Environmental exposure and its impact on fetal growth

 Dr. Hagai Levine, M.D., M.P.H.
Public Health Physician and Epidemiologist, Braun School of Public Health, Hadassah

Exposure of air pollution and environmental insults to pregnant women can cause a negative impact on the vulnerable growing fetus in many ways such as poor growth and development, cardiovascular and respiratory diseases, congenital anomalies, behavioral and cognitive deficiencies, asthma, obesity and epigenetic (hereditary) impact in future generations, and could also lead to premature birth and pregnancy loss. Indeed, air pollution is a well-established risk factor to human health. In spite of this serious health hazard engendered by toxic air pollutants, the mechanism and impact are largely unknown and current standards for air pollution may not be strict enough to protect the fetus.

Dr. Hagai Levine, a public health physician and environmental epidemiologist, is undertaking a very large prospective study in Haifa (representing ~5,000 pregnant women), a congested city with industrial activity and Rehovot-Rishon Lezion (another ~5,000) as a control. This investigation will assess the relationship of environmental exposures (air pollution, air temperature, greenness, etc.) and fetal outcome at different stages of pregnancy among Maccabi HMO pregnant women residing in the relevant areas. Israel is an ideal place to conduct this investigation for several reasons: it is a small country and its inhabitants do not tend to move to other places, allowing the researchers to have full access to their residence for monitoring personal and indoor exposure to air pollution and follow-up; universal health coverage so it is a population-based study easily accessible for full outcome assessment. This investigation has all the elements to become successful – it is a multidisciplinary team partnering with several universities in Israel from a wide range of disciplines including epidemiologists, geographers, physicians, gynecologists, pediatricians, experts in health community and policy and statisticians. For example, Dr. Kloog, a geographer from Ben Gurion Univ. of the Negev, will use an optical density model to obtain satellite data with very high spatial resolution of less than one kilometer of the polluted area. Dr. Levine and his research team will evaluate and compare multiple environmental exposures at the individual level and associations between them and examine whether differences in environmental exposures on the individual level during different stages of pregnancy are independently associated with fetal growth. In a sub-sample of 150 women, at different stages of pregnancy, field studies will have the women fitted with portable air monitors to assess indoor and outdoor levels of pollution. In addition, blood and urine samples from both the mothers and fathers will also be analyzed for levels of chemicals.

This comprehensive and multidisciplinary investigation carried out by Dr. Levine involves different experts in the field of air pollution and its effect on fetal development and will underscore the need for policy makers to take appropriate steps to protect the growing fetus from these avoidable exposures. This study will also measure the impact of particles from dust storms, usually frequent in Israel and is relevant to other nations. Other cities throughout the world with high pollution could emulate this research model in Israel since this project is composed of many kinds of solutions that can be scaled up around the world. Active support for this important investigation can help extend the research in time, space and numbers and bring solutions and warning that can serve as a health data infrastructure to protect current and future generations from environmental risks. It is absolutely important that the bold yet pragmatic steps undertaken by Dr. Levine are a remarkable example for the world to emulate to foster a global culture of air pollution action and its tragic effect on health.