ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Reproduction
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1624480
This article is part of the Research TopicAssessing Environmental Influences on Maternal and Infant Health Amidst Climate ChangeView all 5 articles
The differential impacts of environmental air pollution exposure on the risk of placenta previa and placenta accreta in twin pregnancies
Provisionally accepted
Weizhen Tang
Hong Chen
Hong-Yu Xu
Qin-Yu Cai
Niya ZhouYi-Fan ZhaoBo-Yuan DengXu Zhang
Fei Han
Tai-Hang Liu*Zhen Chen*- Chongqing Medical University, Chongqing, China
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Background This study aims to investigate the association between exposure to air pollutants during pregnancy (until placental accreta) in twin pregnancies and the risk of abnormal placental positioning and development. Methods This retrospective study included 3,670 pregnant women with twin pregnancies, classified into three groups: no placenta previa or accreta (3,017 cases), placenta previa (119 cases), and placenta accreta without previa (534 cases). Air pollution data (PM2.5, PM10, SO2, NO2, CO, and O3) were collected from 12 monitoring stations in Chongqing. Exposure estimates were calculated using geocoding based on hospital locations and the nearest stations. Multivariate logistic regression and trend regression analyses, adjusted for confounders, assessed the impact of these pollutants on placenta previa and placenta accreta risk during the 3 months preconception, first trimester, and second trimester. Stratified analyses based on maternal characteristics and restricted cubic spline (RCS) analysis were performed. A dual-pollutant model was used to validate the results. Results Results showed that none of the six pollutants were significantly associated with placenta previa in either single-pollutant or dual-pollutant models. In the subtypes of placenta previa, NO2 was found to be a protective factor for marginal placenta previa only during the 3 months preconception, with no significant associations observed for other pollutants. For placenta accreta, both single-pollutant and dual-pollutant models indicated that exposure to PM2.5, PM10, SO2, and NO2 during the 3 months preconception might have a protective effect. In contrast, O3 significantly increased the risk of placenta accreta during both the 3 months preconception and the first trimester, regardless of whether it was analyzed in a single-pollutant or dual-pollutant model. Furthermore, the dual-pollutant model revealed that NO2 and CO were risk factors for placenta accreta during the second trimester after adjusting for PM2.5 and PM10. Stratified analyses based on maternal characteristics showed stable associations between the six pollutants and placenta previa across different periods, while the impact of pollutants on placenta accreta varied under different maternal clinical characteristics. Conclusion The mechanisms by which air pollutants affect placenta previa and placenta accreta in twin pregnancies are notably different.
Keywords: Twin pregnancy, Placenta Previa, Placenta Accreta, Air Pollution, Windows of exposure
Received: 07 May 2025; Accepted: 19 Aug 2025.
Copyright: © 2025 Tang, Chen, Xu, Cai, Zhou, Zhao, Deng, Zhang, Han, Liu and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Tai-Hang Liu, Chongqing Medical University, Chongqing, China
Zhen Chen, Chongqing Medical University, Chongqing, China
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