“Anything else you’re interested in is not going to happen if you can’t breathe the air and drink the water. Don’t sit this one out. Do something. You are by accident of fate alive at an absolutely critical moment in the history of our planet.”

Carl Sagan


We have spent the last two days on The PediaBlog discussing the American Lung Association’s State of the Air — 2018 report and specifically what it means for residents of southwestern Pennsylvania. On Monday, we looked at what is known about the components of air pollution, where they come from, and what they can do to our health. On Tuesday, we examined the air pollution challenges Pittsburgh residents faced “back in the day,” the challenges confronting us today, and the dangers that will be staring directly at us in the not-too-distant future. In their defense of the Clean Power Plan, which the current administration in Washington, DC is in the process of repealing, pediatrician Aparna Bole and founder of Healthcare Without Harm, Gary Cohen, review the damage to children done by air pollution:

In the United States, the annual deaths associated with fine particulate matter alone have been estimated to be as high as 52,000 — more than all the people killed in car accidents each year.

Infants and children are particularly at risk for many reasons. For example, critical phases of lung development begins in the fetal period and continues through the teens. Children also breathe more air per pound of body weight than adults.

Additionally, a growing body of scientific research demonstrates that childhood exposure to pollution from coal-fired power plants has neurologic consequences, including impaired cognitive functioning and reduced verbal and nonverbal IQ, memory, test scores and grade-point averages among school children.

Air pollution also disproportionally threatens pregnant mothers by negatively impacting fetal health and contributing to preterm birth and low birth weight. By delaying action to cut power plant pollution and weakening existing protections, the Trump administration is all but guaranteeing lifelong, harmful consequences for many of our nation’s children.


Just in the last few months alone, the headlines concerning air pollution and children’s health have come fast and furious. For example, a study published in the December edition of the Journal of Pediatrics found that women who were exposed to invisible fine particle pollution (PM2.5 are particles smaller than 2.5 micrometers — 30 times smaller than the diameter of a human hair) right before or right after they became pregnant were more likely to have a baby born with congenital malformations. Lisa Rapaport reports that higher exposures to PM2.5 within a month before or after conception increased the risk:

Certain types of birth defects appeared more strongly connected to air pollution, including abdominal malformations and what’s known as hypospadias, an abnormality in boys that occurs when the opening of the urethra doesn’t develop on the tip of the penis and instead forms on the shaft or on the scrotum.


Preterm exposure to air pollution impacts newborns and young infants in other dramatic ways. In a December article in the British Medical Journal, researchers found in “the largest UK study on air pollution and birth weight” that city traffic (London) adversely affects fetal growth. Even low concentrations of PM2.5 pollution can have profound effects on a developing fetus, reports Nicholas Bakalar, who says the study fails to find a safe level of exposure to air pollution:

The average pollution exposure was 14 micrograms per cubic meter of PM 2.5, the tiny particles that easily enter the smallest airways in the lungs. The researchers found that for each 5 microgram per cubic meter increase in PM 2.5, the risk of low birth weight increased by 15 percent. Low birth weight is a predictor of an increased risk for diabetes, heart disease and hypertension in later life.


The United Nations Children’s Fund (UNICEF) estimates that 2 billion children around the world (that’s 90% of all children) breathe air pollution above guidelines set by the World Health Organization. Damian Carrington says the BMJ study serves as a call to action:

The team said that there are no reliable ways for women in cities to avoid chronic exposure to air pollution during pregnancy and called for urgent action from governments to cut pollution from vehicles and other sources.

“It is an unacceptable situation that there are factors a woman cannot control that adversely affect her unborn baby,” said Mireille Toledano, at Imperial College London, and who led the new research…

Unicef executive director Anthony Lake said: “Not only do pollutants harm babies’ developing lungs – they can permanently damage their developing brains – and, thus, their futures. No society can afford to ignore air pollution.”


Prematurity has also been tied to exposure to particulate matter pollution during pregnancy. Earlier this year, Chinese researchers published a study in JAMA Pediatrics showing it’s the ultra fine particles — 1 micrometer and less — which are more readily inhaled and penetrate into the deepest recesses of the lungs that appear to cause the most damage. And regardless of whether a baby is born prematurely or at term, Susan Scutti says there is new evidence that prenatal exposure to air pollution causes chromosomal damage that ultimately determines a person’s longevity:

Pollution affects us even in the womb: Women who are exposed to air pollution during pregnancy have babies with shorter telomeres (a genetic biomarker), a study published Monday in JAMA Pediatrics found.

The length of telomeres — caps at the end of chromosomes, similar to shoelace tips — is considered a marker of biological aging.

Based on their results, the researchers theorize that pre-birth exposure to air pollution may lead to negative health consequences later in life.


There is new research studying the effects of air pollution after pregnancy on children’s health and we’ll take a look at some of it tomorrow on The PediaBlog.