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Traffic-related Air Pollution and Hypertensive Disorders of Pregnancy

The final report and press release from the Traffic-related Air Pollution and Hypertensive Disorders of Pregnancy evaluation is now available.
Pregnant woman exposed to pollution from traffic

Topic Overview

Status: Evaluation completed
Conclusion(s): NTP concluded that Traffic-related Air Pollution (TRAP) is a presumed hazard for hypertensive disorders in pregnant women.

Background Information

Traffic-related air pollution, or TRAP, is a type of air pollution that comes from the emissions of motor vehicles that result from fossil fuel combustion, and has been shown to be a major risk factor for cardiovascular disease, including hypertension. TRAP contributes significantly to outdoor air pollution, especially in urban settings. Children are especially sensitive to air pollution, and there is increasing evidence that exposure to TRAP may impact pregnancy outcomes and child development.

Hypertensive disorders of pregnancy complicate more than 10% of pregnancies worldwide and are a leading cause of maternal and fetal illness and death. These disorders are defined by hypertension (blood pressure > 140/90 mmHg), usually during the second half of pregnancy, and range in severity from hypertension alone to multi-organ dysfunction and seizures in the mother. According to the American College of Obstetricians and Gynecologists, mothers with hypertension during pregnancy are more likely to have a pre-term delivery. Their infants are at greater risk for low birthweight and a range of long-term health problems associated with pre-mature birth.

The project and protocol were developed to evaluate two emerging children’s health issues associated with TRAP exposure: hypertensive disorders of pregnancy and neurological disorders. An assessment of TRAP and developmental neurological disorders is currently under review by other organizations and therefore, the NTP evaluation focuses only on TRAP and hypersensitive disorders of pregnancy.

NTP Evaluation

NTP conducted a systematic review of published research on hypertensive disorders in pregnant women and their possible link to TRAP. NTP evaluated the risk of hypertensive disorders by different pollutant measurements of TRAP, such as particulate matter, nitrogen oxides, carbon monoxide, and black and elemental carbon, along with parameters like traffic density and mother’s proximity to main roads.

What did the evaluation find?

Using its standard scale, NTP concluded that TRAP is a presumed hazard for hypertensive disorders in pregnant women. The scale ranges from the highest hazard rating of “known,” followed by “presumed,” then “suspected,” and finally, “not classifiable.”

FAQ

Q: Why did NTP evaluate studies on TRAP, rather than on all air pollution?
A: Traffic-related air pollution is a significant contributor to ambient air pollution and is a major risk factor for cardiovascular disease, including hypertension. Over the past 10 years, a growing number of epidemiological studies have suggested that TRAP could be linked to hypertensive disorders during pregnancy. NTP conducted a systematic review to evaluate whether exposure to TRAP during pregnancy is associated with hypertensive disorders.

Q: Is hypertension a health risk for all women or just for pregnant women and their babies?
A: Although hypertension can affect women at all phases of life, hypertension in pregnancy presents unique challenges because of its potential long-term adverse effects on both mother and child. Mothers are at an increased risk for developing cardiovascular diseases, stroke, and type 2 diabetes later in life. Infants born to mothers with hypertension during pregnancy are at a higher risk for preterm delivery, low birthweight, and a range of prematurity-related neonatal diseases.

Q: What are hypertensive disorders of pregnancy?
A: Hypertensive disorders of pregnancy refer to a range of clinical conditions, all of which include high blood pressure during pregnancy. The American College of Obstetricians and Gynecologists classify hypertensive disorders of pregnancy into four types: (1) gestational hypertension, (2) preeclampsia/eclampsia, (3) chronic hypertension, and (4) chronic hypertension with superimposed preeclampsia. These disorders can be defined by differences in the timing of the onset of symptoms:

  • Gestational hypertension is high blood pressure in the second half of pregnancy.
  • Preeclampsia is high blood pressure with protein in the urine or impaired liver and kidney function in the second half of pregnancy. If preeclampsia worsens and causes seizures, it becomes eclampsia – a serious condition for mother and child with the potential to be fatal.
  • Chronic hypertension is high blood pressure before pregnancy or early in pregnancy and continues throughout pregnancy.
  • Chronic hypertension with superimposed preeclampsia is high blood pressure before pregnancy or early in pregnancy that continues throughout pregnancy and protein in the urine or impaired liver or kidney function.

Q: How did NTP arrive at its evaluation of presumed hazard?
A: The hazard classification of “presumed” is based on evaluations of individual components of TRAP measures and consideration was given to the likelihood of being exposed to multiple TRAP components at the same time:

  • Particulate matter (PM2.5): Exposure to traffic-related PM2.5 is associated with development of hypertensive disorders in pregnant women on the basis of evidence that the likelihood of developing preeclampsia increases by 51% for every 10 µg/m3 increase in PM2.5 concentration when pregnant women are exposed during the entire pregnancy.
  • Nitrogen oxides (NOX): Exposure to traffic-related NOX increases the likelihood of developing hypertensive disorders of pregnancy when women are exposed during the entire pregnancy period.
  • Traffic density and proximity to main roads: Residing in regions of high-traffic density or in close proximity to main roads may be associated with hypertensive disorders in pregnant women on the basis of evidence that pregnant women who live within a quarter mile of a major roadway (e.g., 10,000 vehicles or more per day) or in high-traffic density regions may be at an increased risk for developing hypertensive disorders of pregnancy.

NTP scientists performed a comprehensive literature search and reviewed hundreds of studies with potentially relevant data. Overall, they evaluated 18 human observational studies and one animal study that specifically addressed hypertension during pregnancy and TRAP. Usually, experimental animal data add certainty in the conclusions; unfortunately, the limited number of animal studies that assessed the effects of environmental exposures during pregnancy is a research gap.

Documents

Documents for Traffic-Related Air Pollution and Children's Health
Date Document
Jul 13, 2012 Federal Register notice requesting information on nomination (PDF HTML)
Apr 16, 2014 NTP Evaluation Concept
Apr 16, 2014 Meeting Presentation: NTP Evaluation Concept - Pregnancy Outcomes Associated With Traffic-Related Air Pollution
Jun 01, 2016 NTP Protocol
Jun 24, 2019 Federal Register notice requesting public comments on draft monograph (PDF HTML)
Aug 01, 2019 Literature Search Results
Dec 18, 2019 NTP Protocol - Revised
Dec 18, 2019 NTP Monograph - Final (Abstract)

Meetings & Events

Listing of related events
Date Event Event Type Materials
Apr 16, 2014

NTP Board of Scientific Counselors Meeting

Board of Scientific Counselors
  • Agenda
  • Meeting Materials

    NTP Board of Scientific Counselors Meeting Meeting Materials
    April 16, 2014

    Supplemental materials for events, meetings, and workshops prior to 2016 have been archived. These archived materials frequently include presentations, background materials, and public comments. Email us or use our contact form to request a list or copy of archived materials for the following meeting.

     
  • Minutes

Supplemental materials for events, meetings, and workshops prior to 2016 have been archived. These archived materials frequently include presentations, background materials, and public comments. Email us or use our contact form to request a list or copy of archived materials for the following meeting.

Public Comments

Public Comments for Air Pollution and Children's Health
Date Received Commenter(s) Affiliation In Response To
Apr 02, 2014 Julie M. Panko Cardno ChemRisk, on behalf of the Rubber Manufacturers Association Mar 07, 2014 Federal Register notice
Jun 24, 2019 Cathleen Reese Private Citizen Jun 24, 2019 Federal Register notice

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