Impacts of gestational age uncertainty in estimating associations between preterm birth and ambient air pollution.
Impacts of gestational age uncertainty in estimating associations between preterm birth and ambient air pollution.
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DOI：
10.1097/ee9.0000000000000031
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发表时间：
2018-12
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影响因子：
--
通讯作者：
Chang HH
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文献类型：
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作者：
Nealy BE;Warren JL;Strickland MJ;Darrow LA;Chang HH
补充数字内容可在文本中找到。先前利用出生记录的流行病学研究表明，怀孕期间接触空气污染与早产（胎龄<37周的肺结核）风险之间存在异质性关联。出生时胎龄的不确定性可能导致这种异质性。我们首先从2002年至2006年亚特兰大市区20个县的个人出生证明数据中研究了临床和基于最后月经期（LMP）的PTB测定之间的差异。然后，我们估计了五个月平均污染物暴露与PTB之间的关系，使用基于临床或LMP胎龄的各种方法定义。最后，使用多重归算方法，我们纳入了胎龄的不确定性，以量化这种可变性对污染物暴露与PTB之间关系的影响。当使用更严格的PTB定义时，优势比（OR）最高。例如，仅当LMP和临床诊断一致时才定义PTB，孕早期一氧化碳暴露每四分位数范围增加的OR为1.09(95%置信区间[CI] = 1.04, 1.14)，而当PTB被定义为LMP或临床诊断时，OR为1.04 （95% CI = 1.01, 1.08）。考虑到结果的不确定性导致cis比假设PTB结果没有误差的人宽7.4%至43.8%。尽管使用临床或LMP胎龄估计得出的PTB存在差异，但我们的分析表明，即使存在胎龄不确定性，PTB与环境空气污染暴露之间也存在明显的正相关。
Supplemental Digital Content is available in the text. Previous epidemiologic studies utilizing birth records have shown heterogeneous associations between air pollution exposure during pregnancy and the risk of preterm birth (PTB, gestational age <37 weeks). Uncertainty in gestational age at birth may contribute to this heterogeneity. We first examined disagreement between clinical and last menstrual period-based (LMP) determination of PTB from individual-level birth certificate data for the 20-county Atlanta metropolitan area during 2002 to 2006. We then estimated associations between five trimester-averaged pollutant exposures and PTB, defined using various methods based on the clinical or LMP gestational age. Finally, using a multiple imputation approach, we incorporated uncertainty in gestational age to quantify the impact of this variability on associations between pollutant exposures and PTB. Odds ratios (OR) were most elevated when a more stringent definition of PTB was used. For example, defining PTB only when LMP and clinical diagnoses agree yielded an OR of 1.09 (95% confidence interval [CI] = 1.04, 1.14) per interquartile range increase in first trimester carbon monoxide exposure versus an OR of 1.04 (95% CI = 1.01, 1.08) when PTB was defined as either an LMP or clinical diagnosis. Accounting for outcome uncertainty resulted in wider CIs—between 7.4% and 43.8% wider than those assuming the PTB outcome is without error. Despite discrepancies in PTB derived using either the clinical or LMP gestational age estimates, our analyses demonstrated robust positive associations between PTB and ambient air pollution exposures even when gestational age uncertainty is present.