Imperial College London

DrRachelSmith

Faculty of MedicineSchool of Public Health

Research Associate in Statistical Epidemiology
 
 
 
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+44 (0)20 7594 3313rachel.smith05

 
 
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Location

 

527Norfolk PlaceSt Mary's Campus

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Summary

 

Publications

Publication Type
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15 results found

Smith R, Beevers S, Gulliver J, Dajnak D, Fecht D, Blangiardo M, Douglass M, Hansell A, Anderson HR, Kelly FJ, Toledano Met al., Impacts of air pollution and noise on risk of preterm birth and stillbirth in London, Environment International, ISSN: 0160-4120

Background: Evidence for associations between ambient air pollution and preterm birth and stillbirth is inconsistent. Road traffic produces both air pollutants and noise, but few studies have examined these co-exposures together and none to date with all-cause or cause-specific stillbirths. Objectives: To analyse the relationship between long-term exposure to air pollution and noise at address level during pregnancy and risk of preterm birth and stillbirth.Methods: The study population comprised 581,774 live and still births in the Greater London area, 2006-2010. Outcomes were preterm birth (<37 completed weeks gestation), all-cause stillbirth and cause-specific stillbirth. Exposures during pregnancy to particulate matter with diameter <2.5 μm (PM2.5) and <10 μm (PM10), ozone (O3), primary traffic air pollutants (nitrogen dioxide, nitrogen oxides, PM2.5 from traffic exhaust and traffic non-exhaust), and road traffic noise were estimated based on maternal address at birth.Results: An interquartile range increase in O3 exposure was associated with elevated risk of preterm birth (OR 1.15 95% CI: 1.11, 1.18, for both Trimester 1 and 2), all-cause stillbirth (Trimester 1 OR 1.17 95% CI: 1.07, 1.27; Trimester 2 OR 1.20 95% CI: 1.09, 1.32) and asphyxia-related stillbirth (Trimester 1 OR 1.22 95% CI: 1.01, 1.49). Odds ratios with the other air pollutant exposures examined were null or <1, except for primary traffic non-exhaust related PM2.5, which was associated with 3% increased odds of preterm birth (Trimester 1) and 7% increased odds stillbirth (Trimester 1 and 2) when adjusted for O3. Elevated risk of preterm birth was associated with increasing road traffic noise, but only after adjustment for certain air pollutant exposures. Discussion: Our findings suggest that exposure to higher levels of O3 and primary traffic non-exhaust related PM2.5 during pregnancy may increase risk of preterm birth and stillbirth; and a possible relationship between long-term

Journal article

Freni Sterrantino A, Afoakwah P, Ghosh R, Smith RB, Hansell ALet al., Birth weight centiles and small for gestational age (SGA) by sex and ethnicity for England and Wales, Archives of Disease in Childhood, ISSN: 1468-2044

Objectives To construct UK Ethnic Birth Weight Centiles (UK-EBWC) for gestational age and cut-offs for small for gestational age (SGA) for England and Wales and to evaluate the SGA misclassification using the UK centiles.Design Analysis of national birth data.Participants All live singleton births in England and Wales in 2006 to 2012, as recorded by the Office for National Statistics (ONS) and birth registrations, linked with National Health Service (NHS) into Numbers for Babies (NN4B).Main Outcome Measures Both sex-specific and ethnicity-sex-specific birth weight centiles for gestational age, and ethnicity-sex-specific SGA cut-offs. Centiles were computed using the Generalized Additive Model for Location, Scale and Shape (GAMLSS). Results Our sex-specific centiles performed well and showed an agreement between the expected and observed number of births below the centiles. The ethnicity-sex-specific centiles for Black and Asian presented lower values compared to the White centiles. Comparisons of sex-specific and ethnicity-sex-specific centiles shows that use of sex-specific centiles increases the SGA diagnosed cases by 50% for Asian, 30% for South Asian (Indian, Pakistani and Bangladeshi) and 20% for Black ethnicity.Conclusions The centiles show important differences between ethnic groups, in particular the 10th centile used to define SGA. To account for these differences and to minimize misclassification of SGA, we recommend the use of customized birth weight centiles .

