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Unconventional natural gas development and adverse birth outcomes in Pennsylvania: The potential mediating role of antenatal anxiety and depression
- Source :
- Environ Res
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- BACKGROUND: Studies have reported associations between unconventional natural gas development (UNGD) and adverse birth outcomes. None have evaluated potential mediating mechanisms. OBJECTIVES: To evaluate associations between (1) UNGD and antenatal anxiety and depression and (2) antenatal anxiety and depression and preterm birth (< 37 weeks gestation) and reduced term birth weight, (3) stochastic direct and indirect effects of UNGD on preterm birth and term birth weight operating through antenatal anxiety and depression, and (4) effect modification by family-level socioeconomic status. METHODS: This retrospective cohort study included mothers without prevalent anxiety or depression at time of conception, who delivered at Geisinger in Pennsylvania between January 2009–January 2013. We assembled phase-specific UNGD activity data from public sources. Mothers were categorized as exposed (quartile 4) or unexposed (quartiles 1–3) based on average daily inverse distance-squared UNGD activity metric between conception and the week prior to anxiety or depression (cases) or the pregnancy-average daily metric (non-cases). We estimated associations with a doubly robust estimator (targeted minimum loss-based estimation) and adjusted for potential individual- and community-level confounding variables. RESULTS: Analyses included 8,371 births to 7,715 mothers, 12.2% of whom had antenatal anxiety or depression. We found 4.3 additional cases of antenatal anxiety or depression per 100 women (95% CI: 1.5, 7.0) under the scenario where all mothers lived in the highest quartile of UNGD activity versus quartiles 1–3. The risk difference appeared larger among mothers receiving Medical Assistance (indicator of low family income) compared to those who did not, 5.6 (95% CI: 0.5, 10.6) versus 2.9 (95% CI: −0.7, 6.5) additional cases of antenatal anxiety or depression per 100 women. We found no relationship between antenatal anxiety or depression and adverse birth outcomes and no mediation effect either overall or when stratifying by Medical Assistance. CONCLUSION: We observed a relationship between UNGD activity and antenatal anxiety and depression, which did not mediate the overall association between UNGD activity and adverse birth outcomes.
- Subjects :
- Male
Mediation (statistics)
medicine.medical_specialty
Anxiety
Natural Gas
010501 environmental sciences
Family income
01 natural sciences
Biochemistry
Article
03 medical and health sciences
0302 clinical medicine
Pregnancy
medicine
Humans
030212 general & internal medicine
Depression (differential diagnoses)
Retrospective Studies
0105 earth and related environmental sciences
General Environmental Science
Depression
Obstetrics
business.industry
Confounding
Infant, Newborn
Pregnancy Outcome
Absolute risk reduction
Retrospective cohort study
Pennsylvania
Pregnancy Complications
Quartile
Maternal Exposure
Premature Birth
Female
medicine.symptom
business
Subjects
Details
- ISSN :
- 00139351
- Volume :
- 177
- Database :
- OpenAIRE
- Journal :
- Environmental Research
- Accession number :
- edsair.doi.dedup.....f63afd4571ddc4a2e850251c06f77cd8