Prenatal Exposure to Air Pollution and Pediatric Biliary Atresia: A Nationwide Population-Based Cohort Study.

Abstract

Introduction: Biliary atresia (BA) is a serious pediatric liver disease and the leading cause of liver transplants in children. Although its cause is unknown, prior research suggests air pollution may influence childhood diseases. This study examines the potential association between prenatal air pollution exposure and BA incidence.

Methods: This nationwide, longitudinal matched case-control study used data from the National Health Insurance Research Database in Taiwan. BA cases were identified using ICD codes in children who underwent the Kasai procedure or liver transplantation. Controls, matched by age, index month, and gender, were selected at a 1:10 ratio. Multivariable logistic regression models, adjusted for potential confounders (age, gender, maternal age, delivery mode, and preterm birth), were utilized to assess the association between individual air pollutants (PSI, SO₂, CO, O₃, PM_2.5, PM₁₀, NO, NO₂, and NO_x) and BA. Quartiles of cumulative air pollutant amounts were analyzed for dose-dependent effects.

Results: A total of 1,663,737 first-time pregnancies were identified from 2004 to 2016. After excluding 8,523 newborns due to congenital neonatal defects, 1,655,214 individuals remained. Among them, a cohort of 253 BA patients was identified. After adjusting for multiple confounders, no significant associations were found between prenatal exposure to air pollutants and BA risk. Quartile analysis of cumulative air pollutant exposure also indicated no dose-response relationship with BA risk for each air pollutant.

Conclusion: This population-based study found no statistically significant association between prenatal air pollution exposure and the risk of BA in newborns in Taiwan.