Prenatal exposure to phthalates and infant development at 6 months: prospective Mothers and Children's Environmental Health (MOCEH) study

Background: There are increasing concerns over adverse effects of prenatal phthalate exposure on the neurodevelopment of infants.Objectives: Our goal was to explore the association between prenatal di(2-ethylhexyl) phthalate and dibutyl phthalate exposure and the Mental and Psychomotor Developmental Indices (MDI and PDI, respectively) of the Bayley Scales of Infant Development at 6 months, as part of the Mothers and Children’s Environmental Health Study.Methods: Between 2006 and 2009, 460 mother–infant pairs from Seoul, Cheonan, and Ulsan, Korea, participated. Prenatal mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP), and mono-n-butyl phthalate (MBP) were measured in one urine sample acquired from each mother during the third trimester of pregnancy. Associations with log-transformed creatinine-corrected phthalate concentrations were estimated using linear regression models adjusted for potential confounders.Results: MDI was inversely associated with the natural log concentrations (micrograms per gram creatinine) of MEHHP [β = –0.97; confidence interval (CI), –1.85 to –0.08] and MEOHP (β = –0.95; CI, –1.87 to –0.03), and PDI was inversely associated with MEHHP (β = –1.20; CI, –2.33 to –0.08). In males, MDI was inversely associated with MEHHP (β = –1.46; CI, –2.70 to –0.22), MEOHP (β = –1.57; CI, –2.87 to –0.28), and MBP (β = –0.93; CI, –1.82 to –0.05); PDI was inversely associated with MEHHP (β = –2.36; CI, –3.94 to –0.79), MEOHP (β = –2.05; CI, –3.71 to –0.39), and MBP (β = –1.25; CI, –2.40 to –0.11). No significant linear associations were observed for females.Conclusions: The results suggest that prenatal exposure to phthalates may be inversely associated with the MDI and PDI of infants, particularly males, at 6 months.     

Urinary bisphenol A and obesity: NHANES 2003-2006

Background

Bisphenol A (BPA) is a chemical suspected of causing endocrine and metabolic disruption in animals and humans. In rodents, in utero exposure to low-dose BPA is associated with weight gain. Detectable levels of BPA are found in most Americans due to its widespread use in the manufacture of food and drink packaging. We hypothesized that urinary BPA concentrations would be positively associated with general and central obesity.

Methods

Cross-sectional analysis of urinary BPA concentrations, body mass index, and waist circumference in 2747 adults (aged 18–74), using pooled data from the 2003/04 and 2005/06 National Health and Nutrition Examination Surveys.

Results

The creatinine-adjusted geometric mean urinary BPA concentration was 2.05 μg/g creatinine (25th percentile: 1.18, 75% percentile: 3.33). Relative to those in the lowest BPA quartile, participants in the upper BPA quartiles were more likely to be classified as obese (quartile 2 odds ratio (OR): 1.85, 95% confidence interval (CI): 1.22, 2.79; quartile 3 OR: 1.60, 95% CI: 1.05–2.44; quartile 4 OR: 1.76, 95% CI: 1.06–2.94). Higher BPA concentration was also associated with abdominal obesity (quartile 2 OR: 1.62, 95% CI: 1.11, 2.36; quartile 3 OR: 1.39, 95% CI: 1.02–1.90; quartile 4 OR: 1.58, 95% CI: 1.03–2.42).

Conclusions

Higher BPA exposure is associated with general and central obesity in the general adult population of the United States. Reverse causation is of concern due to the cross-sectional nature of this study; longitudinal studies are needed to clarify the direction of the association.     

