Rosano A, Gemelli V, Giovannelli Cinzia, Paciotti G, Sabatucci A, Spagnolo A
Laboratorio di Scienze Biomediche e Statistiche, Istituto per gli Affari Sociali, Roma.
Med Lav. 2009 Nov-Dec;100(6):448-54.
Greenhouse workers (GW) are exposed to environmental contaminants, including pesticides, that may not only cause known immediate effects such as acute poisoning, but also long-term effects related to chronic exposure to low dosages, a problem that has not been extensively studied This study investigated the relationship between fertility changes and exposure to pesticides in a group of women working in greenhouses.
The analysis is based on a retrospective cohort of 145 women working in greenhouses located in the province of Latina, Lazio Region, Italy, who were exposed to pesticides at the time of their first pregnancy. Information on health status, lifestyle, work activity, reproductive history and some confounding factors (age, smoking, alcohol abuse, drug consumption) were collected using a questionnaire. Exposure to pesticides was classified in two levels (high or low) according to the work task and the length of exposure. Changes in fertility were measured in terms of time to pregnancy (TTP), that is the number of non-contraceptive cycles that it takes a couple to conceive. A control group was selected among public administration employees in the same province. The difference in average TTP between exposed and non-exposed groups was analysed by using Student t-test. A Cox proportional hazard model was used to compare TTP between the two groups after correction for confounding factors.
In the high-level exposure group average TTP was 10.8 months (+/- 2.0), among the non-exposed average TTP was 6.2 months (+/- 1.0). The difference between exposed and non-exposed was thus 4.6 months (p<0.05). Comparison of the distribution of TTP between the high-level exposure group and nonexposed resulted in a hazard ratio of 1.27 (I.C. 95%: 1.03-1.79); the same analysis using the low-level exposure group and non-exposed group yielded a hazard ratio of 1.12 (I.C. 95%: 0.67-1.87).
The study showed reduced fertility, in terms of TTP, in the population exposed to pesticides. Among GW, TTP was as much as 50% higher than for the control group. Controlling for confounding factors, the study confirmed an increase in risk for the exposed group. The issue under investigation, however, is complex as health status is not the only factor that needs to be taken into account in studies of reproductive health; emotional status as well as congenital and acquired factors may also have a notable impact on women's fertility. Occupational exposure, therefore, can be said to be a condition requiring careful analysis while bearing in mind that other factors may influence the outcome.
温室工人（GW）暴露于环境污染物中，包括农药，这些污染物不仅可能导致已知的即时影响，如急性中毒，还可能导致与长期低剂量接触相关的长期影响，这一问题尚未得到广泛研究。本研究调查了一组在温室工作的女性的生育变化与农药接触之间的关系。
该分析基于意大利拉齐奥地区拉蒂纳省145名在温室工作的女性的回顾性队列，她们在首次怀孕时接触过农药。通过问卷调查收集了有关健康状况、生活方式、工作活动、生殖史和一些混杂因素（年龄、吸烟、酗酒、药物使用）的信息。根据工作任务和接触时长，将农药接触分为两个水平（高或低）。生育变化通过怀孕时间（TTP）来衡量，即一对夫妇受孕所需的非避孕周期数。在同一省份的公共行政雇员中选择了一个对照组。使用学生t检验分析暴露组和非暴露组平均TTP的差异。在对混杂因素进行校正后，使用Cox比例风险模型比较两组之间的TTP。
在高暴露水平组中，平均TTP为10.8个月（±2.0），在非暴露组中，平均TTP为6.2个月（±1.0）。因此，暴露组和非暴露组之间的差异为4.6个月（p<0.05）。高暴露水平组和非暴露组之间TTP分布的比较得出风险比为1.27（95%置信区间：1.03 - 1.79）；使用低暴露水平组和非暴露组进行相同分析得出风险比为1.12（95%置信区间：0.67 - 1.87）。
该研究表明，接触农药的人群在TTP方面生育能力下降。在温室工人中，TTP比对照组高出多达50%。在控制混杂因素后，该研究证实了暴露组风险的增加。然而，所研究的问题很复杂，因为在生殖健康研究中，健康状况不是唯一需要考虑的因素；情绪状态以及先天性和后天性因素也可能对女性生育能力产生显著影响。因此，可以说职业暴露是一个需要仔细分析的情况，同时要记住其他因素可能会影响结果。
