Associations between mixtures of urinary phthalate metabolites with gestational age at delivery: a time to event analysis using summative phthalate risk scores.
Associations between mixtures of urinary phthalate metabolites with gestational age at delivery: a time to event analysis using summative phthalate risk scores.
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DOI：
10.1186/s12940-018-0400-3
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发表时间：
2018-06-20
期刊：
影响因子：
--
通讯作者：
Mukherjee B
中科院分区：
文献类型：
--
作者：
Boss J;Zhai J;Aung MT;Ferguson KK;Johns LE;McElrath TF;Meeker JD;Mukherjee B
早产是一个重大的公共卫生问题，接触邻苯二甲酸盐已被证明与早产几率增加有关。即使是分娩时胎龄的适度减少也可能对新生儿造成病态后果，利用这一额外信息分析数据可能是有用的。在目前的分析中，我们考虑分娩时的胎龄作为我们感兴趣的结果，并检查与多种邻苯二甲酸盐的关系。在马萨诸塞州波士顿的布里格姆妇女医院，妇女在怀孕早期被招募，作为前瞻性、纵向出生队列的一部分。在妊娠期间收集多达四个时间点的尿液样本用于测量尿邻苯二甲酸盐代谢物，并在分娩时记录分娩结果。从这一人群中，我们选择了所有130例早产（< 37周妊娠）以及352例随机对照。我们对前三次就诊的暴露浓度进行了几何平均分析，并对暴露进行了重复测量。使用两种不同的时间到事件模型来检查9种尿邻苯二甲酸盐代谢物浓度与分娩时间之间的关系。两种不同的方法来构建一个总结性邻苯二甲酸盐风险评分也被考虑。使用Cox比例风险模型进行的单污染物分析显示，对数转化的邻苯二甲酸单-2-乙基-5-羧基戊酯（MECPP）平均浓度每四分位范围（IQR）变化的风险比（HR）为1.21(95%置信区间（CI）： 1.09, 1.33)，其相关性最强。使用加速失效时间模型，我们观察到平均对数转换MECPP的IQR变化与胎龄下降1.19% （95% CI: 0.26, 2.11%）相关。接下来，我们研究了与环境风险评分（ERS）的关联。与第一个四分位数相比，ERS的第四个四分位数与1.44 （95% CI: 1.19, 1.75）的HR显著相关，分娩时间（以天为单位）减少2.55% （95% CI: 0.76, 4.30%）。平均而言，尿中个别邻苯二甲酸酯代谢物浓度较高的孕妇分娩时间较短。与单个污染物相比，观察到的关联强度随着风险评分而放大。本文的在线版本（10.1186/s12940-018-0400-3）包含补充资料，仅供授权用户使用。
Preterm birth is a significant public health concern and exposure to phthalates has been shown to be associated with an increased odds of preterm birth. Even modest reductions in gestational age at delivery could entail morbid consequences for the neonate and analyzing data with this additional information may be useful. In the present analysis, we consider gestational age at delivery as our outcome of interest and examine associations with multiple phthalates. Women were recruited early in pregnancy as part of a prospective, longitudinal birth cohort at the Brigham and Women’s Hospital in Boston, Massachusetts. Urine samples were collected at up to four time points during gestation for urinary phthalate metabolite measurement, and birth outcomes were recorded at delivery. From this population, we selected all 130 cases of preterm birth (< 37 weeks of gestation) as well as 352 random controls. We conducted analysis with both geometric average of the exposure concentrations across the first three visits as well as using repeated measures of the exposure. Two different time to event models were used to examine associations between nine urinary phthalate metabolite concentrations and time to delivery. Two different approaches to constructing a summative phthalate risk score were also considered. The single-pollutant analysis using a Cox proportional hazards model showed the strongest association with a hazard ratio (HR) of 1.21 (95% confidence interval (CI): 1.09, 1.33) per interquartile range (IQR) change in average log-transformed mono-2-ethyl-5-carboxypentyl phthalate (MECPP) concentration. Using the accelerated failure time model, we observed a 1.19% (95% CI: 0.26, 2.11%) decrease in gestational age in association with an IQR change in average log-transformed MECPP. We next examined associations with an environmental risk score (ERS). The fourth quartile of ERS was significantly associated with a HR of 1.44 (95% CI: 1.19, 1.75) and a reduction of 2.55% (95% CI: 0.76, 4.30%) in time to delivery (in days) compared to the first quartile. On average, pregnant women with higher urinary metabolite concentrations of individual phthalates have shorter time to delivery. The strength of the observed associations are amplified with the risk scores when compared to individual pollutants. The online version of this article (10.1186/s12940-018-0400-3) contains supplementary material, which is available to authorized users.
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