Journal article

Ghosh R, Freni Sterrantino A, Douglas P, Parkes B, Fecht D, de Hoogh C, Fuller G, Gulliver J, Font A, Smith RB, Blangiardo M, Elliott P, Toledano MB, Hansell ALet al., 2019, Fetal growth, stillbirth, infant mortality and other birth outcomes near UK municipal waste incinerators; retrospective population based cohort and case-control study, Environment International, Vol: 122, Pages: 151-158, ISSN: 0160-4120

BackgroundSome studies have reported associations between municipal waste incinerator (MWI) exposures and adverse birth outcomes but there are few studies of modern MWIs operating to current European Union (EU) Industrial Emissions Directive standards.MethodsAssociations between modelled ground-level particulate matter ≤10 μm in diameter (PM10) from MWI emissions (as a proxy for MWI emissions) within 10 km of each MWI, and selected birth and infant mortality outcomes were examined for all 22 MWIs operating in Great Britain 2003–10. We also investigated associations with proximity of residence to a MWI. Outcomes used were term birth weight, small for gestational age (SGA) at term, stillbirth, neonatal, post-neonatal and infant mortality, multiple births, sex ratio and preterm delivery sourced from national registration data from the Office for National Statistics. Analyses were adjusted for relevant confounders including year of birth, sex, season of birth, maternal age, deprivation, ethnicity and area characteristics and random effect terms were included in the models to allow for differences in baseline rates between areas and in incinerator feedstock.ResultsAnalyses included 1,025,064 births and 18,694 infant deaths. There was no excess risk in relation to any of the outcomes investigated during pregnancy or early life of either mean modelled MWI PM10 or proximity to an MWI.ConclusionsWe found no evidence that exposure to PM10 from, or living near to, an MWI operating to current EU standards was associated with harm for any of the outcomes investigated. Results should be generalisable to other MWIs operating to similar standards.

Journal article

Smith RB, Fecht D, Gulliver J, Beevers SD, Dajnak D, Blangiardo M, Ghosh RE, Hansell AL, Kelly FJ, Anderson HR, Toledano MBet al., 2017, Impacts of London's road traffic air and noise pollution on birth weight: a retrospective population-based cohort study, BMJ, Vol: 359, ISSN: 0959-8138

Objective To investigate the relation between exposure to both air and noise pollution from road traffic and birth weight outcomes.Design Retrospective population based cohort study.Setting Greater London and surrounding counties up to the M25 motorway (2317 km2), UK, from 2006 to 2010.Participants 540 365 singleton term live births.Main outcome measures Term low birth weight (LBW), small for gestational age (SGA) at term, and term birth weight.Results Average air pollutant exposures across pregnancy were 41 μg/m3 nitrogen dioxide (NO2), 73 μg/m3 nitrogen oxides (NOx), 14 μg/m3 particulate matter with aerodynamic diameter <2.5 μm (PM2.5), 23 μg/m3 particulate matter with aerodynamic diameter <10 μm (PM10), and 32 μg/m3 ozone (O3). Average daytime (LAeq,16hr) and night-time (Lnight) road traffic A-weighted noise levels were 58 dB and 53 dB respectively. Interquartile range increases in NO2, NOx, PM2.5, PM10, and source specific PM2.5 from traffic exhaust (PM2.5 traffic exhaust) and traffic non-exhaust (brake or tyre wear and resuspension) (PM2.5 traffic non-exhaust) were associated with 2% to 6% increased odds of term LBW, and 1% to 3% increased odds of term SGA. Air pollutant associations were robust to adjustment for road traffic noise. Trends of decreasing birth weight across increasing road traffic noise categories were observed, but were strongly attenuated when adjusted for primary traffic related air pollutants. Only PM2.5 traffic exhaust and PM2.5 were consistently associated with increased risk of term LBW after adjustment for each of the other air pollutants. It was estimated that 3% of term LBW cases in London are directly attributable to residential exposure to PM2.5>13.8 μg/m3during pregnancy.Conclusions The findings suggest that air pollution from road traffic in London is adversely affecting fetal growth. The results suggest little evidence for an independent exposure-response effect of traffic related noise on b

Journal article

Toledano MB, Smith RB, Chang I, Douglass M, Elliott Pet al., 2015, Cohort profile: UK COSMOS – a UK cohort for study of environment and health, International Journal of Epidemiology, Vol: 46, Pages: 775-787, ISSN: 1464-3685

Journal article

Smith RB, Edwards SC, Best N, Wright J, Nieuwenhuijsen MJ, Toledano MBet al., 2015, Birth Weight, Ethnicity, and Exposure to Trihalomethanes and Haloacetic Acids in Drinking Water during Pregnancy in the Born in Bradford Cohort., Environmental Health Perspectives, Vol: 124, Pages: 681-689, ISSN: 1552-9924

