Risk of stillbirth from occupational and residential exposures
Risk of stillbirth from occupational and residential exposures
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DOI：
10.1136/oem.54.7.511
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发表时间：
1997-07-01
影响因子：
4.9
通讯作者：
Beaumont, JJ
中科院分区：
文献类型：
--
作者：
Pastore, LM;HertzPicciotto, I;Beaumont, JJ
目的分析12例孕妇妊娠期住宅和职业暴露的死产风险。方法：从死亡证明中确定1984年加州10个县24小时内的死产和新生儿死亡。对照从1984年出生的活产婴儿中随机选择，频率与产妇年龄和县的病例相匹配。数据来源包括生命统计数据和自行管理的邮政调查表。进行回归和比例建模；比例危险度考虑了病例间暴露机会的截短。特别关注两类死亡原因：先天性异常（占死亡人数的12%）和胎盘、脐带和膜并发症（占死亡人数的37%）。结果：妊娠头两个月职业性接触农药与先天性异常导致的死产呈正相关（优势比（OR） 2.4, 95%可信区间（95% CI） 1.0至5.9），妊娠头三个月和妊娠中期与所有死亡原因导致的死产呈正相关（风险比（RR） 1.3至1.4,95% CI 1.0至1.7），与胎盘、脐带和膜并发症导致的死产呈正相关（RR 1.6至1.7,95% CI 1.1至2.3）。发现妊娠晚期职业暴露于视频显示终端与死产有适度的负相关（RR 0.7, 95% CI 0.6, 0.9）。家庭农药暴露与先天性异常导致的死产呈正相关（OR 1.7, 95% CI 1.0 - 2.9）。结论：职业性接触农药，特别是在妊娠早期，与死胎有明显的正相关，无论死因如何。在方法学上，这项死产研究在分析具体死亡原因和使用特定时间暴露窗口方面是独一无二的。
Objectives-To analyse the risk of stillbirth from 12 residential and occupational maternal exposures during pregnancy.Methods-Stillbirths and neonatal deaths in 1984 within 24 hours of birth from 10 California counties were identified from death certificates. Controls were randomly selected from live births born in 1984 and frequency matched to cases by maternal age and county. Data sources included vital statistics and a self administered postal questionnaire. regression and proportional modelling were performed; the proportional hazards considered the truncated opportunity for exposure among cases. Special focus was given to two cause of death groups: congenital anomalies (12% of deaths) and complications of the placenta, cord, and membranes (37% of deaths).Results-Occupational exposure to pesticides during the first two months of gestation was positively associated with stillbirths due to congenital anomalies (odds ratio (OR) 2.4, 95% confidence interval (95% CI) 1.0 to 5.9), and during the first and second trimesters with stillbirths due to all causes of death (risk ratios (RR) 1.3-1.4, 95% CI 1.0 to 1.7) and stillbirths due to complications of the placenta, cord, and membranes (RR 1.6-1.7, 95% CI 1.1 to 2.3). Occupational exposure to video display terminals in the third trimester was found to have a modest inverse association with stillbirths (RR 0.7, 95% CI 0.6, 0.9). Home pesticide exposure was positively associated with stillbirths due to congenital anomalies (OR 1.7, 95% CI 1.0 to 2.9).Conclusions-Occupational exposure to pesticides, especially during early pregnancy, had a clear positive association with stillbirths regardless of cause of death. Methodologically, this study of stillbirths is unique in its analysis of specific causes of death and use of time specific exposure windows.