Longitudinal ozone exposure and SARS-CoV-2 infection in late pregnancy: a retrospective cohort study
Lin Zhang, Jiaqi Tian, Shuyin Duan
Frontiers in Cellular and Infection Microbiology, doi:10.3389/fcimb.2024.1476603
Background: Atmospheric ozone is a common air pollutant with known impacts on maternal and fetal health. However, the relationship between gestational ozone exposure and susceptibility to respirovirus infection remains unclear. This study aims to assess the association between longitudinal ozone exposure during pregnancy and COVID-19 risk in late gestation. Methods: This retrospective cohort study included 600 pregnant women (300 infected with SARS-CoV-2 and 300 uninfected) who delivered at one hospital in Jinan, China from November 2022 to January 2023. Individual ozone exposure levels throughout gestation were estimated based on local ambient monitoring data. Logistic regression models were constructed to examine the association between gestational ozone exposure and COVID-19 status in late pregnancy, adjusting for demographic and clinical variables. Results: In Jinan, ozone levels increased by 1.85 ppb annually and peaked between April and October, corresponding to winds from the south and southwest. Higher ozone exposure over pregnancy was associated with lower odds of SARS-CoV-2 infection in late gestation (OR per IQR increase = 0.60, 95% CI: 0.40-0.90). Compared to the lowest quartile (reference), the highest ozone quartile corresponded to a 99% decreased infection risk (OR = 0.01, 95% CI: 0.00-0.03). Increased maternal age and pre-pregnancy BMI were associated with higher COVID-19 risk. Conclusions: Longitudinal ozone exposure during gestation may be protective against SARS-CoV-2 infection in late pregnancy. Further studies are needed to confirm this finding and elucidate underlying mechanisms. These results highlight the potential importance of environmental exposures in COVID-19 susceptibility.
Ethics statement The studies involving humans were approved by Ethics Committee of the Maternal and Child Health Care Hospital of Shandong Province Affiliated to Qingdao University. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants' legal guardians/next of kin.
Author contributions
Funding The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was financially supported by the Natural Science Foundation of Shandong (ZR2022QH079) and the Taishan Scholar Program of Shandong Province (No. tsqn202211359). The funders had no role in study design, data collection, interpretation, or the decision to submit the work for publication.
Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Supplementary material The Supplementary Material for this article can be found..
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'abstract': '<jats:sec><jats:title>Background</jats:title><jats:p>Atmospheric ozone is a common air '
'pollutant with known impacts on maternal and fetal health. However, the relationship between '
'gestational ozone exposure and susceptibility to respirovirus infection remains unclear. This '
'study aims to assess the association between longitudinal ozone exposure during pregnancy and '
'COVID-19 risk in late '
'gestation.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This '
'retrospective cohort study included 600 pregnant women (300 infected with SARS-CoV-2 and 300 '
'uninfected) who delivered at one hospital in Jinan, China from November 2022 to January 2023. '
'Individual ozone exposure levels throughout gestation were estimated based on local ambient '
'monitoring data. Logistic regression models were constructed to examine the association '
'between gestational ozone exposure and COVID-19 status in late pregnancy, adjusting for '
'demographic and clinical '
'variables.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In Jinan, '
'ozone levels increased by 1.85 ppb annually and peaked between April and October, '
'corresponding to winds from the south and southwest. Higher ozone exposure over pregnancy was '
'associated with lower odds of SARS-CoV-2 infection in late gestation (OR per IQR increase = '
'0.60, 95% CI: 0.40-0.90). Compared to the lowest quartile (reference), the highest ozone '
'quartile corresponded to a 99% decreased infection risk (OR = 0.01, 95% CI: 0.00-0.03). '
'Increased maternal age and pre-pregnancy BMI were associated with higher COVID-19 '
'risk.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Longitudinal '
'ozone exposure during gestation may be protective against SARS-CoV-2 infection in late '
'pregnancy. Further studies are needed to confirm this finding and elucidate underlying '
'mechanisms. These results highlight the potential importance of environmental exposures in '
'COVID-19 susceptibility.</jats:p></jats:sec>',
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