Maternal lead exposure and premature rupture of membranes: a birth cohort study in China.
Maternal lead exposure and premature rupture of membranes: a birth cohort study in China.
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母亲铅暴露与胎膜早破：中国出生队列研究
DOI：
10.1136/bmjopen-2018-021565
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发表时间：
2018-07-23
期刊：
影响因子：
2.9
通讯作者：
Li Y
中科院分区：
文献类型：
--
作者：
Huang S;Xia W;Sheng X;Qiu L;Zhang B;Chen T;Xu S;Li Y
目的母亲铅暴露与不良分娩结局相关，但支持铅暴露与胎膜早破之间关系的证据有限。本研究的目的是调查母亲铅暴露是否与胎膜早破和早产相关。设计横断面队列研究。研究人群本研究于2012年至2014年期间从武汉市健康婴儿队列中抽取了7,290名孕妇中国。主要观察指标胎膜早破定义为临产前羊膜自发破裂，用pH≥6.5测定阴道分泌液。用血肌酸值调整母体尿铅水平，并用Logistic回归分析其与胎膜早破的关系。结果研究人群母体尿铅IQR值为2.30~5.6 4 微克/克肌酐，中位数为3.4 4 微克/克肌酐。胎膜早破的风险增加与母亲尿铅水平升高显著相关(调整后OR1.23，95%CI1.0至1.47；调整OR1.51，95% CI1.27至1.80，对于最高三胎)。铅水平与早产胎膜早破的风险显著高于最低三胎(调整后OR1.24，95% CI为0.80至1.92；调整OR1.73，95% CI为1.15至2.60)。此外，铅与胎膜早破的关系在初产妇女中比经产妇女更明显(p为交互作用<；0.01)。结论母血铅暴露水平越高，胎膜早破的风险越高，提示孕期铅暴露可能是胎膜早破的重要危险因素。
Objectives Maternal exposure to lead (Pb) has been suggested to correlate with adverse birth outcomes, but evidence supporting an association between Pb exposure and premature rupture of membranes (PROM) is limited. The aim of our study was to investigate whether maternal Pb exposure was associated with PROM and preterm PROM. Design Cross-sectional cohort study. Study population The present study involved 7290 pregnant women from the Healthy Baby Cohort in Wuhan, China, during 2012–2014. Main outcome measures PROM was defined as spontaneous rupture of amniotic membranes before the onset of labour and was determined with a pH ≥6.5 for vaginal fluid. Maternal urinary Pb level was adjusted by creatinine concentration, and its relationship with PROM was analysed by logistic regression. Results The IQR of maternal urinary Pb concentrations of the study population was 2.30–5.64 µg/g creatinine with a median of 3.44 µg/g creatinine. Increased risk of PROM was significantly associated with elevated levels of Pb in maternal urine (adjusted OR 1.23, 95% CI 1.0 to 1.47 for the medium tertile; adjusted OR 1.51, 95% CI 1.27 to 1.80 for the highest tertile). The risk of preterm PROM associated with Pb levels was significantly higher when compared with the lowest tertile (adjusted OR 1.24, 95% CI 0.80 to 1.92 for the medium tertile; adjusted OR 1.73, 95% CI 1.15 to 2.60 for the highest tertile). In addition, the relationship between Pb and PROM was more pronounced among primiparous women than multiparous women (p for interaction <0.01). Conclusions Our study found that higher levels of maternal Pb exposure was associated with increased risk of PROM, indicating that exposure to Pb during pregnancy may be an important risk factor for PROM.
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