在加纳阿克拉从事街头小贩工作、与交通相关的空气污染暴露及不良妊娠结局风险
Work as a street vendor, associated traffic-related air pollution exposures and risk of adverse pregnancy outcomes in Accra, Ghana.
作者信息
Amegah Adeladza Kofi, Jaakkola Jouni J K
机构信息
Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Public Health, Institute of Health Sciences, University of Oulu, Oulu, Finland; Department of Human Biology, University of Cape Coast, Cape Coast, Ghana; Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana.
Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Public Health, Institute of Health Sciences, University of Oulu, Oulu, Finland; Respiratory Medicine Unit, Department of Medicine, Oulu University Hospital, Oulu, Finland.
出版信息
Int J Hyg Environ Health. 2014 Mar;217(2-3):354-62. doi: 10.1016/j.ijheh.2013.07.010. Epub 2013 Jul 30.
BACKGROUND
Street vending, a dominant occupation in urban areas of developing countries exposes the vendors to several environmental pollutants. We investigated whether work as street vendor impairs foetal growth and shortens gestational duration, and evaluated to what extent exposure to traffic-related air pollution is responsible for these adverse effects.
METHODS
A cross-sectional study was conducted among mothers and their newborns accessing postnatal services at the Korle Bu Teaching Hospital in Accra, Ghana in 2010, focusing on 105 street vendors and a reference group of 281 mothers. We categorized exposure to traffic-related air pollution on the basis of street vending activity patterns and traffic density in the working area.
RESULTS
Multivariate linear regression analysis adjusting for age, social class, marital status and gravidity of mothers, sex of neonate, and indoor air pollution, indicated a 177 g (95% CI: 324, 31) reduction in birth weight among street vendors. Sensitivity analysis performed by restricting the analysis to term births showed further reductions in birth weight. Generalized linear models adjusting for confounders indicated a 35% (risk ratio (RR)=1.35; 95% CI: 0.87, 2.12) increased risk of LBW, albeit statistically not significant. LBW risk increased in the sensitivity analysis but was also not statistically significant. The risk of PTB was not associated with street vending (RR=1.03; 95% CI: 0.67, 1.58). The exposure-response relations observed were not consistent. Moderate activity patterns and high traffic density jointly was associated with a statistically significant 84% (RR=1.84; 95% CI: 1.05, 3.24) increased risk of LBW.
CONCLUSION
Street vending during pregnancy is a determinant of average foetal growth and risk of LBW. More research is required to further quantify their effects on pregnancy outcomes and safeguard maternal and perinatal health in developing countries.
背景
街头贩卖是发展中国家城市地区的主要职业，这使小贩暴露于多种环境污染物中。我们调查了街头小贩工作是否会损害胎儿生长并缩短妊娠期，并评估与交通相关的空气污染在多大程度上导致了这些不良影响。
方法
2010年，在加纳阿克拉的科勒布教学医院，对接受产后服务的母亲及其新生儿进行了一项横断面研究，重点关注105名街头小贩和281名母亲组成的参照组。我们根据街头贩卖活动模式和工作区域的交通密度对与交通相关的空气污染暴露进行了分类。
结果
在对母亲的年龄、社会阶层、婚姻状况和妊娠次数、新生儿性别以及室内空气污染进行调整的多变量线性回归分析中，结果表明街头小贩的新生儿出生体重降低了177克（95%置信区间：324，31）。将分析限制在足月分娩进行的敏感性分析显示出生体重进一步降低。对混杂因素进行调整的广义线性模型表明，低出生体重风险增加了35%（风险比（RR）=1.35；95%置信区间：0.87，2.12），尽管在统计学上不显著。在敏感性分析中低出生体重风险增加，但在统计学上也不显著。早产风险与街头贩卖无关（RR=1.03；95%置信区间：0.67，1.58）。观察到的暴露-反应关系并不一致。中等活动模式和高交通密度共同导致低出生体重风险在统计学上显著增加了84%（RR=1.84；95%置信区间：1.05，3.24）。
结论
孕期街头贩卖是胎儿平均生长和低出生体重风险的一个决定因素。需要更多研究来进一步量化其对妊娠结局的影响，并保障发展中国家孕产妇和围产期健康。
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