Mendola Pauline, Wallace Maeve, Hwang Beom Seuk, Liu Danping, Robledo Candace, Männistö Tuija, Sundaram Rajeshwari, Sherman Seth, Ying Qi, Grantz Katherine L
Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Md.
Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Md.
J Allergy Clin Immunol. 2016 Aug;138(2):432-440.e5. doi: 10.1016/j.jaci.2015.12.1309. Epub 2016 Mar 1.
Ambient air pollutants may increase preterm birth (PTB) risk, but critical exposure windows are uncertain. The interaction of asthma and pollutant exposure is rarely studied.
We sought to assess the interaction of maternal asthma and air pollutant exposures in relation to PTB risk.
Electronic medical records for 223,502 US deliveries were linked with modified Community Multiscale Air Quality model outputs. Logistic regression with generalized estimating equations estimated the odds ratio and 95% CIs for PTB on the basis of the interaction of maternal asthma and particulate matter with aerodynamic diameter of less than 2.5 microns and particulate matter with aerodynamic diameter of less than 10 microns, ozone (O3), nitrogen oxides (NOx), sulfur dioxide (SO2), and carbon monoxide (CO) per interquartile range. For each gestational week 23 to 36, exposures among women who delivered were compared with those remaining pregnant. Three-month preconception, whole pregnancy, weeks 1 to 28, and the last 6 weeks of gestation averages were also evaluated.
On assessing PTB by gestational week, we found that significant asthma interactions were sporadic before 30 weeks but more common during weeks 34 to 36, with higher risk among mothers with asthma for NOx, CO, and SO2 exposure and an inverse association with O3 in week 34. Odds of PTB were significantly higher among women with asthma for CO and NOx exposure preconception and early in pregnancy. In the last 6 weeks of pregnancy, PTB risk associated with particulate matter with aerodynamic diameter of less than 10 microns was higher among women with asthma.
Mothers with asthma may experience a higher risk for PTB after exposure to traffic-related pollutants such as CO and NOx, particularly for exposures 3-months preconception and in the early weeks of pregnancy.
环境空气污染物可能会增加早产风险，但关键的暴露窗口期尚不确定。哮喘与污染物暴露之间的相互作用很少被研究。
我们试图评估母亲哮喘与空气污染物暴露之间的相互作用与早产风险的关系。
将美国223,502例分娩的电子病历与改进的社区多尺度空气质量模型输出结果相联系。采用广义估计方程的逻辑回归，根据母亲哮喘与空气动力学直径小于2.5微米的颗粒物、空气动力学直径小于10微米的颗粒物、臭氧（O3）、氮氧化物（NOx）、二氧化硫（SO2）和一氧化碳（CO）每四分位间距的相互作用，估计早产的优势比和95%可信区间。对于妊娠第23至36周的每一周，将分娩妇女的暴露情况与仍处于妊娠状态的妇女进行比较。还评估了孕前三个月、整个孕期、第1至28周以及妊娠最后6周的平均暴露情况。
按孕周评估早产情况时，我们发现，在30周之前，显著的哮喘相互作用是零星出现的，但在第34至36周更为常见，哮喘母亲在暴露于NOx、CO和SO2时风险更高，在第34周与O3呈负相关。哮喘妇女在孕前和孕早期暴露于CO和NOx时，早产几率显著更高。在妊娠最后6周，哮喘妇女中与空气动力学直径小于10微米的颗粒物相关的早产风险更高。
哮喘母亲在暴露于与交通相关的污染物（如CO和NOx）后，早产风险可能更高，尤其是在孕前三个月和孕早期暴露时。
