Breathing New Life into Air Pollution Research: Examining the Link Between Air Pollution and Adverse Birth Outcomes in the Eastern Mediterranean Region (EMR)

Abstract Study question What is the current understanding of the relationship between air pollution and perinatal health in the EMR? Summary answer The literature on exposure to air pollutants and perinatal health in the EMR is scarce, limited in scope, and using simply study designs and methods. What is known already Air pollution is a significant public health concern in the Eastern Mediterranean Region, due to many factors such as the arid nature of the region, rapid urbanization, oil production, and the emissions from the transportation, energy productions, and other practices. Not only can the degradation in air quality put the health of infants in jeopardy but it can also increase the risk of adverse pregnancy outcomes. Studies on air pollution and birth outcomes and early life development have been conducted in other parts of the world, but only a small number have been conducted in the EMR. Study design, size, duration The authors conducted a comprehensive search of various databases to identify relevant studies and publications on the topic. The findings were then critically evaluated and discussed in relation to the current understanding of the relationship between air pollution and perinatal health in the EMR. The study does not include any new data collection or primary research. The authors used a narrative approach to synthesize the existing literature on the topic. Participants/materials, setting, methods Not applicable Main results and the role of chance The existing literature is concentrated in specific geographic locations out of the 22 countries and territories that comprise the region, and it is focused on a limited number of exposures and outcomes, namely secondhand smoking and criteria air pollutants. The main gaps include the inconsistent and poorly funded air quality monitoring, inappropriate study designs, imprecise and/or unreliable assessments of exposures and outcomes, and the focus on traditional air pollutants rather than new emerging and increasingly concerning air pollutants. Moreover, even though the studies establish associations between air pollutants and adverse birth outcomes, the mechanisms through which these processes take place are yet to be fully understood. An area of research that holds great potential in explaining these processes is epigenetics; however, due to limited funding, expertise and health and environmental data, epigenetic research on the impact of air pollution in the EMR is still in its infancy. Limitations, reasons for caution The review is based on a narrative approach, which is subjective and may not be as rigorous as a systematic review. The reviewed studies also have their own limitations, such as inconsistent air quality monitoring and imprecise assessments of exposures and outcomes. Studies focused on epigenetics in EMR are scarce. Wider implications of the findings The review highlights the need for future research examining the epigenetic processes that underlie the adverse birth outcomes, to better understand them and to develop effective recommendations and intervention strategies. Trial registration number Not applicable