妊娠期铅暴露水平对母婴的影响及相关因素分析

目的研究孕妇和脐血中血铅的暴露水平及其对新生儿生长发育、妊娠结局、妊娠并发症的影响，分析脐血中血铅暴露水平的影响因素，为孕产妇优生优育提供参考。方法选取2010年6月至2011年2月在本院分娩的400例病例，采用微波消解和质谱分析方法测定孕妇和脐血中血铅含量，分析铅暴露水平对母婴的影响。对孕妇居住环境、生活方式、膳食等情况等进行问卷调查，对脐血铅影响因素进行分析。结果新生儿脐血铅水平与其母血铅水平呈正相关（r=0．99，P〈0．05）；新生儿脐血铅水平与新生儿身长、头围、体重呈负相关（分别为r=-0．15，-0．16，-0．17，P〈0．05）。血铅升高组的妊娠不良结局发生率和妊娠并发症发生率分别高于血铅正常组（分别为X^2=39．08，37．28，P均〈0．05）。多元线性回归结果显示被动吸烟、染发、吃皮蛋为铅暴露的危险因素（分别为Wald’f=18．28，12．21，7．52，P均〈O．05）；孕期补钙和孕妇高文化程度为预防铅暴露的保护性因素（分别为Waldf=9．02，8．05，P均〈0．05）。结论新生儿脐血铅水平与母亲血铅水平及环境因素、孕期保健等因素有关；加强健康教育和孕妇孕期保健是预防新生儿铅中毒的有效途径。

Effect of lead exposure during pregnancy on mother and infants and the related factors

Objective To investigate the blood lead level of mother and umbilical cord, and to analyze its effect on the growth and development of infants, pregnancy outcome, and pregnancy complications. Methods A total of 400 pregnant women hospitalized in Xinhua hospital from June 2010 to February 2011 were enrolled in this study. The blood lead level of mother and umbilical cord were determined by microwave digestion and inductively coupled plasma emission mass spectroscopy method (ICP-MS). In addition, all the subjects were required to fill a questionnaire including their living environments, life styles and diet habits. Results The umbilical cord blood lead levels of newborns was positively related to blood lead levels of their mothers (r=0.99, P<0.05) and was negatively related to birth height, head circumference, and birth weight (r=-0.15, -0.16, -0.17, respectively, P<0.05). The incidence of adverse pregnancy outcomes and pregnancy complications were significantly higher in the group of women with elevated blood lead levels than those with normal blood lead levels (χ2=39.08, 37.28, respectively, P<0.05). Multiple regression analysis showed that the lead exposure was significantly correlated to passive smoking, dye hair, eating preserved egg, education degree and calcium supplement during pregnancy. The former three were risk factors (Wald χ2=18.28, 12.21, 7.52, P<0.05) and the later two were protective factors (Wald χ2=9.02, 8.05 respectively, P<0.05). Conclusion The umbilical cord blood lead levels of newborns was related to the blood lead levels of their mothers, environmental factors and health care during pregnancy. Health education and care during pregnancy are effectively approaches for preventing lead poisoning.