孕前及孕期细颗粒物PM2.5对早产效应的因素分析

目的 分析细颗粒物PM2.5暴露与早产的相关性.方法 以河源市全市范围内2014年12月1日至2015年11月30日分娩的单胎活产儿和2013年12月1日至2015年11月30日河源市的细颗粒物PM2.5逐日浓度为研究对象.考虑到孕期的空气污染暴露是一个慢性的、累积的过程,并且每个产妇的孕程不同,首先以新生儿出生时的孕周为起点向后计算,将暴露时间分为4个阶段:孕前3个月,孕早期(1~13周末)、孕中期(14~27周末)和分娩前4周,分别计算PM2.5早产效应的组间差异.以某日为起点向后求和12个月的逐日暴露量作为该日分娩孕妇过去1年的PM2.5暴露总量,建立该日过去1年PM2.5累积暴露量在当日及滞后1~10d内早产例数的回归模型,并计算相对危险度.结果 河源市单胎活产儿的早产发生率为4.25%.逐日PM2.5浓度波动区间为7~108μg/m3,均值37.88μg·(m3)-1·d-1.研究对象孕前3个月、孕早期、孕中期的PM2.5合计暴露水平区间为12470~14960μg/m3,平均值为13700μg/m3.孕前3个月、孕早期、孕中期的PM2.5暴露水平在早产组与足月组间的差异无统计学意义(t值分别为2.199、2.343、0.947,均P>0.05),早产组与足月组间的PM2.5暴露水平在孕晚期的差异有统计学意义(t=4.818,P<0.05).以PM2.5累积暴露量下四分位数及其早产例数为参照(即RR=1),暴露于PM2.5累积量中位数,在滞后的10日内有意义的效应表现在滞后的第8、9、10日,RR值分别为1.49(1.01~2.21)、1.63(1.01~2.63)、1.06(1.01~1.11);暴露于PM2.5累积量中位数在滞后的10日内有意义的效应表现在滞后的第8、9、10日,RR值分别为2.05(1.02~4.15)、2.41(1.02~5.70)、1.11(1.03~1.21),累积暴露量的变化幅度与其对早产的效应呈正比,累积暴露量升高越大,在滞后期内对早产的影响也越大.结论 河源市孕期PM2.5暴露与早产有关,PM2.5暴露对早产存在非线性的滞后影响.     

Relationships between air pollution and preterm birth in California

Air pollution from vehicular emissions and other combustion sources is related to cardiovascular and respiratory outcomes. However, few studies have investigated the relationship between air pollution and preterm birth, a primary cause of infant mortality and morbidity. This analysis examined the effect of fine particulate matter (PM(2.5)) and carbon monoxide (CO) on preterm birth in a matched case-control study. PM(2.5) and CO monitoring data from the California Air Resources Board were linked to California birth certificate data for singletons born in 1999-2000. Each birth was mapped to the closest PM monitor within 5 miles of the home address. County-level CO measures were utilised to increase sample size and maintain a representative population. After exclusion of implausible birthweight-gestation combinations, preterm birth was defined as birth occurring between 24 and 36 weeks' gestation. Each of the 10 673 preterm cases was matched to three controls of term (39-44 weeks) gestation with a similar date of last menstrual period. Based on the case's gestational age, CO and PM(2.5) exposures were calculated for total pregnancy, first month of pregnancy, and last 2 weeks of pregnancy. Exposures were divided into quartiles; the lowest quartile was the reference. Because of the matched design, conditional logistic regression was used to adjust for maternal race/ethnicity, age, parity, marital status and education. High total pregnancy PM(2.5) exposure was associated with a small effect on preterm birth, after adjustment for maternal factors (adjusted odds ratio [AOR] = 1.15, [95% CI 1.07, 1.24]). The odds ratio did not change after adjustment for CO. Results were similar for PM(2.5) exposure during the first month of pregnancy (AOR = 1.21, 95% CI [1.12, 1.30]) and the last 2 weeks of pregnancy (AOR = 1.17, 95% CI [1.09, 1.27]). Conversely, CO exposure at any time during pregnancy was not associated with preterm birth (AORs from 0.95 to 1.00). Maternal exposure to PM(2.5), but not CO, is associated with preterm birth. This analysis did not show differences by timing of exposure, although more detailed examination may be needed.     