Maternal and cord blood manganese (Mn) levels and birth weight: The MIREC birth cohort study

Epidemiological studies have hypothesized that both insufficient and excess blood manganese (Mn) levels during pregnancy are associated with reduced fetal growth. This literature is characterized by inconsistent results and a limited focus on women with exposures representative of the general North American population. We examined the relationship between maternal and cord blood Mn levels and fetal growth among women enrolled in the Maternal-Infant Research on Environmental Chemicals Study (MIREC). Mothers with singleton, term infants and complete maternal first and third trimester blood Mn data were eligible for inclusion in the present study (n?=?1519). Mean birth weight and odds ratios of small for gestational age (SGA) births according to maternal and cord blood Mn levels (low (<10), referent (10–<90), high (≥90) percentiles) were estimated. We also evaluated the association between the ratio of cord and maternal blood Mn and birth weight. Women with low (<0.82?μg/dL) maternal blood third trimester Mn levels had infants that weighed an average of 64.7?g (95% CI: ?142.3,12.8) less than infants born to women in the referent exposure group. This association was strengthened and became statistically significant when adjusted for toxic metals (lead, mercury, arsenic, and cadmium) [?83.3?g (95% CI: ?162.4, ?4.1)]. No statistically significant associations were observed in models of maternal first trimester or cord blood Mn. A one unit increase in the cord/maternal blood Mn ratio was associated with a 29.4?g (95% CI: ?50.2, ?8.7), when adjusted for maternal and neonatal characteristics. Our findings motivate additional research regarding the relation between Mn exposure and fetal growth. Further inquiry is necessary to determine whether an exposure threshold exists, how growth related effects of maternal and fetal Mn may differ, and how concurrent exposure to other toxic metals may impact the association between Mn and growth.     

孕期母体营养与胎儿出生体质量

孕期母体的营养状况对孕妇自身和胎儿均有重要的影响,胎儿出生体质量是评价营养对妊娠结局影响最重要的指标.现阶段评价孕妇营养的指标主要有人体测量学、血液学以及生物电阻抗分析,每一种评价手段各有所长.胎儿出生体质量受多种因素的影响,对异常出生体质量儿(如巨大JD)可能是有意义的指标.但对正常体质量儿不一定有意义,因而对于孕期母体营养与婴儿体质量的关系有待更深入的研究.     

孕期双酚A暴露对学龄前儿童情绪和行为问题的影响

目的 探讨孕期双酚A（BPA）暴露对学龄前儿童情绪和行为问题的远期影响效应。方法 研究样本源于中国安徽出生队列研究（China-Anhui Birth Cohort Study）的前瞻性随访人群。采用课题组编制的调查表收集孕妇和儿童的基本信息,运用固相萃取-同位素内标-高效液相色谱串联质谱法检测母亲孕期血清中游离的BPA含量。应用长处和困难问卷评估学龄前儿童的情绪和行为问题,最终纳入1 713对母子。运用多分类logistic回归模型分析孕期BPA暴露与学龄前儿童情绪和行为问题的病因关联。结果 1 713名学龄前儿童中,情绪症状异常检出率为6.48%,品行问题异常检出率为8.11%,多动/注意缺陷异常检出率为8.35%,同伴交往异常检出率为2.86%,亲社会行为问题异常检出率为11.38%,困难总分异常检出率为7.94%。按血清游离BPA浓度（ng/ml）三分位数法将研究对象分为低暴露组（≤ 0.120）、中暴露组（0.120OR=1.876,95% CI：1.161~3.029）,且在男童中表现更明显（OR=2.291,95% CI：1.126~4.661）。结论 母亲孕期高水平BPA暴露可能增加学龄前儿童品行问题异常的发生风险,且在男童中表现得更为明显。     

Prenatal exposure to PCDDs/PCDFs and dioxin-like PCBs in relation to birth weight

