From the Centre for Research in Environmental Epidemiology, Barcelona, Spain (M.P., L.S., M.J.N., P.D.); CIBER Epidemiología y Salud Pública, Madrid, Spain (M.P., M.J.N., P.D.); Universitat Pompeu Fabra, Barcelona, Spain (M.P., M.J.N., P.D.); INSERM, U823, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute Albert Bonniot, Grenoble, France (M.P., R.S.); Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago (L.S.); University Joseph Fourier, Institute Albert Bonniot, Grenoble, France (R.S.); Danish Cancer Society Research Center, Copenhagen, Denmark (M.S., O.R.-N.); and Department of Maternal-Foetal Medicine, ICGON, Hospital Clinic IDIBAPS, University of Barcelona, Barcelona, Spain (F.F.).
Hypertension. 2014 Sep;64(3):494-500. doi: 10.1161/HYPERTENSIONAHA.114.03545. Epub 2014 Jun 16.
Pregnancy-induced hypertensive disorders can lead to maternal and perinatal morbidity and mortality, but the cause of these conditions is not well understood. We have systematically reviewed and performed a meta-analysis of epidemiological studies investigating the association between exposure to ambient air pollution and pregnancy-induced hypertensive disorders including gestational hypertension and preeclampsia. We searched electronic databases for English language studies reporting associations between ambient air pollution and pregnancy-induced hypertensive disorders published between December 2009 and December 2013. Combined risk estimates were calculated using random-effect models for each exposure that had been examined in ≥4 studies. Heterogeneity and publication bias were evaluated. A total of 17 articles evaluating the impact of nitrogen oxides (NO2, NOX), particulate matter (PM10, PM2.5), carbon monoxide (CO), ozone (O3), proximity to major roads, and traffic density met our inclusion criteria. Most studies reported that air pollution increased risk for pregnancy-induced hypertensive disorders. There was significant heterogeneity in meta-analysis, which included 16 studies reporting on gestational hypertension and preeclampsia as separate or combined outcomes; there was less heterogeneity in findings of the 10 studies reporting solely on preeclampsia. Meta-analyses showed increased risks of hypertensive disorders in pregnancy for all pollutants except CO. Random-effect meta-analysis combined odds ratio associated with a 5-μg/m3 increase in PM2.5 was 1.57 (95% confidence interval, 1.26-1.96) for combined pregnancy-induced hypertensive disorders and 1.31 (95%confidence interval, 1.14-1.50) for preeclampsia [corrected]. Our results suggest that exposure to air pollution increases the risk of pregnancy-induced hypertensive disorders.
妊娠高血压疾病可导致孕产妇和围产儿发病率和死亡率增加，但这些疾病的病因尚不清楚。我们系统地回顾了并对调查环境空气污染与妊娠高血压疾病（包括妊娠期高血压和子痫前期）之间关联的流行病学研究进行了荟萃分析。我们检索了电子数据库，以获取 2009 年 12 月至 2013 年 12 月期间发表的关于环境空气污染与妊娠高血压疾病之间关联的英文研究报告。对于每个暴露因素，我们使用随机效应模型计算了在≥4 项研究中检查过的综合风险估计值。评估了异质性和发表偏倚。共有 17 篇评估氮氧化物（NO2、NOX）、颗粒物（PM10、PM2.5）、一氧化碳（CO）、臭氧（O3）、与主要道路的距离和交通密度对妊娠高血压疾病影响的文章符合我们的纳入标准。大多数研究报告称，空气污染增加了妊娠高血压疾病的风险。在包括 16 项分别或联合报告妊娠期高血压和子痫前期的研究的荟萃分析中存在显著的异质性；在仅报告子痫前期的 10 项研究中，结果的异质性较小。荟萃分析显示，除 CO 外，所有污染物与妊娠高血压疾病的风险增加相关。PM2.5 每增加 5μg/m3，与妊娠高血压疾病综合风险相关的随机效应荟萃分析合并优势比为 1.57（95%置信区间，1.26-1.96），与子痫前期相关的合并优势比为 1.31（95%置信区间，1.14-1.50）[校正]。我们的研究结果表明，暴露于空气污染会增加妊娠高血压疾病的风险。