Ambient air pollution and pregnancy outcomes—a study of functional form and policy implications

We utilize a new data set on ambient air pollution and births from the Salt Lake Valley to study how intensive and cumulative exposure to PM^2.5 in the first trimester affect two important pregnancy outcomes—gestational age at birth and the risk of preterm birth. For identification, we use variation in cumulative exposure for siblings from the same mother in subsequent pregnancies, which can be substantial due to the large seasonal and annual variations in the valley. Controlling for other air pollutants and individual confounders, we find strong evidence of reduced gestational age and increased probability of preterm birth resulting from PM^2.5 exposure and estimate that the marginal effects are larger as cumulative exposure increases. We find weak evidence of an increased marginal effect of intensive exposure vs. total exposure. As cumulative exposure plays a larger role than intensive exposure, this indicates that policies which decrease average pollution levels can be more effective than policies targeted at peak pollution from a pregnancy perspective.     

A time-series analysis of any short-term effects of meteorological and air pollution factors on preterm births in London, UK

Although much is known about the incidence and burden of preterm birth, its biological mechanisms are not well understood. While several studies have suggested that high levels of air pollution or exposure to particular climatic factors may be associated with an increased risk of preterm birth, other studies do not support such an association. To determine whether exposure to various environmental factors place a large London-based population at higher risk for preterm birth, we analyzed 482,568 births that occurred between 1988 and 2000 from the St. Mary's Maternity Information System database. Using an ecological study design, any short-term associations between preterm birth and various environmental factors were investigated using time-series regression techniques. Environmental exposures included air pollution (ambient ozone and PM(10)) and climatic factors (temperature, rainfall, sunshine, relative humidity, barometric pressure, and largest drop in barometric pressure). In addition to exposure on the day of birth, cumulative exposure up to 1 week before birth was investigated. The risk of preterm birth did not increase with exposure to the levels of ambient air pollution or meteorological factors experienced by this population. Cumulative exposure from 0 to 6 days before birth also did not show any significant effect on the risk of preterm birth. This large study, covering 13 years, suggests that there is no association between preterm births and recent exposure to ambient air pollution or recent changes in the weather.     

Local variations in CO and particulate air pollution and adverse birth outcomes in Los Angeles County, California, USA

We extended our previous analyses of term low birth weight (LBW) and preterm birth to 1994-2000, a period of declining air pollution levels in the South Coast Air Basin. We speculated that the effects we observed previously for carbon monoxide, particulate matter < 10 microm in aerodynamic diameter (PM10), and traffic density were attributable to toxins sorbed to primary exhaust particles. Focusing on CO, PM10, and particulate matter < 2.5 microm in aerodynamic diameter (PM2.5), we examined whether varying residential distances from monitoring stations affected risk estimates, because effect attenuation may result from local pollutant heterogeneity inadequately captured by ambient stations. We geocoded home locations, calculated the distance to the nearest air monitors, estimated exposure levels by pregnancy period, and performed logistic regression analyses for subjects living within 1-4 mi of a station. For women residing within a 1-mi distance, we observed a 27% increase in risk for high (> or = 75th percentile) first-trimester CO exposures and preterm birth and a 36% increase for high third-trimester pregnancy CO exposures and term LBW. For particles, we observed similar size effects during early and late pregnancy for both term LBW and preterm birth. In contrast, smaller or no effects were observed beyond a 1-mi distance of a residence from a station. Associations between CO and PM10 averaged over the whole pregnancy and term LBW were generally smaller than effects for early and late pregnancy. These new results for 1994-2000 generally confirm our previous observations for the period 1989-1993, again linking CO and particle exposures to term LBW and preterm birth. In addition, they confirm our suspicions about having to address local heterogeneity for these pollutants in Los Angeles.     

