Air pollution during pregnancy induces placental and fetal hypoxia, inflammation, and oxidative stress which may induce adverse pregnancy outcomes

1. Effect of Air Pollution On
Maternal Outcome In
Upper Egypt
by
DR/ Ahmed Ali M. Nasr
Assistant Professor Of Obstetrics & Gynecology,
Faculty Of Medicine, Al–Azhar University

2. ‫يم‬ ِ‫ح‬َّ‫الر‬ ِ‫حمن‬َّ‫الر‬ ‫هللا‬ ِ‫بسم‬
َ‫ي‬َ‫س‬َ‫ف‬ ‫وا‬ُ‫ل‬َ‫م‬ْ‫ع‬‫ا‬ ِ‫ل‬ُ‫ق‬ ‫و‬َ‫ل‬َ‫م‬َ‫ع‬ ُ‫هللا‬ ‫ى‬َ‫ر‬ْ‫م‬ُ‫ك‬
ُ‫ن‬ِ‫ؤم‬ُ‫م‬ْ‫ل‬‫ا‬َ‫و‬ ُ‫ه‬ُ‫ل‬‫و‬ُ‫س‬َ‫ر‬ َ‫و‬ََ‫و‬
‫ا‬ ُ‫هللا‬ َ‫َق‬‫د‬َ‫ص‬‫ي‬ِ‫ظ‬َ‫ع‬ْ‫ل‬‫م‬

3. INTRODUCTION

4. Magnitude of the problem
Mortality: Air pollution is
estimated to cause approximately
two million premature deaths
worldwide per year
(ENVIRONMENTAL PERFORMANCE INDEX,
2012)

5. Morbidity:
• Air pollution has been shown to
elevate risks of cardiovascular and
respiratory diseases (Eder et al. 2009).
• Air pollution during pregnancy
induces placental and fetal
hypoxia, inflammation, and
oxidative stress which may induce
adverse pregnancy outcomes
(Kannan et al.2006).

6. Facts:
• As many processes in the body are mediated
by sex steroids, toxic response is modulated
in a sex–specific way (Keitt et al., 2008).
• In fact female gender is more vulnerable to
toxicants than men as proved by higher
bioavailability of some drugs in women, (Van
der Pol et al., 2008).

7. WHY

8. Explanations
1. Down regulation of plasma
proteins by sex steroids (Morris et
al., 2007)
2. The larger relative fat mass that
allows larger distribution for fat–
soluble substances, as most
environmental chemicals are
highly lipophilic (Kauppinen et al.,
2007).

9. TOXICOLOGICALLY SPEAKING
Female Gender
Is More
Vulnerable To
Toxicants Than
Male
(Van der Pol et al., 2008).

10. According To
Egypt State Of The Environment Report; 2012
Kom- Ombo district of Aswan is one of the most
polluted areas in Upper Egypt caused by sugar factory.
the concentrations of pollutants were several times
over the maximum allowed of The Executive
Regulation Of Environmental Low No.4 Of 1994.
• Sulpher Dioxide (SO2) • Nitrogen Dioxide (NO2)
• Ozone (O3) • Carbon Monoxide (CO)
• Black Smoke • Particulate Matter (PM10)
These pollutants are

11. Aim of the study
This is a case – control study conducted by
Azhar Assiut Obs. & Gyn. Department
in collaboration with
The Egyptian Ministry Of Health
to investigate the effect of Kom–Ombo Cane
Sugar Factory pollutants on maternal outcome

12. Subjects and Methods
600 pregnant women
Group A
(300 patients)
Living within the polluted area
Group B
(300 controls)
Living away from polluted area

13. Results

14. Average concentrations of pollutants (ug/m3)in Kom-
Ombo in relation to the maximum allowed limits
Pollutants
Concentration in
Kom-Ombo
Maximum
allowed limits
Ratio
CO 30 10 3
SO2 89 60 1.5
NO2 43 40 1.1
PM10 278 70 4.1
Black smoke 144 60 2.4
(Egypt state of the environment report; 2012)

15. Maternal Outcome
Maternal
outcome
group A
(Patients)
group B
(Controls)
X2 P
no. % no. %
Anemia 148 49.3% 83 27.67% 29.74 0.000
PIH 83 27.7% 22 7.3% 42.96 0.0000
UTI 155 51.7% 114 38 % 11.3 0.0008
CD 80 26.7% 31 10.3% 26.5 0.0000
PROM 77 25.7% 47 15.7% 9.15 0.0024
PTL 96 32 % 52 17.3% 17.4 0.0000

17. How air pollution
affects
Maternal outcome?

18. The prevalence of anemia in polluted
area is attributed to toxic materials which
lead to significant damage of red blood
cells, reduced hemoglobin concentrations,
number of erythrocytes and hematocrit.
(Nikolić et al., 2008).

19. The prevalence of UTI in polluted area
could be due to impaired immunity caused
by inhalation of PM10
(Williams; 2011).

20. The prevalence of PIH
could be caused by
mechanisms similar to that
of atherosclerotic cardio–
vascular disease as
inflammation, oxidative
stress and endothelial
dysfunction (Brook et al., 2008).

21. The biological effect of air pollution
on respiratory diseases was explained
by pro inflammatory pathways and
the generation of reactive oxygen
species that lead to pulmonary
inflammation, airway obstruction,
and increased susceptibility to
infection and sensitivity to allergens
(Simkhovich et al., 2008).

22. The prevalence of PTL and PROM
could be attributed to CO, SO2 and
PM10 exposure in early and late
pregnancy. The mechanism may be
due to several pathways including
placental hypoxia, fetal hypoxia,
inflammation and oxidative stress
(Knnan et al. 2006)

23. CONCLUSIONS
&
RECOMMENDATIONS

24. This study concluded the presence of
considerable evidence for some adverse
maternal outcomes related to cane sugar
factory pollutants in Kom- Ombo, but was
inconclusive in identifying the most
harmful pollutants and the most
susceptible periods during gestation.

25. Further investigations should be conducted:
• To identify the most vulnerable period of
exposure in pregnancy,
• To specify the contribution of different
pollutants in the adverse outcomes,
• To clarify the biologic pathways involved in
the adverse outcomes, and
• To study the adverse fetal outcomes.

26. THANK YOU
VERY MUCH