitrogen oxides (NOx)), and socioeconomic factors (mean income, car ownership, divorce rate, etc). The analyses were restricted to 45 districts on which data on air pollution were available for the period 1986-8. The effects of exposure variables on frequency of pregnancy outcomes were estimated by logistic regression with district-years as the units of analysis. RESULTS: Stillbirth rate (4.2\/1000 births in monitored districts) was not significantly associated with any indicator of air pollution, and was weakly related to mean income and proportion of births outside marriage. Crude prevalence of low birthweight (prevalence 5.5%) showed highly significant associations with several socioeconomic factors; after controlling for these, odds ratios (ORs)\/50 micrograms\/m3 increase in pollutant were: 1.04 (95% confidence interval (95% CI) 0.96 to 1.12) for total suspended particles, 1.10 (1.02 to 1.17) for SO2, and 1.07 (0.98 to 1.16) for NOx. When all pollutants were included in one model, SO2 remained related to low birthweight (OR 1.10 (1.01 to 1.20), p = 0.033). CONCLUSION: These results are consistent with a recent study in China where birthweight was also associated with total suspended particles and SO2 but ecological studies must be interpreted cautiously. Residual confounding by socioeconomic factors cannot be ruled out. The association between air pollution and birthweight requires further investigation.<\/jats:p>","DOI":"10.1136\/oem.56.8.539","type":"journal-article","created":{"date-parts":[[2009,1,1]],"date-time":"2009-01-01T00:13:30Z","timestamp":1230768810000},"page":"539-543","source":"Crossref","is-referenced-by-count":127,"title":["Pregnancy outcomes and outdoor air pollution: an ecological study in districts of the Czech Republic 1986-8."],"prefix":"10.1136","volume":"56","author":[{"given":"M","family":"Bobak","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D A","family":"Leon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1999,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1093\/oxfordjournals.aje.a115473","article-title":"Mortality and air pollution in London: a time series analysis","volume":"131","author":"Schwartz, J.; Marcus, A.","year":"1990","unstructured":"Schwartz J, Marcus A. Mortality and air pollution in London: a time series analysis. Am J Epidemiol 1990;131:185\u201394.","journal-title":"Am J Epidemiol"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1093\/ije\/23.5.957","article-title":"Short-term eVects of air pollution on daily mortaity in Athens: a timeseries analysis","volume":"23","author":"Touloumi, G.; Pocock, S.J.; Katsouyanni, K.","year":"1994","unstructured":"Touloumi G, Pocock SJ, Katsouyanni K, et al. Short-term eVects of air pollution on daily mortaity in Athens: a timeseries analysis. Int J Epidemiol 1994;23:957\u201367.","journal-title":"Int J Epidemiol"},{"key":"ref_3","article-title":"Particulate air pollution and daily mortality. Replication and validation of selected studies. The phase I report of the particle epidemiology evaluation project","author":"Health EVects Institute","year":"1995","unstructured":"Health EVects Institute. Particulate air pollution and daily mortality. Replication and validation of selected studies. The phase I report of the particle epidemiology evaluation project. Cambridge, MA: Health EVects Institute, 1995."},{"key":"ref_4","first-page":"53","article-title":"Cross-sectional mortality and air pollution risk assessment","volume":"10","author":"Evans, J.S.; Tosteson, T.; Kinney, P.L.","year":"1984","unstructured":"Evans JS, Tosteson T, Kinney PL. Cross-sectional mortality and air pollution risk assessment. Environ Int 1984;10:53\u2013 83.","journal-title":"Environ Int"},{"key":"ref_5","article-title":"Air pollution and human health","author":"Lave, L.B.; Seskin, E.P.","year":"1977","unstructured":"Lave LB, Seskin EP. Air pollution and human health. Baltimore: John Hopkins University Press, 1977."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1016\/0140-6736(92)93017-H","article-title":"Air pollution and infant mortality in the Czech Republic, 1986\u201388","volume":"340","author":"Bobak, M.; Leon, D.A.","year":"1992","unstructured":"Bobak M, Leon DA. Air pollution and infant mortality in the Czech Republic, 1986\u201388. Lancet 1992;340:1010\u201314.","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1146\/annurev.pu.15.050194.000543","article-title":"Acute respiratory eVects of particulate air pollution","volume":"15","year":"1994","unstructured":"Dockery DW, Pope III CA. Acute respiratory eVects of particulate air pollution. Ann Rev Public Health 1994;15:107\u2013 32.","journal-title":"Ann Rev Public Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1006\/enrs.1994.1033","article-title":"Association between air pollution and mortality due to respiratory diseases in children in Sao Paulo, Brazil: a preliminary report","volume":"65","author":"Saldiva, P.H.N.; Lichtenfels, A.J.F.C.; Paiva, P.S.O.","year":"1994","unstructured":"Saldiva PHN, Lichtenfels AJFC, Paiva PSO, et al. Association between air pollution and mortality due to respiratory diseases in children in Sao Paulo, Brazil: a preliminary report. Environ Res 1994;65:218\u201325.","journal-title":"Environ Res"},{"key":"ref_9","first-page":"161","article-title":"Urbanization and the environmental risk transition","volume-title":"world cities. Problems, policies, and prospects","author":"Smith, K.R.; Lee, Y.