Effect of air pollution on preterm birth among children born in Southern California between 1989 and 1993

We evaluated the effect of air pollution exposure during pregnancy on the occurrence of preterm birth in a cohort of 97,518 neonates born in Southern California. We used measurements of carbon monoxide (CO), nitrogen dioxide, ozone, and particulate matter less than 10 microm (PM10) collected at 17 air-quality-monitoring stations to create average exposure estimates for periods of pregnancy. We calculated crude and adjusted risk ratios (RRs) for premature birth by period-specific ambient pollution levels. We observed a 20% increase in preterm birth per 50-microg increase in ambient PM10 levels averaged over 6 weeks before birth [RRcrude = 1.20; 95% confidence interval (CI) = 1.09-1.33] and a 16% increase when averaging over the first month of pregnancy (RRcrude = 1.16; 95% CI = 1.06-1.26). PM10 effects showed no regional pattern. CO exposure 6 weeks before birth consistently exhibited an effect only for the inland regions (RRcrude = 1.13; 95% CI = 1.08-1.18 per 3 parts per million), and during the first month of pregnancy, the effect was weak for all stations (RRcrude = 1.04; 95% CI = 1.01-1.09 per 3 parts per million). Exposure to increased levels of ambient PM10 and possibly CO during pregnancy may contribute to the occurrence of preterm births in Southern California.     

妊娠窗口期大气颗粒物暴露对早产影响的meta分析

目的综合以往发表的相关文献,分析不同妊娠窗口期大气颗粒物(PM_(2.5)、PM_(10))暴露对早产的影响。方法检索国内外2000年1月1日—2015年10月1日公开发表的关于大气颗粒物暴露对早产影响的研究文献,根据纳入及排除标准筛选出符合要求的文献26篇,采用R 3.1.1软件的metafor统计包对入选文献进行异质性检验和相应的效应值合并,并对结果进行敏感性分析、发表偏倚检验和校正,评价妊娠窗口期颗粒物暴露对早产的影响。结果通过建立各妊娠窗口期大气颗粒物与早产的暴露-反应关系,发现大气PM_(2.5)浓度每升高10μg/m~3,妊娠早、中、晚期及整个妊娠期早产发生的合并OR(95%CI)分别为1.10(1.01~1.21),1.07(0.79~1.45),1.04(0.97~1.10),1.05(0.97~1.13);大气PM10浓度每升高10μg/m~3,妊娠早、中、晚期及整个妊娠期早产发生的合并OR(95%CI)分别为0.98(0.97~1.00),0.99(0.98~1.01),1.01(0.99~1.04)和1.00(1.00~1.00)。结论不同妊娠窗口期的大气颗粒物暴露所致早产发生风险存在差异,妊娠早期大气PM_(2.5)的暴露可明显增加早产风险。     

Ambient air pollution and preterm birth in the environment and pregnancy outcomes study at the University of California, Los Angeles

The authors conducted a case-control survey nested within a birth cohort and collected detailed risk factor information to assess the extent to which residual confounding and exposure misclassification may impact air pollution effect estimates. Using a survey of 2,543 of 6,374 women sampled from a cohort of 58,316 eligible births in 2003 in Los Angeles County, California, the authors estimated with logistic regression and two-phase models the effects of pregnancy period-specific air pollution exposure on the odds of preterm birth. For the first trimester, the odds of preterm birth consistently increased with increasing carbon monoxide exposures and also at high levels of exposure to particulate matter less than or equal to 2.5 microm in diameter (>21.4 microg/m(3)), regardless of type of data (cohort/sample) or covariate adjustment (carbon monoxide exposures of >1.25 ppm increased the odds by 21-25%). Women exposed to carbon monoxide above 0.91 ppm during the last 6 weeks of pregnancy experienced increased odds of preterm birth. Crude and birth certificate covariate-adjusted results for carbon monoxide differed from each other. However, further adjustment for risk factors assessed in the survey did not change effect estimates for short-term pollutant averages appreciably, except for time-activity patterns, which strengthened the observed associations. These results confirm the importance of reducing exposure misclassification when evaluating the effect of traffic-related pollutants that vary spatially.     

