The Urban Exposome during Pregnancy and Its Socioeconomic Determinants

BACKGROUND: The urban exposome is the set of environmental factors that arc experienced in the outdoor urban environment and that may influence child development. OBJECTIVE: The authors' goal was to describe the urban exposome among European pregnant women and understand its socioeconomic determinants. METHODS: Using geographic information systems, remote sensing and spatio-temporal modeling we estimated exposure during pregnancy to 28 environmental indicators in almost 30,000 women from six population-based birth cohorts, in nine urban areas from across Europe. Exposures included meteorological factors, air pollutants, traffic noise, traffic indicators, natural space, the built environment, public transport, facilities, and walkability. Socioeconomic position (SEP), assessed at both the area and individual level, was related to the exposome through an exposome-wide association study and principal component (PC) analysis. RESULTS: Mean standard deviation (SD) NO, levels ranged from 13.6 +/- 5.1 mu g/m(3) (in Heraklion, Crete) to 43.2 +/- 11 mu g/m(3) (in Sabaclell, Spain), mean +/- SD walkability score ranged from 0.22 +/- 0.04 (Kaunas, Lithuania) to 0.32 +/- 0.07 (Valencia, Spain) and mean +/- SD Normalized Difference Vegetation Index ranged from 0.21 +/- 0.05 in Heraklion to 0.51 +/- 0.1 in Oslo, Norway. Four PCs explained more than half of variation in the urban exposome. There was considerable heterogeneity in social patterning of the urban exposome across cities. For example, high-SEP (based on family education) women lived in greener, less noisy, and less polluted areas in Bradford, UK (0.39 higher PC1 score, 95% confidence interval (CI): 0.31, 0.47), hut the reverse was observed in Oslo (-0.57 PC1 score, 95% CI: 0.73, 0.41). For most cities, effects were stronger when SEP was assessed at the area level: In Bradford, women living in high SEP areas had a 1.34 higher average PC1 score (95% CI: 1.21, 1.48). CONCLUSIONS: The urban exposome showed considerable variability across Europe. Pregnant women of low SEP were exposed to higher levels of environmental hazards in some cities, but not others, which may contribute to inequities in child health and development.