Impact of Wood Burning Air Pollution on Preeclampsia and other Pregnancy Outcomes in Temuco

Exposure to air pollutants has important acute and chronic health effects. An important effect that has been recently studied is pregnancy effects of pollutants. Scarce literature exists related to impacts of pollutants on preeclampsia and even less about the specific impact of residential wood burning emissions on pregnancy outcomes. Temuco is located in southern Chile and is known for its very high concentrations of air pollutants associated to residential wood burning.

The main objective of this proposal is to determine whether exposure to air pollutants (specifically PM2.5 and wood burning tracer) have an impact on preeclampsia and other pregnancy outcomes (low birth weight, birth weight, small of gestational age, preterm birth). Reproductive data will be obtained from available databases at the Hospital Dr. Hernan Henriquez Aravena in Temuco and Padre Las
Casas between 2009 and 2015. A total of approximately 18,000 pregnancies are expected. A year-long air pollution campaign will be performed in 3 10-week sessions, including a total of 20 fixed-site sampling points and mobile measurements. The studied pollutants will be PM2.5 and wood burning tracers within it (levoglucosan and others). Data will be fitted to produce spatial models and maps using the Land-Use Regression approach. This model will be used to estimate individual exposures by trimester to the subjects using residential geocoding and historical PM measurements. Finally, logistic and linear regression models will be fitted to estimate the impact of air pollutants exposure on the selected outcomes, adjusting for other individual and temporal variables.

Expected results are i) an air pollution characterization of the campaigns with emphasis in wood burning tracers, ii) a Land-Use Regression model for air pollutants in Temuco including maps of air pollutants, iii) a pregnancy outcome descriptive characterization for the study period in Temuco, iv) results of the epidemiological study showing whether air pollutants (emphasizing wood burning
emissions) have impacts on the studied pregnancy outcomes. To achieve these objective, we will assemble a capable team of both Chilean and UK researchers. Four ISI articles are expected as scientific production.

Additionally, four master thesis, one doctoral thesis, and a two final workshops in Chile to disseminate the research findings.

Social Outreach
Two workshops are expected to be held at the end of the study: one at Santiago and one at Temuco. This workshop will be organized by the researchers sponsored by University of Chile and will count with the help of associated Universities and Authorities. As the social problem of wood burning has many perspectives, it is expected that a broad audience will be assembled including all UK and Chile
researchers, students of both engineering and health science, decision makers at the Health and Environment sector, community leaders and wood stoves and alternative heating manufacturers. We will apply for internal fund to also bring the wood-burning tracer expert (Dr. Betsy Stone). It will be a unique opportunity to gather people from the highest academic background with the members of society that are suffering the impacts of wood burning use and related policies. It will be also the chance to close the gap of scientific knowledge with the decision making and incorporating health risk aspects in
the energy policies and solutions discussed for Temuco and many other southern Chilean cities.

It is expected that all members of the team might be involved in communicating results of the study to the public. We highlight that Dr. Ruiz and Dr. Galbán usually appear in the media (newspaper, radio, and TV) communicating the population the risks of air pollution and advocating for a cleaner environment. The School of Public Health at University of Chile, and Universidad Andrés Bello have a media department that will help the researchers to better communicate results to the public.

Good studies of wood-burning impacts on air quality and health are necessary to underpin the proposal of environment regulation and the several decontamination plans currently undergoing in
southern Chile cities. These studies might also help to generate social support for the enormously difficult and expensive solutions related to replacing wood burning.

The effects of wood burning on pregnancy outcomes will not be specific solely to Chile. These results should capture the interest of policy makers, the medical community and general users in other countries of the world where biomass burning is also common place. The above mentioned dissemination activities, alongside scientific publications in high impact journals (e.g., Environmental Health Perspective) as well as the participation in international conferences will help to spread the results to a wide international audience. In addition, a website of the project will be created both in Spanish and
English, therefore, the study and its results ensure access to anyone with similar interests. Finally, an executive summary will be produced and submitted to international organizations such as the World Health Organization, the UK Committee on Medical Effects of Air Pollution, or the US Environmental Protection Agency to ensure that the results of the study are known to key international stakeholders.