A cohort study of traffic-related air pollution impacts on birth outcomes

BACKGROUND: Evidence suggests that air pollution exposure adversely affects pregnancy outcomes. Few studies have examined individual-level intraurban exposure contrasts. OBJECTIVES: We evaluated the impacts of air pollution on small for gestational age (SGA) birth weight, low full-term birth weight (LBW), and preterm birth using spatiotemporal exposure metrics. METHODS: With linked administrative data, we identified 70,249 singleton births (1999-2002) with complete covariate data (sex, ethnicity, parity, birth month and year, income, education) and maternal residential history in Vancouver, British Columbia, Canada. We estimated residential exposures by month of pregnancy using nearest and inverse-distance weighting (IDW) of study area monitors [carbon monoxide, nitrogen dioxide, nitric oxide, ozone, sulfur dioxide, and particulate matter < 2.5 (PM2.5) or < 10 (PM10) microm in aerodynamic diameter], temporally adjusted land use regression (LUR) models (NO, NO2, PM2.5, black carbon), and proximity to major roads. Using logistic regression, we estimated the risk of mean (entire pregnancy, first and last month of pregnancy, first and last 3 months) air pollution concentrations on SGA (< 10th percentile), term LBW (< 2,500 g), and preterm birth. RESULTS: Residence within 50 m of highways was associated with a 26% increase in SGA [95% confidence interval (CI), 1.07-1.49] and an 11% (95% CI, 1.01-1.23) increase in LBW. Exposure to all air pollutants except O3 was associated with SGA, with similar odds ratios (ORs) for LUR and monitoring estimates (e.g., LUR: OR = 1.02; 95% CI, 1.00-1.04; IDW: OR = 1.05; 95% CI, 1.03-1.08 per 10-microg/m3 increase in NO). For preterm births, associations were observed with PM2.5 for births < 37 weeks gestation (and for other pollutants at < 30 weeks). No consistent patterns suggested exposure windows of greater relevance. CONCLUSION: Associations between traffic-related air pollution and birth outcomes were observed in a population-based cohort with relatively low ambient air pollution exposure.     

空气污染物对出生体重影响的研究

目的研究空气污染物可吸入颗粒物（PM10）、二氧化硫（SO2）、二氧化氮（NO2）对新生儿出生体重的影响。方法收集了广东某地2003—2005年分娩时孕满37周的围产数据。调查的因素包括产妇的年龄、职业、文化、出生地、是否有准生证、孕周、是否有高危因素、末次月经时间、分娩日期、孕次、产次；产妇丈夫的职业、文化；新生儿的性别、出生身高、体重。用2002—2005年的空气污染数据估计暴露水平。结果性别、母亲年龄、母亲职业、母亲原地址、孕期高危情况、孕次、是否有准生证分组，出生体重组间差异有统计学意义；不同孕期PM10、SO2、NO2暴露分组之间出生体重差异有统计学意义。多元线性回归分析显示可吸入颗粒物PM10、SO2、NO2浓度每增加10μg/m^3，出生体重分别减少1．90～3．94g、1．65～2．73g、2．70～3．76g。结论空气污染物与低出生体重有关，空气污染对妊娠结局的影响值得关注。     

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.     

