Is residential proximity to polluted sites during pregnancy associated with preterm birth or low birth weight? Results from an integrated exposure database in North Carolina (2003–2015)

Background Preterm birth (PTB) and term low birth weight (LBW) have been associated with pollution and other environmental exposures, but the relationship between these adverse outcomes and specific characteristics of polluted sites is not well studied. Objectives We conducted a retrospective cohort study to examine relationships between residential proximity to polluted sites in North Carolina (NC) and PTB and LBW. We further stratified exposure to polluted sites by route of contaminant emissions and specific contaminants released at each site. Methods We created an integrated exposure geodatabase of polluted sites in NC from 2002 to 2015 including all landfills, Superfund sites, and industrial sites. Using birth certificates, we assembled a cohort of 1,494,651 singleton births in NC from 2003 to 2015. We geocoded the gestational parent residential address on the birth certificate, and defined exposure to polluted sites as residence within one mile of a site. We used log-binomial regression models to estimate adjusted risk ratios (aRR) and 95% confidence intervals (CI). Binomial models were used to estimate adjusted risk differences (aRD) per 10,000 births and 95% CIs for associations between exposure to polluted sites and PTB or LBW. Results We observed weak associations between residential proximity to polluted sites and PTB [aRR(95% CI): 1.07(1.06,1.09); aRD(95% CI): 61(48,74)] and LBW [aRR(95% CI): 1.09(1.06,1.12); aRD(95% CI): 24(17,31)]. Secondary analyses showed increased risk of both PTB and LBW among births exposed to sites characterized by water emissions, air emissions, and land impoundment. In analyses of specific contaminants, increased risk of PTB was associated with proximity to sites containing arsenic, benzene, cadmium, lead, mercury, and polycyclic aromatic hydrocarbons. LBW was associated with exposure to arsenic, benzene, cadmium, lead, and mercury. Significance This study provides evidence for potential reproductive health effects of polluted sites, and underscores the importance of accounting for heterogeneity between polluted sites when considering these exposures. Impact statement We documented an overall increased risk of both PTB and LBW in births with gestational exposure to polluted sites using a harmonized geodatabase of three site types, and further examined exposures stratified by site characteristics (route of emission, specific contaminants present). We observed increased risk of both PTB and LBW among births exposed to sites with water emissions or air emissions, across site types. Increased risk of PTB was associated with gestational proximity to sites containing arsenic, benzene, cadmium, lead, mercury, and polycyclic aromatic hydrocarbons; increased risk of LBW was associated with exposure to arsenic, benzene, cadmium, lead, and mercury.