-S.F.","year":"1992","unstructured":"Smith KR, Lee Y-SF. Urbanization and the environmental risk transition. In: Kasarda JD, Parnell AM, eds. Third world cities. Problems, policies, and prospects. London: Sage, 1992:161\u201382."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1136\/jech.48.3.237","article-title":"Is living near a coking works harmful to health? A study of industrial air pollution","volume":"48","author":"Bhopal, R.S.; Phillimore, P.; MoVatt, S.","year":"1994","unstructured":"Bhopal RS, Phillimore P, MoVatt S, et al. Is living near a coking works harmful to health? A study of industrial air pollution. J Epidemiol Community Health 1994;48:237\u201347.","journal-title":"J Epidemiol Community Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1289\/ehp.97105514","article-title":"Association between air pollution and low birthweight: a community based study","volume":"105","author":"Wang, X.; Ding, H.; Ryan, L.","year":"1997","unstructured":"Wang X, Ding H, Ryan L, et al. Association between air pollution and low birthweight: a community based study. Environ Health Perspect 1997;105:514\u201320.","journal-title":"Environ Health Perspect"},{"key":"ref_12","article-title":"Ministry of Environment of the Czech Republic. Zivotni prostredi Ceske republiky. (Environment in the Czech Republic)","year":"1990","unstructured":"Ministry of Environment of the Czech Republic. Zivotni prostredi Ceske republiky. (Environment in the Czech Republic). Prague: Academia, 1990."},{"key":"ref_13","author":"World Health Organization. Air quality guidelines for Europe","year":"1987","unstructured":"World Health Organization. Air quality guidelines for Europe. Copenhagen: WHO Regional OYce for Europe, 1987."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1093\/oxfordjournals.aje.a114892","article-title":"The ecological fallacy","volume":"127","author":"Piantadosi, S.; Byar, D.P.; Green, S.B.","year":"1988","unstructured":"Piantadosi S, Byar DP, Green SB. The ecological fallacy. Am J Epidemiol 1988;127:893\u2013904.","journal-title":"Am J Epidemiol"},{"key":"ref_15","article-title":"Atlas of disease distributions. Analytical approaches to epidemiological data","author":"CliV, A.D.; Haggett, P.","year":"1988","unstructured":"CliV AD, Haggett P. Atlas of disease distributions. Analytical approaches to epidemiological data. Oxford: Blackwell, 1988."},{"key":"ref_16","article-title":"Epidemiologic research. Principles and quantitative methods","author":"Kleinbaum, D.G.; Kupper, L.L.; Morgenstern, H.","year":"1982","unstructured":"Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic research. Principles and quantitative methods. New York: Van Nostrand Reinhold, 1982."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1016\/0895-4356(91)90155-3","article-title":"How independent are \u201cindependent\u201d eVects? Relative risk estimation when correlated exposures are measured imprecisely","volume":"44","author":"Phillips, A.N.; Davey Smith, G.","year":"1991","unstructured":"Phillips AN, Davey Smith G. How independent are \u201cindependent\u201d eVects? Relative risk estimation when correlated exposures are measured imprecisely. J Clin Epidemiol 1991;44:1223\u201331.","journal-title":"J Clin Epidemiol"},{"key":"ref_18","article-title":"Inequalities in health: The Black report; The health divide","author":"Black, D.; Morris, J.N.; Smith, C.","year":"1992","unstructured":"Black D, Morris JN, Smith C, et al. Inequalities in health: The Black report; The health divide. London: Penguin Group, 1992."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1111\/j.1471-0528.1990.tb01788.x","article-title":"Socio-economic and ethnic factors in stillbirth and neonatal mortality in North-East Thames Regional Health Authority 1983","volume":"97","author":"Parsons, L.; Duley, L.; Alberman, E.","year":"1990","unstructured":"Parsons L, Duley L, Alberman E. Socio-economic and ethnic factors in stillbirth and neonatal mortality in North-East Thames Regional Health Authority 1983. Br J Obstet Gynaecol 1990;97:237\u201344.","journal-title":"Br J Obstet Gynaecol"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1177\/140349489302100206","article-title":"Social diVerences in reproductive health. A study on birthweight, stillbirths and congenital malformations in Denmark","volume":"21","author":"Olsen, J.; Frische, G.","year":"1993","unstructured":"Olsen J, Frische G. Social diVerences in reproductive health. A study on birthweight, stillbirths and congenital malformations in Denmark. Scand J Soc Med 1993;21:90\u20137.","journal-title":"Scand J Soc