Exposure to traffic-related air pollution and the risk of premature rupture of membranes: a cohort analysis of the Korean CHildren’s ENvironmental health Study (Ko-CHENS)

Premature rupture of membranes (PROM) is a common and consequential childbirth complication. Although several studies suggest that air pollution may elevate PROM risk, the evidence remains limited. We therefore examined the association between traffic-related air pollutants, other ambient pollutants, and PROM in a prospective mother-child cohort. We analyzed 4096 mother-child pairs enrolled in the Korean CHildren's ENvironmental health Study (Ko-CHENS) core cohort. Ambient exposures to particulate matter (PM<sub>2.5</sub> and PM<sub>10</sub>), sulfur dioxide (SO<sub>2</sub>), nitrogen dioxide (NO<sub>2</sub>), ozone (O<sub>3</sub>), and carbon monoxide (CO) were estimated using geostatistical kriging based on residential addresses recorded during pregnancy. PROM was identified from medical records completed by hospital clinicians at delivery. We fitted multivariable generalized linear mixed models with regional-level random effects, adjusting for potential confounders. PROM occurred in 4.0% of participants. PM<sub>2.5</sub> exposure throughout pregnancy was associated with increased PROM risk (odds ratio (OR) = 1.48, 95% confidence interval (CI) = 1.07-2.05) per interquartile-range increase (3.92 µg/m<sup>3</sup>). Compared with the lowest quartile, the 2nd, 3rd, and 4th quartiles of PM<sub>2.5</sub> were associated with ORs of 2.23 (95% CI = 1.30-3.84), 2.47 (95% CI = 1.42-4.33), and 2.48 (95% CI = 1.32-4.67), respectively. Elevated NO<sub>2</sub> exposure during the 2nd trimester (highest vs. lowest quartile) was also linked to higher PROM odds (OR = 2.31, 95% CI = 1.09-4.89). Residence in areas with very high traffic volume was associated with PROM (OR = 1.83, 95% CI = 1.06-3.16). Our findings indicate that traffic-related air pollutants, including PM<sub>2.5</sub> and NO<sub>2</sub>, contribute to a higher risk of PROM. These results support the need for environmental policies targeting reductions in traffic-related emissions, particularly PM<sub>2.5</sub> and NO<sub>2</sub>, to help prevent PROM and promote maternal health.

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Journal
Environmental Science and Pollution Research
Published
2026-03-27
DOI
https://doi.org/10.1007/s11356-026-37637-8
Primary Topic
Air Quality and Health Impacts
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article
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article

Exposure to traffic-related air pollution and the risk of premature rupture of membranes: a cohort analysis of the Korean CHildren’s ENvironmental health Study (Ko-CHENS)

Wonsuck Yoon, A Ram Kim, Hoon Kook, Seung‐Ah Choe et al.
Environmental Science and Pollution Research
Air Quality and Health Impacts
article

Exposure to traffic-related air pollution and the risk of premature rupture of membranes: a cohort analysis of the Korean CHildren’s ENvironmental health Study (Ko-CHENS)

Wonsuck Yoon, A Ram Kim, Hoon Kook, Seung‐Ah Choe, K. S. Lee, Baek-Yong Choi, Sunghun Na, Jongil Hur, Seung-Woo Ryoo, Seunghyun Kim, Sanghwan Song, Suejin Kim, 양원호, Hyun Jeong Kim, M. Park, JungHeum Jo, Seung-Hwa Lee, Yi‐Jun Kim, Changsun Sim, Ji Tae Choung, Huibyeol Park, Ki-Chung Paik, Jeong Hee Kim, Jisuk Bae, Seok‐Ju Yoo, Heung Won Seo, Keun Hwa Lee, Kwan Woo Lee, Dong‐Wook Lee, Jihyun Kim, Soon-Won Jung, Suyoung Kim, Jongmin Oh, Dae-Hyun Lim, Kangmo Ahn, Ji-Hyeon Lee, Surabhi Suresh Shah, Won Ju Park, A-Ra Jung, Eunhee Ha, Young-Soub Hong, Woo‐Jin Kim, Seung Do Yu, Hyesook Kim, Myung-Ho Lim, Jai Dong Moon, Namkyoung Hwang, Dong Jin Jeong, Hee Jo Baek, Sung-Chul Hong, Hwan-Cheol Kim, Sanghyuk Bae, Seok-Yoon Son, Sukyung Kim, Kuck-Hyeun Woo, Mi-Hye Park, Jue-Seong Lee, Jueun Lee, Jiho Lee, Byungmi Kim, Sooyeon Hong, Sung-Yong Choi, Inbo Oh, Kim Seong Su, Kyoung Sook Jeong, Young Yoo, Dae-Jin Song, Choonghee Park, Yoon-Seong Yong, Seulbi Lee, Yun-Chul Hong, Myoung-Nam Lim, Myung-Geun Shin, Seung Jin Yoo, the Ko-CHENS Study Group, Jin-Kyung Kim, Kyung-Hwa Choi, Ho-Jang Kwon, Hyunjin Son, Yu-Mi Kim
article en

Abstract

Premature rupture of membranes (PROM) is a common and consequential childbirth complication. Although several studies suggest that air pollution may elevate PROM risk, the evidence remains limited. We therefore examined the association between traffic-related air pollutants, other ambient pollutants, and PROM in a prospective mother-child cohort. We analyzed 4096 mother-child pairs enrolled in the Korean CHildren's ENvironmental health Study (Ko-CHENS) core cohort. Ambient exposures to particulate matter (PM<sub>2.5</sub> and PM<sub>10</sub>), sulfur dioxide (SO<sub>2</sub>), nitrogen dioxide (NO<sub>2</sub>), ozone (O<sub>3</sub>), and carbon monoxide (CO) were estimated using geostatistical kriging based on residential addresses recorded during pregnancy. PROM was identified from medical records completed by hospital clinicians at delivery. We fitted multivariable generalized linear mixed models with regional-level random effects, adjusting for potential confounders. PROM occurred in 4.0% of participants. PM<sub>2.5</sub> exposure throughout pregnancy was associated with increased PROM risk (odds ratio (OR) = 1.48, 95% confidence interval (CI) = 1.07-2.05) per interquartile-range increase (3.92 µg/m<sup>3</sup>). Compared with the lowest quartile, the 2nd, 3rd, and 4th quartiles of PM<sub>2.5</sub> were associated with ORs of 2.23 (95% CI = 1.30-3.84), 2.47 (95% CI = 1.42-4.33), and 2.48 (95% CI = 1.32-4.67), respectively. Elevated NO<sub>2</sub> exposure during the 2nd trimester (highest vs. lowest quartile) was also linked to higher PROM odds (OR = 2.31, 95% CI = 1.09-4.89). Residence in areas with very high traffic volume was associated with PROM (OR = 1.83, 95% CI = 1.06-3.16). Our findings indicate that traffic-related air pollutants, including PM<sub>2.5</sub> and NO<sub>2</sub>, contribute to a higher risk of PROM. These results support the need for environmental policies targeting reductions in traffic-related emissions, particularly PM<sub>2.5</sub> and NO<sub>2</sub>, to help prevent PROM and promote maternal health.

Environmental Science and Pollution Research
Ewha Womans University (KR), Seoul National University (KR), Ewha Womans University Medical Center (KR), Inha University Hospital (KR), Ministry of Environment (KR), National Institute of Environmental Research (KR)
Good health and well-being
Openalex Percentile: Top 8%
Air Quality and Health Impacts
DOIOpen Access PDFOpenAlex
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