Several human studies have shown that low-level exposure to environmental contaminants, such as polychlorinated biphenyls (PCBs) and organochlorine pesticides, negatively influences birth outcomes. However, the effects of low-level exposure to polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and dioxin-like PCBs (DL-PCBs) on birth outcomes have not been clarified in human studies.A prospective cohort study was established to investigate the possible adverse effects of PCDDs/PCDFs and DL-PCBs on fetal growth and neurodevelopment. We recruited 514 pregnant women between July 2002 and October 2005 in Sapporo, Japan. We measured 29 congener levels of PCDDs/PCDFs and DL-PCBs in maternal blood.Using multiple liner regression analysis of the association between birth weight and the levels of PCDDs/PCDFs and DL-PCBs with full adjustments for potential confounders, a significant adverse effect was observed regarding total PCDDs toxic equivalents (TEQ) levels (adjusted β=−231.5 g, 95% CI: −417.4 to −45.6) and total PCDFs TEQ levels (adjusted β=−258.8 g, 95% CI: −445.7 to −71.8). Among male infants, significant adverse associations with birth weight were found for total PCDDs TEQ level, total PCDDs/PCDFs TEQ level, and total TEQ level. However, among female infants, these significant adverse associations were not found. With regard to individual congeners of PCDDs/PCDFs and DL-PCBs, we found significantly negative association with the levels of 2,3,4,7,8-PeCDF (adjusted β=−24.5 g, 95% CI: −387.4 to −61.5).Our findings suggest that prenatal low-level exposure to PCDDs and PCDFs, especially 2,3,4,7,8-PeCDF, may accumulate in the placenta and retard important placental functions, which result in lower birth weight.     

Traffic-related air pollution, preterm birth and term birth weight in the PIAMA birth cohort study

Background

Maternal exposure to air pollution has been associated with adverse pregnancy outcomes. Few studies took into account the spatial and temporal variation of air pollution levels.

Objectives

To evaluate the impact of maternal exposure to traffic-related air pollution during pregnancy on preterm birth and term birth weight using a spatio-temporal exposure model.

Methods

We estimated maternal residential exposure to nitrogen dioxide (NO₂), particulate matter (PM_2.5) and soot during pregnancy (entire pregnancy, 1st trimester, and last month) for 3853 singleton births within the Dutch PIAMA prospective birth cohort study by means of temporally adjusted land-use regression models. Associations between air pollution concentrations and preterm birth and term birth weight were analyzed by means of logistic and linear regression models with and without adjustment for maternal physical, lifestyle, and socio-demographic characteristics.

Results

We found positive, statistically non-significant associations between exposure to soot during entire pregnancy and during the last month of pregnancy and preterm birth [adj. OR (95% CI) per interquartile range increase in exposure 1.08 (0.88–1.34) and 1.09 (0.93–1.27), respectively]. There was no indication of an adverse effect of air pollution exposure on term birth weight.

Conclusions

In this study, maternal exposure to traffic-related air pollution during pregnancy was not associated with term birth weight. There was a tendency towards an increased risk of preterm birth with increasing air pollution exposure, but statistical power was low.     

孕期总增重与不良妊娠结局关系的前瞻性研究

目的 探讨孕期总增重与不良妊娠结局之间的关系。方法 选取成都市妇幼医疗机构产前门诊1 220名6~12孕周、单胎健康的妇女为研究对象进行前瞻性研究。通过问卷调查收集孕妇年龄、孕前体重等基本信息,于分娩前测量孕妇体重,计算孕期总增重,参照2009年美国医学研究所发布的孕期增重推荐标准将研究对象分为增重适宜、增重不足和增重过多组。于分娩后通过医院信息系统收集妊娠结局相关信息。采用多因素非条件logistic回归分析探讨孕期总增重与不良妊娠结局关系。结果 共纳入1 045名单胎活产孕妇进行分析。与孕期增重适宜组相比,孕期增重过多组脐带缠绕和大于胎龄儿发生风险升高（分别为OR=1.641,95% CI：1.197~2.252和OR=1.678,95% CI：1.132~2.488）;孕期增重过少组早产发生风险升高（OR=3.189,95% CI：1.604~6.341）。结论 孕期总增重过多和过少均可能导致不良妊娠结局。应重视孕期体重监测,降低不良妊娠结局发生风险。     

