A preconception cohort study of air pollution, fertility, and miscarriage

Boston University Medical Campus, Boston MA

Investigators

Linked publications, trials & patents

Abstract

Infertility and spontaneous abortion (SAB) each affect up to 20% of reproductive-aged couples. Despite the high population burden of these conditions, few modifiable risk factors have been identified. A growing body of research findings, including findings from the first 5 years of our parent grant (R01-ES028923), indicate that environmental exposures are important determinants of reproductive outcomes. In this renewal application, we request additional funds to build on our previous work, expand the range of reproductive outcomes evaluated, and elucidate biological mechanisms via which previously identified associations operate. Given the scarcity of epidemiologic research on exposure to air pollution from both outdoor and indoor sources, we also propose to explore the extent to which personal air pollution exposure influences reproduction. We will leverage data from Pregnancy Study Online (PRESTO), an ongoing North American preconception cohort study of nearly 20,000 couples that has been funded by the NIH since 2013. We propose to extend our spatiotemporal air pollution models through the end of 2026 and evaluate the following specific aims: 1) examine the effect of ambient concentrations of PM2.5, NO2, and O3 on menstrual disturbances; female sexual dysfunction; and anti-mullerian hormone (marker of ovarian reserve), 2) assess the effect of ambient concentrations of PM2.5, NO2, and O3 on semen quality (semen volume, sperm concentration, and sperm motility measured with a validated at-home semen testing kit); and erectile dysfunction; and 3) measure the effect of residential ambient concentrations of PM2.5, NO2, and O3 on cause-specific infertility in the couple (ovulation factor, tubal factor, cervical factor, male factor, or unidentified cause). Finally, we will conduct a pilot study to examine the feasibility of measuring partner-specific personal exposure to air pollution using low-cost particulate matter (PM) sensors among 250 newly enrolled couples in PRESTO. This renewal application will allow our highly productive interdisciplinary team to continue our impactful research investigating the effects of air pollution on reproductive outcomes. We will investigate a novel set of research hypotheses that will broaden and deepen our scientific understanding of the effects of air pollution on reproductive endpoints, enabling the identification of biologic pathways linking air pollution exposure during critical windows with reproductive health. The study population is large and geographically heterogeneous (including participants from all 50 U.S. states and all 10 Canadian provinces). The prospective study design and preconception recruitment of participants will overcome the methodologic limitations of previous studies. Study findings could be used to develop actionable individual-level recommendations for couples trying to conceive, to implement interventions to mitigate the reproductive effects of air pollution, and to advocate for population-level policy changes that can help reduce the risk of subfertility and SAB.