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Andréa Paula Peneluppi de Medeiros,¹ Nelson Gouveia,¹ Reinaldo Paul Pérez Machado,² Miriam Regina de Souza,¹ Gizelton Pereira Alencar,³ Hillegonda Maria Dutilh Novaes,¹ and Márcia Furquim de Almeida³

¹Department of Preventive Medicine, Faculty of Medicine, ²Department of Geography, and ³Department of Epidemiology, Faculty of Public Health, University São Paulo, São Paulo, Brazil

Abstract
Background: Ambient levels of air pollution may affect the health of children, as indicated by studies of infant and perinatal mortality. Scientific evidence has also correlated low birth weight and preterm birth, which are important determinants of perinatal death, with air pollution. However, most of these studies used ambient concentrations measured at monitoring sites, which may not consider differential exposure to pollutants found at elevated concentrations near heavy-traffic roadways.

Objectives: Our goal was to examine the association between traffic-related pollution and perinatal mortality.

Methods: We used the information collected for a case–control study conducted in 14 districts in the City of São Paulo, Brazil, regarding risk factors for perinatal deaths. We geocoded the residential addresses of cases (fetal and early neonatal deaths) and controls (children who survived the 28th day of life) and calculated a distance-weighted traffic density (DWTD) measure considering all roads contained in a buffer surrounding these homes.

Results: Logistic regression revealed a gradient of increasing risk of early neonatal death with higher exposure to traffic-related air pollution. Mothers exposed to the highest quartile of the DWTD compared with those less exposed exhibited approximately 50% increased risk (adjusted odds ratio = 1.47 ; 95% confidence interval, 0.67–3.19) . Associations for fetal mortality were less consistent.

Conclusions: These results suggest that motor vehicle exhaust exposures may be a risk factor for perinatal mortality.

Key words: air pollution, epidemiology, geographic information systems, perinatal mortality, traffic density. Environ Health Perspect 117:127–132 (2009) . doi:10.1289/ehp.11679 available via http://dx.doi.org/ [Online 22 September 2008]

Address correspondence to N. Gouveia, Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455, São Paulo, SP 01246-903, Brazil. Telephone: (55 11) 3061-7075. Fax: (55 11) 3062-6018. E-mail: ngouveia@usp.br

This study is part of the project “Perinatal Mortality in the South Region of the City of São Paulo: A Case–Control Population-Based Study” approved by the Committee of Ethics in Research of the Faculty of Public Health, University São Paulo ; it is funded by the State of São Paulo’s Research Support Foundation (Fapesp Process 99/11985-9) , and by the National Scientific and Technological Development Council (CNPq Process 479007/2001-2) .

The authors declare they have no competing financial interests.

Received 8 May 2008 ; accepted 22 September 2008.