双酚A暴露与儿童青少年肥胖关系的Meta分析

目的采用Meta分析系统评价双酚A(Bisphenol A,BPA)暴露与儿童青少年肥胖的关系,为预防和控制儿童青少年肥胖的发生提供思路。方法全面检索Medline、Web of Science、中国生物医学文献数据库、中国知网数据库、维普数据库和万方数据库等中文和外文数据库,查找国内外关于BPA暴露与儿童青少年肥胖关系的中英文文献。使用Stata12.0进行Meta分析,选择标准化均数差(standardized mean difference,SMD)及其置信区间和随机效应模型合并效应值。Q检验和I2统计量用于评价研究的异质性,漏斗图、Egger和Begg检验评价发表偏倚。结果共纳入13项研究,3 932名研究对象,其中病例组1 046例,对照组2 886人。尿液中BPA水平与肥胖呈正相关(SMD=0.26,95%CI=0.01～0.51),而血清中BPA水平与肥胖不存在相关性(SMD=0.07,95%CI=-0.44～0.58)。各研究之间存在高度异质性(I²=87. 3%,P <0.01)。亚组分析发现,美国(SMD=0.27,95%CI=0. 16...     

环境内分泌干扰物与多囊卵巢综合征关系的研究进展

环境内分泌干扰物（EED）广泛存在于日常生活中，是一类可以干扰激素行为的外源性化学物。EED可以结合人体内不同的受体，通过多种机制增强或抑制体内正常的内分泌功能，从而引发多种疾病。多囊卵巢综合征（PCOS）病因复杂，已有研究结果表明PCOS的发生与环境因素有关。相关流行病学和基础实验研究表明，EED参与PCOS的发生、发展，但具体作用机制仍需进一步研究。现就EED与PCOS的关系及可能的相关作用机制进行阐述，总结EED与PCOS的关系,为干预PCOS患者的生活方式并阻断疾病发生提供新的线索。     

Jail incarceration and birth outcomes

This study examined the relationships between jail incarceration during pregnancy and infant birth weight, preterm birth, and fetal growth restriction. We used multivariate regression analyses to compare outcomes for 496 births to women who were in jail for part of pregnancy with 4,960 Medicaid-funded births as matched community controls. After adjusting for potential confounding variables, the relationship between jail incarceration and birth outcomes was modified by maternal age. Relative to controls, women incarcerated during pregnancy had progressively higher odds of low birth weight and preterm birth through age 39 years; conversely, jail detainees older than 39 years were less likely than controls to experience low birth weight or preterm birth. For women in jail at all ages, postrelease maternity case management was associated with decreased odds of low birth weight, whereas prenatal care was associated with decreased odds of preterm birth. Local jails are important sites for public health intervention. Efforts to ensure that all pregnant women released from jail have access to enhanced prenatal health services may improve perinatal outcomes for this group of particularly vulnerable women and infants.     

环境雌激素双酚A对小鼠生殖内分泌激素的影响

目的观察双酚A对小鼠体内生殖内分泌激素水平的影响。方法采用放射免疫法分别测定不同剂量双酚A腹腔注射染毒3d及相同剂量双酚A一次染毒后30min、4、12、24、36、48和72h的小鼠血清雌二醇（E：）和睾丸组织睾酮（T）水平。结果不同剂量双酚A染毒3d后,各染毒组T含量明显低于阴性对照组（P〈0．05）,且随着染毒剂量的增加而明显降低;雄性和雌性小鼠血清E2浓度随染毒剂量的增加而逐渐升高,当剂量达到80umol／kg时,明显高于阴性对照组（P〈0．05）。相同剂量双酚A一次染毒后0．5～12h内,小鼠睾丸组织T及血清E2水平迅速下降,之后缓慢上升,72h内可恢复正常水平。结论双酚A对小鼠具有内分泌干扰作用,可引起小鼠组织睾酮水平下降及血清雌二醇水平升高。     

Surrounding greenness and birth weight: Results from the GINIplus and LISAplus birth cohorts in Munich

AimWe investigated the association between surrounding greenness at the mother's residential address at the time of delivery and birth weight in two German birth cohorts and explored potential underlying hypotheses.MethodsComplete data on 3203 newborns, recruited in Munich between 1996 and 1999, were available. Surrounding greenness was defined using the mean of the Normalized Difference Vegetation Index, which was derived from Landsat 5 TM satellite images.ResultsAn interquartile increase of surrounding greenness in a 500-m buffer was associated with an average birth weight increase of 17.6 g (95% CI=0.5 to 34.6). The effect strengthened after individual adjustment for NO₂, PM2.5, distance to major road and population density. The strongest association was found for mothers with less than 10 years of school education. The results remained robust when additionally adjusted for noise or maternal stress during pregnancy. Neighbourhood green spaces were not associated with birth weight.ConclusionsSurrounding greenness at the birth address was positively associated with birth weight in two birth cohorts in Munich. The mechanisms driving this association remain unclear and warrant further investigation.     

