上海市闵行区大气污染与早产的相关性
Associations between ambient air pollution and preterm birth in Minhang District, Shanghai
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摘要:
目的 母亲孕期大气污染暴露可能引起一系列不良妊娠结局。本研究拟探讨上海市闵行区大气污染与新生儿早产的关联及其影响因素。
方法 收集上海市闵行区2015-2016年的全部新生儿分娩和产妇相关资料，同时收集同期的大气污染和气象资料。采用病例对照研究设计，建立非条件logistic回归模型，分析不同孕期各个大气污染物对新生儿早产的影响。采用分层分析的方法，探讨不同个体特征对大气污染与早产关系的影响。
结果 研究期间闵行区6家接产医院总分娩新生儿29 324人，其中早产儿1 402例，早产发生率4.8%；早产儿中位数孕周为35.0周。研究期间，PM2.5和NO2的年平均浓度分别为50.4、44.3μg/m3，超过了国家标准。在孕早期，各大气污染物对早产的影响均不存在统计学意义。在孕中期，PM2.5和CO对早产存在影响；其日平均浓度每升高1个四分位数间距（20.8μg/m3和0.2 mg/m3），早产的发生率将会分别升高11.2%（95%CI：6.7%~15.6%）和15.6%（95%CI：12.0%~19.1%）。在孕晚期，各污染物的影响均有统计学意义；PM2.5、SO2、NO2、O3和CO的日平均浓度每升高1个四分位数间距（分别为20.3、7.2、17.2、43.7 μg/m3和0.2 mg/m3），早产的发生率将会分别升高14.6%（95%CI：3.3%~25.8%）、6.3%（95%CI：2.3%~10.3%）、13.8%（95%CI：5.8%~21.7%）、29.8%（95%CI：21.9%~37.8%）和9.5%（95%CI：2.4%~16.6%）。分层分析结果显示，在孕中期或孕晚期暴露于各大气污染物导致女胎、多胎、二孩及以上和35岁及以上高龄产妇发生早产的风险较高。
结论 上海市闵行区孕妇在孕中期和孕晚期暴露于大气污染可增加发生早产的风险。
Abstract:Objective Maternal exposure to air pollution during pregnancy has been linked to adverse birth outcomes. This study aims to explore the associations between ambient air pollution and preterm birth in Minhang District, Shanghai and the potential effect modifiers.
Methods We collected data about all newborns delivered in 2015 and 2016 and their mothers in Minhang District, as well as air pollution and weather conditions in the same area and same years. In this case-control study, unconditional logistic regression models were established to analyze the associations between different ambient air pollutants and preterm birth. Stratification analyses were conducted to explore the potentially different impacts of air pollution in relation to individual characteristics.
Results During the study period, 6 hospitals in Minhang District recorded 29 324 live births, of which there were 1 402 preterm births (4.8%). The annual average levels of PM2.5 (50.4 μg/m3) and NO2 (44.3 μg/m3) exceeded the National Air Quality Standard. In the first trimester, various air pollutants showed no significant impacts on preterm births. In the second trimester, PM2.5 and CO showed significant effects with 11.2% (95% CI:6.7%-15.6%) and 15.6% (95% CI:12.0%-19.1%) increments of preterm births respectively in association with an interquartile range increase in their concentrations (PM2.5:20.8 μg/m3, CO:0.2 mg/m3). In the third trimester, all air pollutants were significantly associated with increased preterm births; an interquartile range increase in the concentrations of PM2.5 (20.3 μg/m3), SO2 (7.2 μg/m3), NO2 (17.2 μg/m3), CO (43.7 μg/m3), and O3 (0.2 mg/m3) corresponded to increments of 14.6% (95% CI:3.3%-25.8%), 6.3% (95% CI:2.3%-10.3%), 13.8% (95% CI:5.8%-21.7%), 29.8% (95% CI:21.9%-37.8%), and 9.5% (95% CI:2.4%-16.6%) in preterm birth, respectively. The results of stratification analyses showed exposure to air pollutants during the second and third trimesters would lead to higher risks of preterm births for female fetus, multiple birth, and pregnant women with second or more deliveries and older than 35 years.
Conclusion Maternal exposure to air pollution in the second and third trimesters would increase the risk of preterm birth in Minhang District of Shanghai.
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