Association between trimester-specific prenatal air pollution exposure and placental weight of twins

Introduction: This study investigates the association between maternal exposure to particulate matter (PM₁₀) and nitric dioxide (NO₂) during the first, second and third trimester and placental weight and birth weight/placental weight (BW/PW) ratio in twins at birth. Methods: Cross-sectional data of 3340 twins from the East Flanders Prospective Twin Survey was used. Air pollutant exposure was estimated via spatial temporal interpolation. Univariable and multivariable mixed model analyses with a random intercept to account for the relatedness of newborns were conducted for twins with separate placentas. Twin pairs with one placental mass were studied with linear and logistic regression. Results: In the third trimester, for each 10 μm/m³ increase in PM₁₀ or NO₂ placental weight decreased −19.7 g (95%-C.I. −35.1; −4.3) and −17.7 g (95%-C.I. −30.4; −0.5) respectively, in moderate to late preterm twins with separate placentas. Consequently, BW/PW ratio increased with higher air pollution exposure. PM₁₀ exposure in the last week of pregnancy was associated with a higher odds ratio (OR) of 1.20 (95%-C.I. 1.00; 1.44) for a “small for gestational age placenta” (placental weight <10th percentile). Conversely, first trimester air pollutant exposure was associated with lower ORs of 0.55 (95%-C.I. 0.35; 0.88) and 0.60 (95%-C.I. 0.42; 0.84). Discussion: The association of PM₁₀ and NO₂ on placental weight is trimester-specific, differs for twins with one versus two placentas and is most pronounced in moderate to late preterm twins. Longitudinal studies are needed to better understand the relationship between air pollutant exposure and placental weight evolution across different trimesters.