双酚A对女性生殖功能损伤及药物干预的研究进展

双酚A（bisphenol A,BPA）是一种广泛存在于环境中的有机化合物,可干扰机体正常的新陈代谢,参与多种疾病的发生、发展。高剂量BPA暴露对生殖系统具有急性毒性作用;长期BPA暴露对生殖系统损伤更为显著,甚至可以产生跨代效应,影响后代的生长发育。BPA通过多种机制途径损伤女性生殖功能,降低女性生育力,因此,开发相关药物来缓解此种不良反应显得尤为重要。综述BPA对女性生殖系统的损伤,并介绍抗氧化剂、益生菌、维生素及中药对缓解BPA生殖损伤作用的研究进展,但相关药物在临床上的应用还需要循证医学证据支持。     

Maternal arsenic exposure and birth outcomes: A comprehensive review of the epidemiologic literature focused on drinking water

Inorganic arsenic (iAs) is a human toxicant to which populations may be exposed through consumption of geogenically contaminated groundwater. A growing body of experimental literature corroborates the reproductive toxicity of iAs; however, the results of human studies are inconsistent. Therefore, we conducted a comprehensive review of epidemiologic studies focused on drinking water iAs exposure and birth outcomes to assess the evidence for causality and to make recommendations for future study. We reviewed 18 English language papers assessing birth weight, gestational age, and birth size. Thirteen of the studies were conducted among populations with frequent exposure to high-level groundwater iAs contamination (>10 μg/L) and five studies were conducted in areas without recognized contamination. Most studies comprised small samples and used cross-sectional designs, often with ecologic exposure assessment strategies, although several large prospective investigations and studies with individual-level measurements were also reported. We conclude that: (1) the epidemiologic evidence for an increased risk of low birth weight (<2500 g) is insufficient, although there exists limited evidence for birth weight decreases; (2) the evidence for increased preterm delivery is insufficient; and, (3) there exists minimal evidence for decreased birth size. In further investigation of birth weight and size, we recommend incorporation of individual susceptibility measures using appropriate biomarkers, with collection timed to windows of vulnerability and speciated arsenic analysis, as well as consideration of populations exposed primarily to drinking water iAs contamination <10 μg/L. Given the large potential public health impact, additional, high quality epidemiologic studies are necessary to more definitively assess the risk.     

双酚A日常生活暴露与生殖中心就诊男性性功能关系的研究

目的 探讨双酚A（BPA）日常生活暴露与男性性功能的关系。方法 选取2014年9月至2015年4月在山西省妇幼保健院生殖中心门诊部因不孕不育就诊的男性作为研究对象,收集其一般人口学特征、性功能状况资料和空腹静脉血标本。应用德尔菲专家评分法计算性功能总得分,采用高效液相色谱法测定研究对象血清BPA水平。采用Spearman秩相关、秩和检验,多因素logistic回归分析进行BPA水平、影响因素、性功能指标之间的关联性及趋势分析。结果 共纳入353名研究对象,总体性功能异常率为45.0%,性欲低下（47.3%）为性功能异常的主要类型。研究对象血清BPA浓度范围为0.38~21.93 ng/ml,中位数5.79 ng/ml。血清BPA水平与总体性功能、性欲、勃起能力、射精力度均呈负相关,与早泄呈正相关。按BPA水平的四分位数分组,以低浓度组（0.38~3.79 ng/ml）为参照进行关联性分析,发现BPA水平增高可增加性功能障碍的发生风险。结论 性欲低下是男性性功能障碍的主要类型,日常暴露于较高水平的BPA可能增加男性性功能障碍。     