Different effects of PM<Subscript>10</Subscript> exposure on preterm birth by gestational period estimated from time-dependent survival analyses

Purpose  We conducted this study to determine if the preterm risks due to PM₁₀ exposure vary with the exposure periods during pregnancy. This study was also conducted to estimate the different effects of PM₁₀ exposure on preterm birth by exposure periods using the extended Cox model with PM₁₀ exposure as a time-dependent covariate. Methods  We studied birth data obtained from the Korea National Statistical office for 374,167 subjects who were delivered between 1998 and 2000 in Seoul, South Korea. We used PM₁₀ data that was measured hourly to give 24-h averages at 27 monitoring stations in Seoul. The extended Cox model with time-dependent exposure was used to determine if the risk of preterm delivery could be associated with PM₁₀ exposures for each trimester during pregnancy. Results  Effect of PM10 exposure prior to the 37 weeks of gestational period was stronger on the risk of premature birth than that posterior to the 37 weeks of gestational weeks. This trend was consistent for each trimester; however, the hazard ratios for preterm delivery associated with PM₁₀ exposure in the first and third trimester were slightly higher than those of the second trimester. Conclusions  The risk of preterm birth associated with exposure to PM₁₀ differed with the exposure period of the neonates. Therefore, when studying the impact of air pollution exposure during pregnancy, the exposure period during pregnancy should be considered.     

Traffic-related air pollution and risk of preterm birth in the San Joaquin Valley of California

PurposeTo evaluate associations between traffic-related air pollution during pregnancy and preterm birth in births in four counties in California during years 2000 to 2006.MethodsWe used logistic regression to examine the association between the highest quartile of ambient air pollutants (carbon monoxide, nitrogen dioxide, particulate matter <10 and 2.5 μm) and traffic density during pregnancy and each of five levels of prematurity based on gestational age at birth (20–23, 24–27, 28–31, 32–33, and 34–36 weeks) versus term (37–42 weeks). We examined trimester averages and the last month and the last 6 weeks of pregnancy. Models were adjusted for birthweight, maternal age, race/ethnicity, education, prenatal care, and birth costs payment. Neighborhood socioeconomic status (SES) was evaluated as a potential effect modifier.ResultsThere were increased odds ratios (ORs) for early preterm birth for those exposed to the highest quartile of each pollutant during the second trimester and the end of pregnancy (adjusted OR, 1.4–2.8). Associations were stronger among mothers living in low SES neighborhoods (adjusted OR, 2.1–4.3). We observed exposure–response associations for multiple pollutant exposures and early preterm birth. Inverse associations during the first trimester were observed.ConclusionsThe results confirm associations between traffic-related air pollution and prematurity, particularly among very early preterm births and low SES neighborhoods.     

Air pollution exposure during pregnancy: maternal asthma and neonatal respiratory outcomes

Purpose

Maternal asthma increases adverse neonatal respiratory outcomes, and pollution may further increase risk. Air quality in relation to neonatal respiratory health has not been studied.

Relationship between low birthweight and air pollution in the city of Sao Paulo, Brazil

OBJECTIVE: Air pollution has been investigated as a potential determinant for low birthweight. The aim of the present study was to study the effect of air pollution on birthweight. METHODS: We analyzed all deliveries by mothers living in the municipality of Sao Paulo, Southeastern Brazil, between 1998 and 2000. We estimated the prevalence of low birthweight according to newborn, mother, and delivery characteristics. Only births occurring in the most central districts of the city were analyzed, totaling 311.735 events. For the evaluation of the effects of air pollution, we excluded preterm and multiple deliveries. Pollutants analyzed were ozone (O3), sulfur dioxide (SO2), nitrogen dioxide (NO2), suspended particles (PM10), and carbon monoxide (CO). The effect of maternal exposure to air pollution on birthweight was evaluated using linear and logistic regression. RESULTS: A total of 4.6% of newborns weighed less than 2,500 g at birth. Maternal exposure to CO, PM10, and NO2 during the first trimester of pregnancy was significantly associated with decreased birthweight. CONCLUSIONS: Our results reinforce the notion that maternal exposure to air pollution during the first trimester of pregnancy may contribute to lesser weight gain in the fetus.     

