The “SYNDEMIC” Effect: Intersecting Crises of COVID-19 and Air Pollution
Abstract
Introduction: Environmental pollution, particularly fine particulate matter (PM2.5), poses severe health risks to vulnerable populations, including pregnant women and developing fetuses. While previous studies link PM2.5 to adverse pregnancy outcomes, there is a distinct gap in understanding how pandemic-specific environmental and systemic stressors interact to affect maternal and neonatal health.
Research aim: This study aimed to investigate how varying levels of prenatal PM2.5 exposure correlated with childbirth mode, newborn birth weight, and APGAR scores among women who gave birth during the COVID-19 pandemic in Lithuania.
Methodology: A cross-sectional study was conducted utilizing data from 1,559 women who gave birth in Lithuania (excluding Kaunas city) during the pandemic. Data was collected via a comprehensive questionnaire regarding maternal characteristics and childbirth outcomes, and cross-referenced with residential air quality data from the Lithuanian Environmental Protection Agency. Participants were categorized into low, moderate, and high PM2.5 exposure groups.
Results: Findings demonstrated a striking dose-response relationship between PM2.5 exposure and adverse neonatal outcomes. Women in the high exposure group (>100 µg/m³) experienced a drastically higher cesarean section rate (75.9%) compared to the low exposure group (16.4%). Furthermore, increased PM2.5 exposure correlated with a significant reduction in average birth weight (from 3300g to 2900g) and markedly lower APGAR scores at both 1 minute (6.8 vs. 8.5) and 5 minutes (8.0 vs. 9.0) post-childbirth.
Conclusions: The research illustrates the profound negative impact of prenatal PM2.5 exposure on maternal and neonatal outcomes. It highlights an urgent need for multi-sectoral public health strategies that integrate environmental health and maternal care, ensuring that air quality mitigation is prioritized during public health emergencies to protect vulnerable populations.
Key messages: • The research illustrates the profound negative impact of prenatal PM2.5 exposure on maternal and neonatal outcomes during the pandemic.
• Results highlights an urgent need for multi-sectoral public health strategies that integrate environmental health and maternal care, ensuring that air quality mitigation.
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BibTeX
@article{jotautis2026syndemic,
title = {{The “SYNDEMIC” Effect: Intersecting Crises of COVID-19 and Air Pollution}},
author = {V Jotautis and A Liepinaitienė},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1276},
url = {https://doi.org/10.1093/eurpub/ckag169.1276},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - The “SYNDEMIC” Effect: Intersecting Crises of COVID-19 and Air Pollution
AU - V Jotautis
AU - A Liepinaitienė
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1276
UR - https://doi.org/10.1093/eurpub/ckag169.1276
AB - Introduction: Environmental pollution, particularly fine particulate matter (PM2.5), poses severe health risks to vulnerable populations, including pregnant women and developing fetuses. While previous studies link PM2.5 to adverse pregnancy outcomes, there is a distinct gap in understanding how pandemic-specific environmental and systemic stressors interact to affect maternal and neonatal health. Research aim: This study aimed to investigate how varying levels of prenatal PM2.5 exposure correlated with childbirth mode, newborn birth weight, and APGAR scores among women who gave birth during the COVID-19 pandemic in Lithuania. Methodology: A cross-sectional study was conducted utilizing data from 1,559 women who gave birth in Lithuania (excluding Kaunas city) during the pandemic. Data was collected via a comprehensive questionnaire regarding maternal characteristics and childbirth outcomes, and cross-referenced with residential air quality data from the Lithuanian Environmental Protection Agency. Participants were categorized into low, moderate, and high PM2.5 exposure groups. Results: Findings demonstrated a striking dose-response relationship between PM2.5 exposure and adverse neonatal outcomes. Women in the high exposure group (>100 µg/m³) experienced a drastically higher cesarean section rate (75.9%) compared to the low exposure group (16.4%). Furthermore, increased PM2.5 exposure correlated with a significant reduction in average birth weight (from 3300g to 2900g) and markedly lower APGAR scores at both 1 minute (6.8 vs. 8.5) and 5 minutes (8.0 vs. 9.0) post-childbirth. Conclusions: The research illustrates the profound negative impact of prenatal PM2.5 exposure on maternal and neonatal outcomes. It highlights an urgent need for multi-sectoral public health strategies that integrate environmental health and maternal care, ensuring that air quality mitigation is prioritized during public health emergencies to protect vulnerable populations. Key messages: • The research illustrates the profound negative impact of prenatal PM2.5 exposure on maternal and neonatal outcomes during the pandemic. • Results highlights an urgent need for multi-sectoral public health strategies that integrate environmental health and maternal care, ensuring that air quality mitigation.
SN - 1101-1262
SN - 1464-360X
ER -