Harville Emily W, Shankar Arti, Zilversmit Leah, Buekens Pierre
Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, 1440 Canal St. Ste. 2000 #8318, New Orleans, LA 70112-2715, USA.
Department of Global Biostatistics and Data Science, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112-2715, USA.
Int J Environ Res Public Health. 2017 Jun 27;14(7):692. doi: 10.3390/ijerph14070692.
Adverse infant outcomes often rise in the aftermath of disaster, but few studies have assessed the effects of disaster on maternal health. 1091 southern Louisiana women were interviewed about their pregnancy history, including pregnancy complications. Associations between oil spill exposures and gestational diabetes, hypertensive disorders, and nausea/vomiting were assessed for all reported pregnancies. 631 women had a pregnancy both before and after the oil spill. Generalized estimating equations (logistic regression) with adjustment for confounders were used. To assess possible unmeasured confounding, instead of considering oil spill exposure as a time-varying exposure, women were defined as oil spill-exposed or not. If oil spill-exposed women were equally prone to complications in pregnancies that occurred prior to the oil spill as after it, it was considered that any associations were likely due to selection or reporting issues. Women who reported oil spill exposure, particularly loss of use of the coast, were more likely to report gestational diabetes; however, the level of association was similar for pregnancies before and after the spill ( for interaction >0.10 and odds ratios (ORs) for pregnancies prior to the spill > than those after the spill). No associations were found between oil spill exposure and hypertensive disorders. This analysis does not suggest an increased risk of pregnancy complications associated with exposure to the oil spill; however, future studies should assess exposure and outcomes prospectively and clinically instead of relying on self-report.
婴儿不良结局往往在灾难后有所增加，但很少有研究评估灾难对孕产妇健康的影响。对路易斯安那州南部的1091名妇女进行了访谈，询问她们的妊娠史，包括妊娠并发症。对所有报告的妊娠情况评估了漏油暴露与妊娠期糖尿病、高血压疾病以及恶心/呕吐之间的关联。631名妇女在漏油事件前后都有过妊娠。使用了对混杂因素进行调整的广义估计方程（逻辑回归）。为了评估可能存在的未测量混杂因素，不是将漏油暴露视为随时间变化的暴露，而是将妇女定义为暴露于漏油或未暴露于漏油。如果暴露于漏油的妇女在漏油事件之前和之后发生的妊娠中出现并发症的可能性相同，则认为任何关联可能是由于选择或报告问题所致。报告暴露于漏油的妇女，尤其是失去海岸使用权的妇女，更有可能报告妊娠期糖尿病；然而，漏油事件前后妊娠的关联程度相似（交互作用>0.10，漏油事件之前妊娠的优势比（OR）大于之后妊娠的OR）。未发现漏油暴露与高血压疾病之间存在关联。该分析并未表明暴露于漏油会增加妊娠并发症的风险；然而，未来的研究应该前瞻性地和临床上评估暴露情况和结局，而不是依赖自我报告。