Association between maternal exposure to elevated ambient sulfur dioxide during pregnancy and term low birth weight

This retrospective cohort study investigated whether the risk of delivering full term (37-44 completed weeks of gestation) low birth weight (LBW) infants is associated with differences in exposure to air pollutants in different trimesters. Full-term infants (37 completed weeks of gestation) with a birth weight below 2500 g were classified as term LBW infants. The study infants comprised 92,288 full-term live singletons identified from the Taiwan birth registry and born in the city of Taipei or Kaoshiung in Taiwan between 1995 and 1997. Maternal exposures to various air pollutants including CO, SO2, O3, NO2, and PM10 in each trimester of pregnancy was estimated as the arithmetic means of all daily measurements taken by the air quality monitoring station nearest to the district of residence of the mother at birth. The multivariable logistic regression model with adjustment for potential confounders was used to assess the independent effect of specific air pollutants on the risk of term LBW. This study suggested a 26% increase in term LBW risk given maternal ambient exposure to SO2 concentration exceeding 11.4 ppb during pregnancy compared to low exposure (<7.1 ppb) (OR=1.26, 95% CI=1.04-1.53). Since the relative risk of term LBW was reassessed according to exposure level in each trimester, mothers exposed to >12.4 ppb of SO2 in the last trimester showed 20% higher risk (OR=1.20, 95% CI=1.01-1.41) of term LBW delivery than mothers with lower exposure (<6.8 ppb). No significant elevation ORs was observed for other air pollutants.     

太原市孕期空气污染暴露对早产的影响

目的探讨太原市空气污染物暴露对早产的影响。方法选择太原市城区2005年11月1日至2007年8月1日出生的围生儿为研究对象。出生数据来源于太原市出生监测系统,数据清洗后符合研究质量要求的为31145例,早产组1092例,对照组30053例。研究协变量共计15项,包括母亲年龄、民族、文化程度、家庭住址、家庭收入、职业、职业暴露、吸烟、饮酒、父亲吸烟、采暖方式、叶酸增补、产前检查、怀孕季节、围生儿性别。空气污染数据来源于太原市环境保护监测站,包括SO2、NO2、PM10的逐日平均浓度。应用Logistic回归模型,控制混杂因素,基本模型建立后,分别以其中一种大气污染物为目标变量,建立怀孕初期和怀孕末期3个月单污染物、双污染物、三污染物影响的Logistic回归模型。结果怀孕初期3个月,控制了混杂因素和其他污染物的影响后,NO2最高污染物水平(≥25.43μg/m3)与最低污染物水平(<22.12μg/m3)相比,早产的危险度(OR值)升高22.7%。关于PM10的影响,未发现有统计学意义(P>0.10)。本研究未发现怀孕初期SO2空气污染对早产的有害影响。临产前3个月,单污染物模型中,NO2每升高一个四分位数,早产的危险度(OR值)升高19.1%。与怀孕初期相比,SO2空气污染对早产的影响明显增加,三污染物模型中OR值由0.615～0.771上升到0.823～1.045,PM10的影响减小,三污染物模型中OR值由1.136～1.231降为0.885～1.014。但SO2和PM10对早产的影响无统计学意义(P>0.10)。结论本研究进一步证实了孕期NO2暴露对早产的影响,未来研究需要进一步探讨适宜的研究设计和孕期暴露敏感时段。     

妊娠期PM_(2.5)暴露与新生儿低出生体重的meta分析

目的定量分析和评价妊娠期PM_(2.5)暴露对新生儿低出生体重的影响。方法通过计算机联机检索国内外文献数据库,采用meta分析对妊娠期PM_(2.5)暴露与新生儿低出生体重关系的研究进行整合分析。经异质性检验后选择合适的效应模型进行统计量的计算合并,同时检验结果的稳健性及是否存在发表偏倚。结果最终筛选出16篇文献,meta分析结果显示,整个妊娠期PM_(2.5)暴露浓度每升高10μg/m~3,新生儿发生低出生体重的风险增加9.53%(95%CI:3.92%~14.84%);妊娠早、中、后期PM_(2.5)暴露浓度每升高10μg/m~3,新生儿发生低出生体重的风险分别增加6.77%(95%CI:-4.08%~17.40%),5.83%(95%CI:-2.02%~13.98%),2.96%(95%CI:-3.05%~9.53%)。敏感性分析发现,所获得的研究结果相对稳定可靠,但在分析整个妊娠期PM_(2.5)暴露对新生儿低出生体重的影响时仍存在一定的发表偏倚。结论整个妊娠期PM_(2.5)的暴露可能增加新生儿发生低出生体重的风险。     

