Vitamin B, a personal weapon to mitigate the effects of Air Pollution.

Vitamin B could attenuate the effects of most dangerous type of air pollution and could be used at personal level to protect against the ill effects. The study was recently published in Proceedings of the National Academy of Sciences of the United States of America.[1]

The investigators looked at the effects caused by PM2.5, one of the most dangerous type of pollution on volunteers in a cross over trial.  PM2.5 refers to atmospheric particulate matter (PM) that have a diameter less than 2.5 micrometers, which is about 3% the diameter of a human hair.

The fine PM finds its way into blood stream through lungs and causes pulmonary and placental inflammation, coagulopathies, endothelial dysfunction and hematological responses and eventually lead to heart attack and stroke.

Studies have also shown adverse effects on mother and neonates due to Pollution. Outdoor air pollution has been identified as a possible risk factor for preterm births across the globe according to a study published in Journal of Environment International online February 10, 2017. Air pollution identified as a possible risk factor for nearly 3 million preterm births every year.

Scientist also suspect that exposure to PM2.5 can cause "epigenetic" changes to our cells leading to mutations that can damage our health.

WHO recently estimated that 92% of the world's population lives is exposed to dangerous levels of pollution exceeding the recommended threshold.[2]

WHO map depicting global air pollution 

In this cross over study, 10 volunteers were exposed to clean air and given placebo as supplements to know the baseline levels. Than the same 10 persons were exposed to polluted air and given placebo for 4 weeks. Lastly the individuals received polluted air but this time with Vitamin B supplementation (2.5 mg/d folic acid, 50 mg/d vitamin B6, and 1 mg/d vitamin B12), respectively.

The researchers looked at epigenome-wide methylation before and after each exposure. PM2.5 induced methylation changes in genes involved in mitochondrial oxidative energy metabolism.

PM2.5 depleted 11.1% of the mitochondrial DNA content and B-vitamin supplementation attenuated the PM2.5 effect by 102% (P= 0.01).

Andrea A. Baccarellia, Mailman School of Public Health, Columbia University, New York "Future studies, especially in heavily polluted areas, are urgently needed to validate our findings and ultimately develop preventive interventions using B vitamins to contain the health effects of air pollution," said Baccarelli.

"While emission control and regulation is the backbone of prevention, high exposures are, unfortunately, the rule still in many megacities throughout the world," she further added.

Although this study has small sample size, it helps fill the critical knowledge gap regarding ways of personal protection at individual level. People around the globe use all kind of masks, scarf but nothing was known about taking supplementation to mitigate the effects at cellular level.

 We as individuals do not have the choice to determine the type of air we breathe in; government regulation implementation will go a long way in protecting the society members and society against the effects of Global Warming.

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[1] http://www.pnas.org/content/early/2017/03/07/1618545114.abstract

[2] http://www.who.int/phe/publications/air-pollution-global-assessment/en/

Air pollution identified as a possible risk factor for nearly 3 million preterm births every year.

Air pollution 

Outdoor air pollution has been identified as a possible risk factor for preterm births across the globe according to a study published in Journal of Environment International online February 10, 2017.[1] 

The 2010 study estimated that 2.7–3.4 million preterm births may be prevented if PM_2.5 exposure is brought down.

It is estimated that 14·9 million babies were born preterm worldwide in 2010.

There exists a wide disparity between Preterm Births(PTBs) rates across the globe, European countries have the lowest rate at 4-5% vs. countries in Africa and South Asia with rates as high as 15–18%.

In South Asia, about 1 million   PM_2.5 associated PTBs happened in India, followed by China which contributed another 500,000.

                                       

A pregnant woman in India or China will likely be exposed to 10 times more pollution as compared to a woman in Canada or UK.

It is estimated that in 2010, out of 135 million livebirths globally 14.9 million babies (11.1%) were preterm, including both spontaneous and iatrogenic births. [2]

Exposure of mother to fine particulate matter(PM) has been identified as one of the many risk factors for PTBs as well low birth weight babies. The fine PM finds its way into blood stream through lungs and causes pulmonary and placental inflammation, coagulopathies, endothelial dysfunction and hematological responses.

Fine particles are produced from all types of combustion, including motor vehicles, power plants, solid cooking fuels, residential wood burning, forest fires, agricultural burning, and some industrial processes.

Desert dust also contributes to Particulate Matter ( PM) and in Sub Saharan Africa, Middle East and North Africa it is the major exposure. 

"Air pollution may not just harm people who are breathing the air directly - it may also seriously affect a baby in its mother's womb," said Chris Malley, lead author of the study which is based on data for 2010.

The study further demonstrated that majority of the PM_2.5 associated preterm birth could be prevented by implementing strict emission control strategies in these regions except in in Sub Saharan Africa, Middle East and North Africa where nothing much can be done to change the geography of the area.

Johan Kuylenstierna, co-author of the study, and SEI's policy director said "In a city, maybe only half the pollution comes from sources within the city itself - the rest will be transported there by the wind from other regions or even other countries."

Nevertheless, the study demonstrated that reduction of maternal PM_2.5 exposure through emission reduction strategies could bring down the global preterm rate, limit in utero exposure to PM_2.5 bringing down postnatal and long term neonatal morbidity.

Exposure to PM_2.5 is also responsible for 9–14% of total preterm births globally out of the total risk percentage. It should also be targeted along with other risk factors to reduce the incidence of preterm birth.