Med"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1097\/00001648-199503000-00005","article-title":"Maternal smoking, alcohol drinking, caVeine consumption, and fetal growth: results from a prospective study","volume":"6","author":"Xiao, O.S.; Hatch, M.C.; Mills, J.","year":"1995","unstructured":"Xiao OS, Hatch MC, Mills J, et al. Maternal smoking, alcohol drinking, caVeine consumption, and fetal growth: results from a prospective study. Epidemiology 1995;6:115\u2013 20.","journal-title":"Epidemiology; 20"},{"key":"ref_22","first-page":"414","article-title":"Epidemiology of preterm birth","volume":"15","author":"Berkowitz, G.S.; Papiernik, E.","year":"1993","unstructured":"Berkowitz GS, Papiernik E. Epidemiology of preterm birth. Epidemiol Res 1993;15:414\u201343.","journal-title":"Epidemiol Res"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1016\/0002-9378(92)91628-N","article-title":"A review of premature birth and subclinical infection","volume":"166","author":"Gibbs, R.S.; Romero, R.; Hillier, S.L.","year":"1992","unstructured":"Gibbs RS, Romero R, Hillier SL, et al. A review of premature birth and subclinical infection. Am J Obstet Gynecol 1992;166:1515\u201328.","journal-title":"Am J Obstet Gynecol"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1016\/S0140-6736(97)01211-7","article-title":"Increased plasma viscosity during an air pollution episode: a link to mortality?","volume":"349","author":"Peters, A.; Doering, A.; Wichmann, H.E.","year":"1997","unstructured":"Peters A, Doering A, Wichmann HE, et al. Increased plasma viscosity during an air pollution episode: a link to mortality? Lancet 1997;349:1582\u20137.","journal-title":"Lancet"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/0028-2243(87)90098-0","article-title":"The influence of maternal whole blood viscosity on fetal growth","volume":"25","author":"Zondervan, H.A.; Oosting, J.; Hardeman, M.R.","year":"1987","unstructured":"Zondervan HA, Oosting J, Hardeman MR, et al. The influence of maternal whole blood viscosity on fetal growth. Eur J Obstet Gynecol Reprod Biol 1987;25:187\u201394.","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1038\/360256a0","article-title":"Molecular and genetic damage in humans from environmental pollution in Poland","volume":"360","author":"Perera, F.P.; Hemminki, K.; Gryzbowska, E.","year":"1992","unstructured":"Perera FP, Hemminki K, Gryzbowska E, et al. Molecular and genetic damage in humans from environmental pollution in Poland. Nature 1992;360:256\u20138.","journal-title":"Nature"},{"key":"ref_27","first-page":"4122","article-title":"Serum antibodies to benzo(a)pyrene diol epoxide-DNA adducts in the general population: eVects of air pollution, tobacco smoking, and family history of lung diseases","volume":"58","author":"Petruzzelli, S.; Celi, A.; Pulera, N.","year":"1998","unstructured":"Petruzzelli S, Celi A, Pulera N, et al. Serum antibodies to benzo(a)pyrene diol epoxide-DNA adducts in the general population: eVects of air pollution, tobacco smoking, and family history of lung diseases. Cancer Res 1998;58:4122\u20136.","journal-title":"Cancer Res"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1002\/(SICI)1098-2280(1997)30:2<184::AID-EM11>3.0.CO;2-9","article-title":"Influence of GSTM1 and NAT2 genotypes on placental DNA adducts in an environmentally exposed population","volume":"30","author":"Topinka, J.; Binkova, B.; Mrackova, G.","year":"1997","unstructured":"Topinka J, Binkova B, Mrackova G, et al. Influence of GSTM1 and NAT2 genotypes on placental DNA adducts in an environmentally exposed population. Environ Mol Mutagen 1997;30:184\u201395.","journal-title":"Environ Mol Mutagen"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1093\/oxfordjournals.aje.a009451","article-title":"Recent developments in molecular epidemiology: a study of the eVects of environmental polycyclic aromatic hydrocarbons on birth outcomes in Poland","volume":"147","author":"Perera, F.P.; Whyatt, R.M.; Jedrychowski, W.","year":"1998","unstructured":"Perera FP, Whyatt RM, Jedrychowski W, et al. Recent developments in molecular epidemiology: a study of the eVects of environmental polycyclic aromatic hydrocarbons on birth outcomes in Poland. Am J Epidemiol 1998;147:309\u2013 14.","journal-title":"Am J Epidemiol"}],"container-title":["Occupational and Environmental Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/oem.56.8.539","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T17:17:47Z","timestamp":1716484667000},"score":1,"resource":{"primary":{"URL":"https:\/\/oem.bmj.com\/lookup\/doi\/10.1136\/oem.56.8.539"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1999,8]]},"references-count":29,"journal-issue":{"issue":"8","published-online":{"date-parts":[[1999,8,1]]},"published-print":{"date-parts":[[1999,8]]}},"alternative-id":["10.1136\/oem.56.8.539"],"URL":"https:\/\/doi.org\/10.1136\/oem.56.8.539","relation":{},"ISSN":["1351-0711","1470-7926"],"issn-type":[{"value":"1351-0711","type":"print"},{"value":"1470-7926","type":"electronic"}],"subject":[],"published":{"date-parts":[[1999,8]]}}}