深圳市新生儿早产影响因素的病例对照研究

目的 探讨深圳市新生儿早产相关危险因素,为预防早产提供参考依据。 方法 在深圳市某妇幼保健院选取2015年1月1日－12月31日分娩的产妇和新生儿为研究对象,以妊娠满28周不足37周的200例新生儿母亲为病例组,妊娠满37周~42周的200例新生儿母亲为对照组。收集2014年1月1日－2015年12月31日SO₂、NO₂、PM₁₀、PM_2.5、CO和O₃逐日浓度。运用logistic回归模型分析早产影响因素。 结果 2014－2015年深圳市空气质量良好。病例组和对照组孕早期SO₂暴露浓度分别为(10.00±5.10)μg/m³、(8.66±5.03)μg/m³,NO₂暴露浓度分别为(38.23±15.98)μg/m³、(35.33±15.01)μg/m³,差异均有统计学意义(P＜0.05);病例组和对照组孕晚期PM₁₀暴露浓度分别为(54.26±28.00)μg/m³、(51.39±27.92)μg/m³,PM_2.5暴露浓度分别为(32.96±19.20)μg/m³、(30.11±18.36)μg/m³,差异均有统计学意义(P＜0.05)。病例组和对照组产妇年龄分别为(29.2±5.4)岁、(27.6±6.0)岁,家族早产史所占比例分别为38.5%、26.5%,大专及以上文化程度所占比例分别为62.5%、73.5%,差异均有统计学意义(P＜0.05)。进一步进行早产影响因素的多因素logistic回归分析发现:产妇年龄(OR=1.009, 95%CI:1.002~1.018)、有家族早产史(OR=1.308,95%CI:1.019~1.714)、孕晚期PM_2.5(OR=1.387,95%CI:1.112~1.579)、孕晚期PM₁₀(OR=1.267,95%CI:1.108~1.531)、孕早期SO₂(OR=1.118,95%CI:1.009~1.329)、孕早期NO₂(OR=1.106,95%CI:1.009~1.273)对早产有影响。 结论 深圳市空气SO₂、NO₂、PM₁₀、PM_2.5污染、产妇年龄和家族早产史与早产有关。     

Low levels of ambient air pollution during pregnancy and fetal growth among term neonates in Brisbane, Australia

There is mounting evidence that maternal exposure to ambient air pollution during pregnancy is associated with adverse birth outcomes. We examined birth weight and small for gestational age (SGA <10th percentile for age and gender) among 26,617 singleton full-term births in Brisbane, Australia (July 2000-June 2003), in relation to ambient pollution during pregnancy. We also examined head circumference (HC) and crown-heel length (CHL) among a sub-sample (n=21,432) of the term neonates. Maternal exposure to PM(10), visibility reducing particles (bsp), O(3) and NO(2) was assessed by calculating average exposure estimates over months and trimesters of pregnancy based on a citywide average of the pollutants. Linear and logistic regression models were employed to examine the effect of these pollutants on the birth outcomes after adjusting for potential confounders and season of birth. The regression coefficients were based on an inter-quartile range (IQR) increase in exposure as well as quartiles of exposure with the lowest used as a reference category. Trimester- and monthly specific exposures to all pollutants were not significantly associated with a reduction in either birth weight or HC, or an increased risk of SGA. An IQR increase in NO(2) during the third trimester was associated with a reduction in CHL (beta=-0.15cm, 95% CI -0.25 to -0.05cm) and this was concentrated around exposure during month nine. No other pollutants were associated with a reduction in CHL. In conclusion, there was no strong evidence suggesting that ambient air pollution during pregnancy is associated with sub-optimal fetal growth in Brisbane.