Identifying windows of susceptibility for maternal exposure to ambient air pollution and preterm birth
Identifying windows of susceptibility for maternal exposure to ambient air pollution and preterm birth
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确定孕产妇暴露于环境空气污染和早产的易感窗口
DOI：
10.1016/j.envint.2018.09.021
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发表时间：
2018
影响因子：
11.8
通讯作者：
Huang Cunrui
中科院分区：
文献类型：
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作者：
Wang Qiong;Benmarhnia Tarik;Zhang Huanhuan;Knibbs Luke D;Sheridan Paige;Li Changchang;Bao Junzhe;Ren Meng;Wang Suhan;He Yiling;Zhang Yawei;Zhao Qingguo;Huang Cunrui
母亲暴露于环境空气污染与早产（PTB）有关，然而，通常报告整个妊娠或特定孕期的关联，这可能不足以识别易感性窗口。我们使用中国南方大城市广州（人口约1450万）的出生登记数据，包括2015年1月至2017年7月期间469，975例单胎活产，在一项回顾性队列研究中评估了每周空气污染暴露与PTB之间的关联。从11个监测站的PM2.5，PM10，NO2，SO2和O3的日平均浓度被用来估计每个参与者在怀孕期间的地区居住的基础上，区域特定的暴露。在控制温度、季节性和个体水平的协变量后，采用结合考克斯比例风险模型的分布滞后模型（DLM）来估计每周母亲暴露于空气污染物和PTB风险（作为事件发生时间的结果）之间的关联。我们还考虑了中度PTB（32-36孕周）和重度PTB（28-31孕周）作为关注的结局。计算研究期间空气污染物四分位距（IQR）增加的风险比（HR）和95%置信区间（95%CI）。妊娠第20 ~ 28周PM2.5暴露IQR增加（27.0 μg/m3）与PTB风险显著相关，其中妊娠第25周影响最大（HR = 1.034，95%CI：1.010-1.059）。PM10、NO2和O3的显著暴露窗口分别为第19 ~ 28周、第18 ~ 31周和第23 ~ 31周。在第25周观察到PM10（IQR = 37.0 μg/m3; HR = 1.048，95%CI：1.034-1.062），NO2（IQR = 29.0 μg/m3; HR = 1.060，95%CI：1.028-1.094）和O3（IQR = 90.0 μg/m3; HR = 1.063，95%CI：1.046-1.081）的最强关联。中度肺结核（32-36孕周）和重度肺结核（28-31孕周）的PM2.5、PM10、NO2暴露模式相似，但重度肺结核的影响更大。我们没有观察到妊娠期SO2暴露与PTB风险之间的任何关联。我们的研究结果表明，中晚期妊娠是中国广州市妇女最易受到空气污染和PTB的空气污染暴露窗口。
Maternal exposure to ambient air pollution has been associated with preterm birth (PTB), however, entire pregnancy or trimester-specific associations were generally reported, which may not sufficiently identify windows of susceptibility. Using birth registry data from Guangzhou, a megacity of southern China (population ~14.5 million), including 469,975 singleton live births between January 2015 and July 2017, we assessed the association between weekly air pollution exposure and PTB in a retrospective cohort study. Daily average concentrations of PM2.5, PM10, NO2, SO2, and O3from 11 monitoring stations were used to estimate district-specific exposures for each participant based on their district residency during pregnancy. Distributed lag models (DLMs) incorporating Cox proportional hazard models were applied to estimate the association between weekly maternal exposure to air pollutant and PTB risk (as a time-to-event outcome), after controlling for temperature, seasonality, and individual-level covariates. We also considered moderate PTB (32–36 gestational weeks) and very PTB (28–31 gestational weeks) as outcomes of interest. Hazard ratios (HRs) and 95% confidential intervals (95% CIs) were calculated for an interquartile range (IQR) increase in air pollutants during the study period. An IQR increase in PM2.5exposure during the 20th to 28th gestational weeks (27.0 μg/m3) was significantly associated with PTB risk, with the strongest effect in the 25th week (HR = 1.034, 95% CI:1.010–1.059). The significant exposure windows were the 19th–28th weeks for PM10, the 18th–31st weeks for NO2, and the 23rd–31st weeks for O3, respectively. The strongest associations were observed in the 25th week for PM10(IQR = 37.0 μg/m3; HR = 1.048, 95% CI:1.034–1.062), the 26th week for NO2(IQR = 29.0 μg/m3; HR = 1.060, 95% CI:1.028–1.094), and in the 28th week for O3(IQR = 90.0 μg/m3; HR = 1.063, 95% CI:1.046–1.081). Similar patterns were observed for moderate PTB (32–36 gestational weeks) and very PTB (28–31 gestational weeks) for PM2.5, PM10, NO2exposure, but the effects were greater for very PTB. We did not observe any association between pregnancy SO2exposure and the risk of PTB. Our results suggest that middle to late pregnancy is the most susceptible air pollution exposure window for air pollution and PTB among women in Guangzhou, China.