随着全球环境污染问题日益加剧，环境污染与不良妊娠结局的相关性成为环境与健康领域的关注焦点。云南宣威农村室内空气污染严重，妇女肺癌死亡率高。本研究应用队列研究，在宣威农村建立孕期PM2.5暴露出生队列，以早期确诊怀孕为队列起点，采用可移动的、能随身携带的小型空气质量监测仪测量妇女孕早、中、晚期PM2.5个体暴露水平，检测二手烟暴露量，监测孕妇孕中、晚期营养素摄入状况；观察不良妊娠结局发生情况，检测脐血中血糖、胰岛素、血脂、脂联素和瘦素等糖脂代谢相关指标。运用mplus软件进行增长混合模型分析，分别探讨不同孕期PM2.5暴露累积、二手烟暴露与不良妊娠结局的关系以及对早期儿童糖脂代谢的影响。同时运用MlwiN或SAS软件进行多水平模型分析以上结果的影响因素。研究结果可为宣威及同类地区环境保护政策的制定、不良妊娠结局的预防工作提供科学依据。所建立的队列为进一步研究儿童早期暴露与健康的关系奠定基础。

Air pollution may have significant impact on pregnancy and birth outcomes, as well as on risk of metabolic disorders such as obesity. This study proposes to follow pregnant women and their newborn children to examine how fetal exposure to air particulate matter less than 2.5 microns (PM2.5) influences birth outcomes and risk of obesity and metabolic disorders in the offspring. Conducted in Xuanwei, which has the highest level of indoor air pollution in the country and one of the highest rates of lung cancer mortality, this study is to examine the role of air pollution in obesity development. Using a sampling design that will select 20 areas of Xuanwei with varying levels of outdoor air pollution, this study will recruit 600 pregnant women during their first trimester and follow them through each trimester. The air quality to which women are exposed will be measured using a portable PM2.5 air quality monitor worn by each woman for a week at a time. Diet and exposure to tobacco smoke, potential confounders, will be assessed from 24-hour diet recalls and urinary cotinine. In addition, a questionnaire will be developed to gather additional diet and tobacco exposure data as well as data on other confounders including physical activity, socioeconomic status, and pregnancy complications. The outcome varibles of interest - fetal growth; birth weight, height and head circumference; and newborn development and metabolic indicators in umbilical cord blood (insulin, glucose, lipids, leptin and adiponectin) - will be measured using standardized protocols. Using appropriate statistial techniques, a growth mixture model will be constructed to estimate the independent effects of PM2.5 exposure and secondhand smoke. Findings will be used to develop a prospective cohort study to investigate the contribution of air pollution to obesity and other metabolic disorders. The goal is to improve child health and reduce risk of chronic metabolic disorders by addressing environmental pollutants in rapidly changing China.