Interactive effects of maternal exposure to chemical fertilizer and socio-economic status on the risk of low birth weight

Background: Maternal exposure to chemical fertilizer and disadvantaged maternal socio-economic status (SES) have been found to associate with increased risk of low birth weight (LBW). However, whether the two factors would interact to elevate the risk of LBW remains unknown. The present study aimed to explore the interactive effects of maternal exposure to chemical fertilizer during pregnancy and low SES on the risk of term LBW (tLBW). Methods: In this population-based case-control study, 179 tLBW cases (birthweight < 2500 g and gestational age >= 37 weeks) and 204 controls (birthweight >= 2500 g and gestational age >= 37 weeks) were chosen from the Perinatal Health Care Surveillance System of Pingding County, Shanxi Province, China between 2007 and 2012. Data on basic socio-demographic, dietary and lifestyle characteristics and environmental exposure were directly extracted from the system. Maternal exposure to chemical fertilizer was measured at both household level and village level. Household-level exposure was indicated by household chemical fertilizer use in farming during pregnancy and the data was collected by trained healthcare workers after the selection of cases and controls in 2013. Village-level exposure was indicated by annual amount of village chemical fertilizer consumption per acre and the data came from the Annals of National Economics Statistics of Pingding County in 2010. Interactions between maternal exposure to chemical fertilizer and SES were assessed in logistic regressions using relative excess risk due to interaction (RERI), which indicates an additive interaction if larger than 0. Results: The combination of low maternal SES and high exposure to village-level chemical fertilizer consumption was associated with increased risk of tLBW (aOR = 2.62, 95%CI: 1.44 similar to 4.77); The combination of low maternal SES and exposure to household chemical fertilizer use was associated with elevated risk of tLBW (aOR = 2.18, 95%CI: 1.24 similar to 3.83). Additive interactions were detected between high exposure to village-level chemical fertilizer consumption and low maternal SES (RERI:1.79, P < 0.001) and between exposure to household chemical fertilizer use and low maternal SES (RERI:0.77, P < 0.05). Conclusions: Our study suggested negative impacts of potential agricultural pollutants on adverse pregnancy outcomes, especially in disadvantaged socio-economic populations.