Impact of London's road traffic air and noise pollution on birth weight: retrospective population based cohort studyBMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5299 (Published 05 December 2017) Cite this as: BMJ 2017;359:j5299
All rapid responses
Smith el al must be commended for clearly demonstrating that air pollution from road traffic in London adversely affects fetal growth.(1) The study adjusted for confounding variables and the estimate of a 3% population attributable factor (the proportional reduction in population morbidity that would occur if exposure was reduced to zero) is merely the tip of the iceberg in terms of public health challenges. Indeed, the most frequent avoidable causes of low fetal growth and preterm birth are associated with the social gradient and they interact: smoking, pollution, poor education, poor nutrition, poor housing, single motherhood… and more - the list goes on. Accordingly, in such a quagmire, no adjustment method can reliably calculate the population attributable factor for each cause separately, and what would be the point? The response must be comprehensive but Marmot’s salient call to reduce unfair distribution of resources and conditions of everyday life continues to remain almost ignored.(2)
In the UK, as in France, around 60,000 babies are born prematurely each year as over 1 in 10 pregnancies ends in preterm birth: half after spontaneous onset of labour and half after provider-initiated intervention. This is a major issue as gestational age is highly associated with neonatal mortality and with short- and long-term morbidities. Healthcare professionals must apply good evidence when intervening in individual cases, but also lobby for universal social justice. Who better to advocate for the future children destined for poor health from before their births? Otherwise, like the daughters of Danaus, they will be condemned for eternity to fill an ever-draining barrel with water carried in sieves.(3).
1 Smith RS, Fecht D, Gulliver J et al. Impact of London's road traffic air and noise pollution on birth weight: retrospective population based cohort study. BMJ 2017;359:j5299
2 Marmot M. Commission on Social Determinants of Health. Achieving health equity: from root causes to fair outcomes. Lancet 2007;370:1153-63.
3 Daughters of Danaus. Available at https://en.wikipedia.org/wiki/Daughters_of_Danaus
Competing interests: No competing interests