Li Shufang, Xu Jian, Liu Zhiwei, Yan Chong-Huai
Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Children's HealthCare, Shanghai 200092, China.
Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Children's HealthCare, Shanghai 200092, China.
Neurotoxicology. 2017 Mar;59:191-196. doi: 10.1016/j.neuro.2016.07.005. Epub 2016 Jul 7.
Neuro-developmental impairments in the developing fetus due to exposure to low-level lead have been well documented. However, few studies have investigated the relation between maternal stress levels and low-level lead exposure among pregnant women.
To investigate the relation between maternal blood lead and stress levels during index pregnancy.
1931 pregnant women (gestational week 28-36) were investigated using stratified-cluster-sampling in Shanghai in 2010. Maternal life event stress and emotional stress were assessed using "Life-Event-Stress-Scale-for-Pregnant-Women" (LESPW) and "Symptom-Checklist-90-Revised" (SCL-90-R), respectively. Maternal whole blood lead levels were determined, and other data on covariates were obtained from maternal interviews and medical records. Two piecewise linear regression models were applied to assess the relations between blood lead and stress levels using a data-driven approach according to spline smoothing fitting of the data.
Maternal blood lead levels ranged from 0.80 to 14.84μg/dL, and the geometric mean was 3.97μg/dL. The P-values for the two piecewise linear models against the single linear regression models were 0.010, 0.003 and 0.017 for models predicting GSI, depression and anxiety symptom scores, respectively. When blood lead levels were below 2.57μg/dL, each unit increase in log10 transformed blood lead levels (μg/dL) was associated with about 18% increase in maternal GSI, depression and anxiety symptom scores (P=0.013, P=0.002, P=0.019, respectively). However, no significant relation was found when blood lead levels were above 2.57μg/dL (all P-values>0.05).
Our findings suggested a nonlinear relationship between blood lead and emotional stress levels among pregnant women. Emotional stress increased along with blood lead levels, and appeared to be plateaued when blood lead levels reached 2.57μg/dL.
胎儿发育过程中因接触低水平铅而导致神经发育受损已有充分记录。然而，很少有研究调查孕妇中母亲压力水平与低水平铅暴露之间的关系。
研究本次妊娠期间母亲血铅水平与压力水平之间的关系。
2010年在上海采用分层整群抽样法对1931名孕妇（妊娠28 - 36周）进行调查。分别使用“孕妇生活事件压力量表”（LESPW）和“症状自评量表90修订版”（SCL - 90 - R）评估母亲的生活事件压力和情绪压力。测定母亲全血铅水平，并从母亲访谈和病历中获取其他协变量数据。应用两个分段线性回归模型，根据数据的样条平滑拟合，采用数据驱动方法评估血铅与压力水平之间的关系。
母亲血铅水平范围为0.80至14.84μg/dL，几何平均值为3.97μg/dL。预测GSI、抑郁和焦虑症状评分的两个分段线性模型相对于单一线性回归模型的P值分别为0.010、0.003和0.017。当血铅水平低于2.57μg/dL时，log10转换后的血铅水平（μg/dL）每增加一个单位，母亲的GSI、抑郁和焦虑症状评分约增加18%（分别为P = 0.013、P = 0.002、P = 0.019）。然而，当血铅水平高于2.57μg/dL时，未发现显著关系（所有P值>0.05）。
我们的研究结果表明孕妇血铅与情绪压力水平之间存在非线性关系。情绪压力随血铅水平升高而增加，当血铅水平达到2.57μg/dL时似乎趋于平稳。
