Exposure Assessment Of Indoor Particulate Matter During Pregnancy: A Narrative Review Of The Literature

Objective: The aim of this review was to summarize the evidence of the exposure assessment approaches of indoor particulate matter (PM) during pregnancy and to recommend future focus areas.Content: Exposure to indoor PM during pregnancy is associated with adverse birth outcomes. However, many questions remain about the consistency of the findings and the magnitude of this effect. This may be due to the exposure assessment methods used and the challenges of characterizing exposure during pregnancy. Exposure is unlikely to remain constant over the nine-month period. Pregnant females' mobility and activities vary - for example, employment status may be random among females, but among those employed, activities are likely to be greater in the early pregnancy than closer to the delivery of the child.Summary: Forty three studies that used one of the five categories of indoor PM exposure assessment (self-reported, personal air monitoring, household air monitoring, exposure models and integrated approaches) were assessed. Our results indicate that each of these exposure assessment approaches has unique characteristics, strengths, and weaknesses. While questionnaires and interviews are based on self-report and recall, they were a major component in the reviewed exposure assessment studies. These studies predominantly used large sample sizes. Precision and detail were observed in studies that used integrated approaches (i. e. questionnaires, measurements and exposure models).Outlook: Given the limitations presented by these studies, exposure misclassification remains possible because of personal, within and between household variability, seasonal changes, and spatiotemporal variability during pregnancy. Therefore, using integrated approaches (i. e. questionnaire, measurements and exposure models) may provide better estimates of PM levels across trimesters. This may provide precision for exposure estimates in the exposure-response relationship.