BACKGROUND: Evidence for a relationship between trihalomethane (THM) or haloacetic acid (HAA) exposure and adverse fetal growth is inconsistent. Disinfection by-products exist as complex mixtures in water supplies, but THMs and HAAs have typically been examined separately. OBJECTIVES: We investigated joint exposure at the individual level to THMs and HAAs in relation to birth weight in the multi-ethnic Born in Bradford birth cohort. METHODS: Pregnant women reported their water consumption and activities via questionnaire. These data were combined with area-level THM and HAA concentrations to estimate integrated uptake of THMs into blood and HAA ingestion, accounting for boiling/filtering. We examined the relationship between THM and HAA exposures and birth weight of up to 7,438 singleton term babies using multiple linear regression, stratified by ethnicity. RESULTS: Among Pakistani-origin infants, mean birth weight was significantly lower in association with the highest versus lowest tertiles of integrated THM uptake (e.g., -53.7 g; 95% CI: -89.9, -17.5 for ≥ 1.82 vs. < 1.05 μg/day of total THM) and there were significant trends (p < 0.01) across increasing tertiles, but there were no associations among white British infants. Neither ingestion of HAAs alone or jointly with THMs was associated with birth weight. Estimated THM uptake via showering, bathing, and swimming was significantly associated with lower birth weight in Pakistani-origin infants, when adjusting for THM and HAA ingestion via water consumption. CONCLUSIONS: To our knowledge, this is the largest DBP and fetal growth study to date with individual water use data, and the first to examine individual-level estimates of joint THM-HAA exposure. Our findings demonstrate associations between THM, but not HAA, exposure during pregnancy and reduced birth weight, but suggest this differs by ethnicity. This study suggests that THMs are not acting as a proxy for HAAs, or vice-versa. CITATION: Smith RB

Journal article

Toledano MB, Smith RB, Brook JP, Douglass M, Elliott Pet al., How to Establish and Follow up a Large Prospective Cohort Study in the 21st Century - Lessons from UK COSMOS., PLOS One, ISSN: 1932-6203

Journal article

Smith RB, Bennett JE, Rantakokko P, Martinez D, Nieuwenhuijsen MJ, Toledano MBet al., 2015, The relationship between MX [3-Chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone], routinely monitored trihalomethanes, and other characteristics in drinking water in a long-term survey, Environmental Science & Technology, Vol: 49, Pages: 6485-6493, ISSN: 1520-5851

MX (3-Chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone) is a drinking water disinfection byproduct (DBP). It is a potent mutagen and is of concern to public health. Data on MX levels in drinking water, especially in the UK, are limited. Our aim was to investigate factors associated with variability of MX concentrations at the tap, and to evaluate if routinely measured trihalomethanes (THMs) are an appropriate proxy measure for MX. We conducted quarterly water sampling at consumers’ taps in eight water supply zones in and around Bradford, UK, between 2007 and 2010. We collected 79 samples which were analyzed for MX using GC-HRMS. Other parameters such as pH, temperature, UV-absorbance and free chlorine were measured concurrently, and total THMs were modeled from regulatory monitoring data. To our knowledge this is the longest MX measurement survey undertaken to date. Concentrations of MX varied between 8.9 and 45.5 ng/L with a median of 21.3 ng/L. MX demonstrated clear seasonality with concentrations peaking in late summer/early fall. Multivariate regression showed that MX levels were associated with total trihalomethanes, UV-absorbance and pH. However, the relationship between TTHM and MX may not be sufficiently consistent across time and location for TTHM to be used as a proxy measure for MX in exposure assessment.

Journal article

Pedersen M, Mendez MA, Schoket B, Godschalk RW, Espinosa A, Landstrom A, Villanueva CM, Merlo DF, Fthenou E, Gracia-Lavedan E, van Schooten F-J, Hoek G, Brunborg G, Meltzer HM, Alexander J, Nielsen JK, Sunyer J, Wright J, Kovacs K, de Hoogh K, Gutzkow KB, Hardie LJ, Chatzi L, Knudsen LE, Anna L, Ketzel M, Haugen M, Botsivali M, Nieuwenhuijsen MJ, Cirach M, Toledano MB, Smith RB, Fleming S, Agramunt S, Kyrtopoulos SA, Lukacs V, Kleinjans JC, Segerback D, Kogevinas Met al., 2015, Environmental, dietary, maternal, and fetal predictors of bulky DNA adducts in cord blood: a European mother-child study (NewGeneris), Environmental Health Perspectives, Vol: 123, Pages: 374-380, ISSN: 0091-6765

