Is there a common mechanism underlying air pollution exposures and reproductive outcomes noted in epidemiologic and in vitro fertilization lab-based studies?


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Volume 109, Issue 1, Page 68


Shruthi Mahalingaiah, M.D., M.S.


Reflections on "Ambient air pollution and the risk of pregnancy loss: a prospective cohort study" by Ha et al.

Read the full text here.

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. 


Go to the profile of Sandie Ha
over 3 years ago

RE: Is there a common mechanism underlying air pollution and reproductive outcomes noted in epidemiologic and IVF lab based studies?

Sandie Ha(1) and Pauline Mendola(2)

1. Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, CA

2. Division of Intramural Population Research, National Institute of Child Health and Human Development, Bethesda, MD

We thank Dr. Mahalingaiah for her commentary (1) on our recent study on the association between air pollution and pregnancy loss (2). Using a prospective cohort design, we evaluated the risk of pregnancy loss in a healthy population without infertility associated with ambient air pollution.  We looked at three time windows including the week prior to ovulation, two weeks before the pregnancy loss, and the average over the whole pregnancy. We found no association with the acute, shorter time windows but average exposure to ozone and fine particulate matter exposure during the whole pregnancy (per interquartile increase) was associated with a 12-13% higher risk of pregnancy loss.

As Dr. Mahalingaiah noted, our study provides evidence on the potential longitudinal impact of air pollution on the intrauterine environment. The strongest evidence for the health effects of air pollution focus on mortality and cardiorespiratory outcome risk (3, 4). The literature on the potential link between air pollution and reproductive health outcomes is more limited and the critical time windows for exposure-outcome relationships are not well described. Longitudinal and chronic effects of exposure, including preconception exposures, are relatively understudied. Our study is among first to demonstrate that the chronic effects of air pollution on reproductive outcomes may be more important than previously thought, and warrant further attention. Given the existing literature on the biologic mechanisms underlying the health effects of air pollution, it is possible that its reproductive health effects also involve similar mechanisms including oxidative stress, systemic inflammation and impaired DNA repair mechanisms (5-7). More mechanistic studies are needed to understand embryo responses to various environmental stressors particularly air pollution, a ubiquitous exposure.  We look forward to the online discussion and welcome your comments.



1.         Mahalingaiah S. Is there a common mechanism underlying air pollution and reproductive outcomes noted in epidemiologic and IVF lab based studies? Fertility and Sterility 2017.

2.         Ha S, Sundaram R, Buck Louis G, Nobles C, Seeni I, Sherman S et al. Ambient air pollution and the risk of pregnancy loss: a prospective cohort study. Fertility and Sterility 2017.

3.         Requia WJ, Adams MD, Arain A, Papatheodorou S, Koutrakis P, Mahmoud M. Global Association of Air Pollution and Cardiorespiratory Diseases: A Systematic Review, Meta-Analysis, and Investigation of Modifier Variables. Am J Public Health 2017:e1-e8.

4.         Zhao L, Liang HR, Chen FY, Chen Z, Guan WJ, Li JH. Association between air pollution and cardiovascular mortality in China: a systematic review and meta-analysis. Oncotarget 2017;8:66438-48.

5.         Li W, Dorans KS, Wilker EH, Rice MB, Ljungman PL, Schwartz JD et al. Short-Term Exposure to Ambient Air Pollution and Biomarkers of Systemic Inflammation: The Framingham Heart Study. Arterioscler Thromb Vasc Biol 2017;37:1793-800.

6.         Nagiah S, Phulukdaree A, Naidoo D, Ramcharan K, Naidoo RN, Moodley D et al. Oxidative stress and air pollution exposure during pregnancy: A molecular assessment. Hum Exp Toxicol 2015;34:838-47.

7.         Slama R, Darrow L, Parker J, Woodruff TJ, Strickland M, Nieuwenhuijsen M et al. Meeting report: atmospheric pollution and human reproduction. Environ Health Perspect 2008;116:791-8.