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[1] http://www.sciencedirect.com/science/article/pii/S0160412016305992

[2] http://www.sciencedirect.com/science/article/pii/S0140673612608204

Low dose aspirin in prevention of spontaneous preterm births- A Systematic Review and Meta-analysis.

fda.gov

Antiplatelet agents(Aspirin) reduce spontaneous preterm birth(PTBs) in pregnant women at risk for preeclampsia according to a study published in February issue of Journal of Obstetrics and Gynecology.

This is an additional analysis of data from The Perinatal Antiplatelet Review of International Studies Individual Participant Data meta-analysis which showed moderate reduction in risk of preeclampsia (relative risk [RR] 0.90, 95% confidence interval [CI] 0.84–0.97).

Preterm birth(PTB) is the birth of an infant before 37 weeks of pregnancy, according to WHO statistics an estimated 15 million babies born preterm out of whom 1 million succumb. PTB is also responsible for long term neurological complications in children like cerebral palsy, learning disabilities and visual and hearing problems.

The current global preterm birth rate is 5% to 18% and statistic shows a steady increase recently. More than 60% of preterm births occur in Africa and South Asia, India topping the list with 3 519 100 PTBs.

Three forth of these births could be prevented, saving lives and money across the globe. History of uterine evacuation is an independent risk factor for preterm birth.[1] Other risk factors for PTBs are Myometrial contractions, mother's cervicovaginal microbiota and Intrauterine infections. Myometrial contractions are triggered by interplay between mechanical, endocrine and immune factors. Increasing body of evidence suggests that uteroplacental ischemia could play an important role in bringing on preterm births similar to its role in preeclampsia. 

The evidence comes from examining the placental tissues in women with spontaneous PTBs. At least one third biopsies depicted placental vascular pathology in terms of failure of physiological transformation of spiral arteries as seen in preeclampsia.

Keeping in view the similar pathologies for PTBs and preeclampsia the authors wanted to know whether aspirin could prevent iatrogenic as well as spontaneous preterm births.

After excluding the women who did not meet the study criteria, 27,510 women were randomized to receive low dose aspirin vs. Placebo. These women were at low to moderate risk for developing preeclampsia.

Low dose aspirin was started between 16- 20 weeks  depending upon the gestational age upon entering into the studies. 

The study was evaluated based on 3 primary endpoints: spontaneous preterm birth at < 37 weeks, < 34 weeks, and < 28 weeks of gestation.

Antiplatelet agent (Aspirin) significantly reduced the risk of PTBs by 7%. PTBs before 34 weeks were reduced by 14%. The study did not find significant reduction in preterm births before 28 weeks of gestation. It may be because of lack of power in that subgroup or pathologies other than placental ischemia may play a role in very early PTBs.

Incidence of antepartum hemorrhage, placental abruption or neonatal bleeding remained the same for the two study arms. Slight higher incidence of PPH was seen in aspirin group, but was not statistically significant.

The administration of antiplatelet agents such as aspirin during pregnancy is considered a safe intervention as a recent review commissioned by the U.S. Preventive Services Task Force concluded.

The authors concluded “The current findings might be applicable to a broader population of pregnant women. Because there is a paucity of preventive strategies for spontaneous preterm birth, we suggest that the use of antiplatelet agents may be a promising intervention for women who have a history of spontaneous preterm birth.” They further added “The current study provides clinicians with the best available evidence to counsel women regarding who might benefit from this intervention.”

Full text of the article can be accessed here.

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[1] https://obgynupdated.blogspot.com/2016/06/history-of-uterine-evacuation-is.html

Mother’s Cervicovaginal microbiota could be the key to prevent Spontaneous Preterm Births--News from SMFM 2017, Las Vegas.

Courtesy: CDC

More exciting news from the pregnancy meeting, SMFM 2017, Las Vegas. Researchers have identified that maternal cervicovaginal (CV) flora plays an important role in timing of delivery, it could increase or prevent the risk of Spontaneous Preterm Births (SPTB).  

The study abstract was presented on January 26,2017 at the meeting and won the March of Dimes award for best abstract on prematurity.

This was a nested study of a large project called as “Motherhood and the Microbiome” that was funded by National Institute of Nursing Research (NINR). This is a large observational, prospective study of women with a term birth undergoing follow up for Preterm Births.

Dr. Elovitz, professor of Obstetrics and Gynecology at the University of Pennsylvania, vice chair of Translational Research and Director of the Maternal and Child Health Research Center at PENN University and his colleagues worked on the hypothesis that preterm birth occurs because of some changes at molecular, anatomical and microbial level in the cervicovaginal space that are different in women who have a SPTB vs. women who deliver at term.

The study recruited about 1500 patients and collected cervicovaginal specimens at 3 time points throughout pregnancy. From this larger pool of participants, 80 cases with SPTB and 320 term controls were matched and analyzed. 16S rRNA gene analyses was used to identify bacterial specimens.

Additionally, in 616 patients single sample was collected to serve as validation.

Presence of Bifidobacterium species in the cervicovaginal space was highly protective for SPTB at all time while BV-associated bacteria (BVABs) and Mobiluncus were associated with statistically significant rise in SPTBs. (p<0.0001).

Edward R.B. McCabe, MD, PhD, senior vice president and chief medical officer of the March of Dimes said “From these data, we may learn how to prevent preterm birth either by eliminating the CV bacteria that are associated with an increased risk and/or by enhancing the presence of protective bacteria. This is a promising new area that should become a research priority.”