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Air pollution raises the risk of miscarriage for pregnant women as much as smoking. That was the finding of scientists investigating the impact of air quality on birth outcomes last year, while other studies have shown that pollution can increase the risk of premature birth and low birth weight.

Pregnant women are among those groups being urged to take special care as the capital struggles with the coronavirus outbreak. Before these times of social distancing and self-isolation, they also found themselves particularly challenged by air pollution. 

Talking before the pandemic, at 38 weeks pregnant, Victoria Frend acknowledged that the benefits of walking outdoors outweigh the negative impacts of pollution. But she still found herself being careful during her daily walks. “With my first pregnancy I didn’t have the choice; I just had to get on with it,” she noted. “I do lots of things without really thinking about it now such as moving away from a big truck pumping out fumes because I’m thinking about the baby, or walking a quiet back route to the park instead of along busy roads.”

Frend is co-founder of Pooches & Prams, a platform that encourages mums with dogs to get outside together.    Coronavirus has changed our social behaviour, but in ordinary times, she loved putting two-year-old son Arthur in the pram, and heading out to the park with dog Rupert. After moving from Wandsworth in Zone Two to Enfield in Zone Five, and swapping her daily commute to Tottenham Court Road for maternity leave, she explained that she had became more aware of the potential impact of pollution on her family.

It’s an issue that many Londoners are concerned about, which is why we are reporting on the impact of the capital’s dirty air on our health through our  year-long Air We Breathe project.

Frend said that when she was still making weekly trips into central London, she would really notice air pollution. “If I took my dog with me I could see his eyes get red and watery towards the end of the day. When you’re commuting every day you don’t notice it — and you don’t have a choice anyway.”

Pregnant women have particular reason to worry about air pollution: recent research found pollution particles in placentas. Jonathan Grigg, a professor of paediatric respiratory and environmental medicine at Queen Mary University of London, was among academics who conducted the research involving pregnant women living in London: the study found sooty particles in the placenta of each woman’s baby.

These findings were recently replicated by academics in Belgium, who believe it is possible particles can also enter the unborn babies. The Belgian scientists found particles on the foetal side of placentas, indicating they are directly exposed to pollution, although more research needs to be done.

“In the last five years there has been an explosion of work into birth outcomes and these are currently being reviewed by advisory bodies,” Dr Grigg told the Evening Standard. “What we don’t know yet is the direct link between the changes we see in the placenta and negative effects on the foetus. But the evidence supports a causal link.”

Other studies have linked low birth weight, pre-term birth and even stillbirth to air pollution — the discovery of particles in placentas could explain how the dirty air reaches the foetus.

Dr Guddi Singh, of campaining group Doctors Against Diesel, which wants diesel fuels to be phased out in urban areas, said the studies have “galvanised anger within the paediatric profession about the political failure to deal with this problem”.

He added:“This is the first evidence we’ve seen that particles inhaled by a pregnant woman can move through the lungs, into the bloodstream, and into the placenta. While we don’t yet understand what effect those particles might have on the developing foetus, the potential for lifelong damage to health has raised fears amongst paediatricians like me that millions of babies worldwide are being harmed.”

Air pollution can also affect pregnant women’s health. During last Easter’s heatwave, Victoria Lane collapsed in front of her two young children near her home in Stoke Newington. Lane, who was four months pregnant and on her way to her GP, was rushed to hospital with respiratory failure. She spent the next few weeks in intensive care before  being diagnosed with late-onset asthma. It was “terrifying”, she said, speaking earlier this month.

Lane’s son Seb, now seven months old, doesn’t appear to have been harmed by the incident. But following her experience, Lane joined the Air Team, a group of parents, teachers and campaigners lobbying for better air quality in London.

It can be difficult to quantify the impact of air pollution. Lane said her consultant believed her collapse was due to a mix of pollution, pregnancy hormones and reduced lung capacity in pregnancy. “He couldn’t say for certain it was pollution as it’s just not something they can know for sure, but I’m 38 and I’ve never had asthma and I had just moved to live on a very busy road,” she said.

As with the general population, exposure to air pollution can increase the risks of respiratory and cardiovascular conditions for pregnant women and exacerbate pre-existing conditions such as asthma.

 According to Dr Norrice Liu, a paediatrician and clinical research fellow at Queen Mary, studies show a link between air pollution and increased risks of high blood pressure, gestational diabetes, and pre-eclampsia. “All of these can impact on maternal and foetal wellbeing,” she said.

“There is also strong evidence antenatal exposure is associated with adverse birth outcomes such as low birth weight and premature labour, and subsequent health issues later in life. It’s also important to remember that pollution can disproportionately affect low-income communities who often live closer to big roads and in heavily-polluted areas.”

Many of us are now choosing to limit how much we travel. But before the coronavirus pandemic, TfL recommended Londoners take public transport rather than drive, despite exposure to air pollution in the city. Talking before the outbreak, Elizabeth Fonseca, senior air quality manager for the Environmental Defense Fund, suggested Londoners seeking a less polluted walking route use website WalkIt.com. She also highlighted a Cambridge study that found the benefits of physical activity outweigh the harm caused by air pollution. You should however check current advice on exercising outdoors.

 Amelia Cook, a doctor at a central London hospital, was 23 weeks pregnant with her first child when she spoke to the Evening Standard. She explained that air pollution had been on her mind since she developed late-onset asthma in her early 30s, and was told it is common for sufferers to develop it after moving to London.

Cook, who  commutes by bike, explained that she and her partner are “very pro-cycling and very pro-public transport”, and since becoming pregnant, she had been more interested in what is being done about air pollution. While London Mayor Sadiq Khan has made tackling air pollution a priority, she believes more could be done. 

“I feel more motivated because I’m thinking about bringing a child into the world, where they are going to be living and their health,” she said. “Leaving London’s not really practical and doesn’t fit with our social and professional lives.

“The thing about air pollution is that it affects everybody. You can be as green as you like and never go in a taxi and walk and cycle everywhere, but you’re going to be affected by everyone else’s air pollution so this is something we have to do together. This should be a public health matter, not just about individual actions.”