Association Between Ozone-Polluted Air and Birth Weight in Rural and Suburban Spain

Low birth weight (LBW) is associated with neonatal morbidity, mortality and long-term health complications. Global studies report an association between air pollution, such as tropospheric ozone, and LBW. This study aims to analyze the association between ozone exposure during pregnancy and LBW in 130 municipalities in rural and semi-urban Spain. We conducted a retrospective population-based cohort study using data from the Instituto Nacional de Estadística (INE) and air quality data from the Spanish Government for the 2001–2017 period. We performed descriptive analysis, logistic regression and linear regression analyses adjusted for various covariates. In addition, we fitted generalized additive models (GAMs) to estimate non-linear relationships. An association between decreased neonatal weight and high ozone exposure was found, especially in the first and second trimester. An increase in ozone concentration could lower neonatal weight but not enough evidence demonstrates an association with LBW. More research is needed to understand the impact of ozone exposure on neonates during pregnancy.