• Marie Pedersen, Lise Giorgis-Allemand, Claire Bernard, Inmaculada Aguilera, Anne-Marie Nybo Andersen, Ferran Ballester, Rob M J Beelen, Leda Chatzi, Marta Cirach, Asta Danileviciute, Audrius Dedele, Manon van Eijsden, Marisa Estarlich, Ana Fernández-Somoano, Mariana F Fernández, Francesco Forastiere, Ulrike Gehring, Regina Grazuleviciene, Olena Gruzieva, Barbara Heude, Gerard Hoek, Kees de Hoogh, Edith H van den Hooven, Siri E Håberg, Vincent W V Jaddoe, Claudia Klümper, Michal Korek, Ursula Krämer, Aitana Lerchundi, Johanna Lepeule, Per Nafstad, Wenche Nystad, Evridiki Patelarou, Daniela Porta, Dirkje Postma, Ole Raaschou-Nielsen, Peter Rudnai, Jordi Sunyer, Euripides Stephanou, Mette Sørensen, Elisabeth Thiering, Derek Tuffnell, Mihály J Varró, Tanja G M Vrijkotte, Alet Wijga, Michael Wilhelm, John Wright, Mark J Nieuwenhuijsen, Göran Pershagen, Bert Brunekreef, Manolis Kogevinas, and Rémy Slama.
• Centre for Research in Environmental Epidemiology, Barcelona, Spain; Centros de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid, Spain; INSERM, U823, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute Albert Bonniot, Grenoble, France. Electronic address: mpedersen@creal.cat.
• Lancet Respir Med. 2013 Nov 1;1(9):695-704.

BackgroundAmbient air pollution has been associated with restricted fetal growth, which is linked with adverse respiratory health in childhood. We assessed the effect of maternal exposure to low concentrations of ambient air pollution on birthweight.MethodsWe pooled data from 14 population-based mother-child cohort studies in 12 European countries. Overall, the study population included 74 178 women who had singleton deliveries between Feb 11, 1994, and June 2, 2011, and for whom information about infant birthweight, gestational age, and sex was available. The primary outcome of interest was low birthweight at term (weight <2500 g at birth after 37 weeks of gestation). Mean concentrations of particulate matter with an aerodynamic diameter of less than 2·5 μm (PM2·5), less than 10 μm (PM10), and between 2·5 μm and 10 μm during pregnancy were estimated at maternal home addresses with temporally adjusted land-use regression models, as was PM2·5 absorbance and concentrations of nitrogen dioxide (NO2) and nitrogen oxides. We also investigated traffic density on the nearest road and total traffic load. We calculated pooled effect estimates with random-effects models.FindingsA 5 μg/m(3) increase in concentration of PM2·5 during pregnancy was associated with an increased risk of low birthweight at term (adjusted odds ratio [OR] 1·18, 95% CI 1·06-1·33). An increased risk was also recorded for pregnancy concentrations lower than the present European Union annual PM2·5 limit of 25 μg/m(3) (OR for 5 μg/m(3) increase in participants exposed to concentrations of less than 20 μg/m(3) 1·41, 95% CI 1·20-1·65). PM10 (OR for 10 μg/m(3) increase 1·16, 95% CI 1·00-1·35), NO2 (OR for 10 μg/m(3) increase 1·09, 1·00-1·19), and traffic density on nearest street (OR for increase of 5000 vehicles per day 1·06, 1·01-1·11) were also associated with increased risk of low birthweight at term. The population attributable risk estimated for a reduction in PM2·5 concentration to 10 μg/m(3) during pregnancy corresponded to a decrease of 22% (95% CI 8-33%) in cases of low birthweight at term.InterpretationExposure to ambient air pollutants and traffic during pregnancy is associated with restricted fetal growth. A substantial proportion of cases of low birthweight at term could be prevented in Europe if urban air pollution was reduced.FundingThe European Union.Copyright © 2013 Elsevier Ltd. All rights reserved.

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