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Air Pollution from Incinerators and Reproductive Outcomes: A Multisite Study

Candela, Silvia; Ranzi, Andrea; Bonvicini, Laura; Baldacchini, Flavia; Marzaroli, Paolo; Evangelista, Andrea; Luberto, Ferdinando; Carretta, Elisa; Angelini, Paola; Sterrantino, Anna Freni; Broccoli, Serena; Cordioli, Michele; Ancona, Carla; Forastiere, Francesco

doi: 10.1097/EDE.0b013e3182a712f1
Air Pollution

Background: The few studies that have investigated the relationship between emissions from municipal solid-waste incinerators and adverse pregnancy outcomes have had conflicting results. We conducted a study to assess the effects of air emissions from the eight incinerators currently in operation in the Emilia-Romagna Region of Italy on reproductive outcomes (sex ratio, multiple births, preterm births, and small for gestational age [SGA] births).

Methods: We considered all births (n = 21,517) to women residing within a 4-km radius of an incinerator at the time of delivery during the period 2003–2010 who were successfully linked to the Delivery Certificate database. This source also provided information on maternal characteristics and deliveries. Each newborn was georeferenced and characterized by a specific level of exposure to incinerator emissions, categorized in quintiles of PM10, and other sources of pollution (NOx quartiles), evaluated by means of ADMS-Urban system dispersion models. We ran logistic regression models for each outcome, adjusting for exposure to other pollution sources and maternal covariates.

Results: Incinerator pollution was not associated with sex ratio, multiple births, or frequency of SGA. Preterm delivery increased with increasing exposure (test for trend, P < 0.001); for the highest versus the lowest quintile exposure, the odds ratio was 1.30 (95% confidence interval = 1.08–1.57). A similar trend was observed for very preterm babies. Several sensitivity analyses did not alter these results.

Conclusions: Maternal exposure to incinerator emissions, even at very low levels, was associated with preterm delivery.

Supplemental Digital Content is available in the text.

From the aEpidemiology Unit, Local Health Authority, Reggio Emilia, Italy; bRegional Reference Centre on Environment and Health, ARPA Emilia-Romagna, Modena, Italy; cPublic Health Service, Emilia-Romagna Region, Italy; and dDepartment of Epidemiology, Lazio Region, Italy.

This study was funded by the Regione Emilia-Romagna, Italy, as a part of the Moniter Project (MONitoring Incinerators in the Territory of Emilia-Romagna Region) (Del. N 466, 11 April 2007), and by the Italian Ministry of Health, as a part of the Strategic Project “Impatto sanitario associate alla residenza in siti inquinati, in territori interessati da impianti di smaltimento/incenerimento rifiuti ed alla esposizione a inquinamento in aree urbane,” July 2007. The authors declare no conflicts of interest.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article ( This content is not peer-reviewed or copy-edited; it is the sole responsibility of the author.

Correspondence: Silvia Candela, Epidemiology Unit, Local Health Authority, Via Amendola 2, Reggio Emilia, Italy. E-mail:

Received December 21, 2012

Accepted June 22, 2013

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