Children's Environmental Health Risks: A State-of-the-Art Conference

More than 100 academic and private-sector researchers, government officials, politicians, and public health practitioners met to discuss issues regarding children's environmental health. Of special concern were the lack of toxicological data on many chemicals, the paucity of studies of children's exposure to these chemicals, and our limited understanding of pediatric toxicology. The increased incidence of childhood cancers and asthma were also of concern, as was our lack of understanding of how exposures to multiple environmental chemicals in low doses may influence child growth and development, disrupt endocrine function, and stimulate development of chronic diseases. An agenda for basic research, education and outreach, and policy and program development was created, with a goal of moving children's environmental health issues forward in a logical and thoughtful manner.     

3034名单胎活产儿出生体重及影响因素

目的:了解山东省某县新生儿出生体重分布及影响因素,为制定相关措施提供依据。方法:利用2005年《医学出生证明》资料,运用SPSS软件计算出生体重的均数和标准差、低出生体重与巨大儿发生率描述出生体重分布;采用单因素分析和无序多分类Logistic回归分析进行统计推断,估计因素对低出生体重和巨大儿发生的调整优势比。结果:3 034名单胎活产儿的平均出生体重为(3 516±470)g,低出生体重发生率为(1.38±0.21)%,巨大儿发生率为(17.90±0.70)%。男婴较女婴重117 g,足月儿较早产儿重700 g,母亲分娩年龄≥30岁组较<30岁组活产儿重136 g。早产是低出生体重的主要原因,调整OR为56.25(27.76,113.99);与巨大儿发生有关的因素为过期产、男婴和母亲年龄≥30岁,调整OR依次为1.72(1.16,2.54)、1.64(1.35,1.98)和1.78(1.47,2.15)。结论:研究地区出生体重分布表现为平均出生体重和巨大儿发生率高、低出生体重发生率低的两高一低的特点,为全国出生体重水平和巨大儿发生率最高的地区之一。出生体重超重是研究地区活产儿出生体重的一个主要问题,值得关注和进一步的研究,年龄≥30岁的产妇和经产妇为重点关注人群。对孕妇进行孕期合理营养指导是减少巨大儿发生的一个可行途径,避免早产是降低研究地区低出生体重的主要措施。     

孕期甲状腺激素敏感性与出生结局关系的队列研究

目的  研究孕期妇女甲状腺激素敏感性与出生结局的关系。方法  依托武汉市大型出生队列,以符合入选标准的5 411对孕妇-新生儿为研究对象。利用孕期体检的血清三碘甲状腺素(free triiodothyronine, FT3)、游离甲状腺素(free thyroxine, FT4)和甲状腺刺激激素(thyroid stimulating hormone, TSH),计算甲状腺激素中枢敏感性的指标：促甲状腺激素指数(thyroid stimulating hormone index, TSHI)、促甲状腺激素细胞-T4抵抗指数(thyrotroph thyroxine resistance index, TT4RI)和甲状腺反馈分位数指数(thyroid feedback quantile-based index, TFQI)。结局指标包括出生体重、出生孕周、出生体重Z评分,以及低出生体重、早产和小于胎龄儿(small for gestational age, SGA)。分别利用多元线性回归、logistic回归分析模型对甲状腺指标和出生结局中的连续型变量、分类变量进行回归分析,并控制可能混杂因素。结果  FT4、TSHI、TFQI与出生体重和出生体重Z评分呈负相关(均P≤0.01);甲状腺激素敏感性指标TSHI、TT4RI、TFQI与SGA存在统计学意义的正相关(TSHI: OR=1.52, 95% CI: 1.12~2.06, P＜0.01; TT4RI: OR=1.15, 95% CI: 1.03~1.29, P=0.02; TFQI: OR=1.41, 95% CI: 1.10~1.81, P＜0.01);甲状腺功能和甲状腺激素敏感性与低出生体重、早产的差异均无统计学意义。将妊娠合并甲状腺功能减退(甲减)人群排除后进行敏感性分析,研究结果一致。结论  孕期妇女甲状腺激素敏感性受损是不良出生结局SGA的独立风险因素。