Background: Bulky DNA adducts reflect genotoxic exposures, have been associated with lower birth weight, and may predict cancer risk.oBjective: We selected factors known or hypothesized to affect inutero adduct formation and repair and examined their associations with adduct levels in neonates.Methods: Pregnant women from Greece, Spain, England, Denmark, and Norway were recruited in 2006–2010. Cord blood bulky DNA adduct levels were measured by the 32P-postlabeling technique (n=511). Diet and maternal characteristics were assessed via questionnaires. Modeled exposures to air pollutants and drinking-water disinfection by-products, mainly trihalomethanes (THMs), were available for a large proportion of the study population.results: Greek and Spanish neonates had higher adduct levels than the northern European neonates [median, 12.1 (n=179) vs. 6.8 (n=332) adducts per 108 nucleotides, p<0.001].Residence in southern European countries, higher maternal body mass index, delivery by cesarean section, male infant sex, low maternal intake of fruits rich in vitaminC, high intake of dairyproducts, and low adherence to healthy diet score were statistically significantly associated with higher adduct levels in adjusted models. Exposure to fine particulate matter and nitrogen dioxide was associated with significantly higher adducts in the Danish subsample only. Overall, the pooled results for THMs in water show no evidence of association with adduct levels; however, there are country-specific differences in results with a suggestion of an association in England.conclusion: These findings suggest that a combination of factors, including unknown country-specific factors, influence the bulky DNA adduct levels in neonates.citation: Pedersen M, Mendez MA, Schoket B, Godschalk RW, Espinosa A, LandströmA, Villanueva

Journal article

Smith RB, Nieuwenhuijsen MJ, Wright J, Raynor P, Cocker J, Jones K, Kostopoulou-Karadanelli M, Toledano MBet al., 2013, Validation of trichloroacetic acid exposure via drinking water during pregnancy using a urinary TCAA biomarker, ENVIRONMENTAL RESEARCH, Vol: 126, Pages: 145-151, ISSN: 0013-9351

Journal article

Grellier J, Bennett J, Patelarou E, Smith RB, Toledano MB, Rushton L, Briggs DJ, Nieuwenhuijsen MJet al., 2010, Exposure to Disinfection By-products, Fetal Growth, and Prematurity A Systematic Review and Meta-analysis, EPIDEMIOLOGY, Vol: 21, Pages: 300-313, ISSN: 1044-3983

Journal article

Nieuwenhuijsen MJ, Smith R, Golfinopoulos S, Best N, Bennett J, Aggazzotti G, Righi E, Fantuzzi G, Bucchini L, Cordier S, Villanueva CM, Moreno V, La Vecchia C, Bosetti C, Vartiainen T, Rautiu R, Toledano M, Iszatt N, Grazuleviciene R, Kogevinas Met al., 2009, Health impacts of long-term exposure to disinfection by-products in drinking water in Europe: HIWATE, JOURNAL OF WATER AND HEALTH, Vol: 7, Pages: 185-207, ISSN: 1477-8920

Journal article

Nieuwenhuijsen MJ, Smith R, Golfinopoulos S, Best N, Bennett J, Aggazzotti G, Righi E, Fantuzzi G, Bucchini L, Cordier S, Villanueva CM, Moreno V, La Vecchia C, Bosetti C, Vartiainen T, Rautiu R, Toledano M, Iszatt N, Grazuleviciene R, Kogevinas Met al., 2009, Health impacts of long-term exposure to disinfection by-products in drinking water in Europe: HIWATE., J Water Health, Vol: 7, Pages: 185-207

Nieuwenhuijsen MJ, Smith R, Golfinopoulos S, Best N, Bennett J, Aggazzotti G, Righi E, Fantuzzi G, Bucchini L, Cordier S, Villanueva CM, Moreno V, La Vecchia C, Bosetti C, Vartiainen T, Rautiu R, Toledano M, Iszatt N, Grazuleviciene R, Kogevinas M.

Journal article

Nieuwenhuijsen MJ, Grellier J, Smith R, Iszatt N, Bennett J, Best N, Toledano Met al., 2009, The epidemiology and possible mechanisms of disinfection by-products in drinking water., Philos Transact A Math Phys Eng Sci, Vol: 367, Pages: 4043-4076

Journal article

Smith RB, Toledano MB, Wright J, Raynor P, Nieuwenhuijsen MJet al., 2009, Tap water use amongst pregnant women in a multi-ethnic cohort., Environmental Health, Vol: 21

Journal article

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