Wesselink Amelia K, Carwile Jenny L, Fabian María Patricia, Winter Michael R, Butler Lindsey J, Mahalingaiah Shruthi, Aschengrau Ann
Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA.
Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA.
Int J Environ Res Public Health. 2017 Jun 24;14(7):682. doi: 10.3390/ijerph14070682.
Exposure to air pollution may adversely impact placental function through a variety of mechanisms; however, epidemiologic studies have found mixed results. We examined the association between traffic exposure and placental-related obstetric conditions in a retrospective cohort study on Cape Cod, MA, USA. We assessed exposure to traffic using proximity metrics (distance of residence to major roadways and length of major roadways within a buffer around the residence). The outcomes included self-reported ischemic placental disease (the presence of at least one of the following conditions: preeclampsia, placental abruption, small-for-gestational-age), stillbirth, and vaginal bleeding. We used log-binomial regression models to estimate risk ratios (RR) and 95% confidence intervals (CI), adjusting for potential confounders. We found no substantial association between traffic exposure and ischemic placental disease, small-for-gestational-age, preeclampsia, or vaginal bleeding. We found some evidence of an increased risk of stillbirth and placental abruption among women living the closest to major roadways (RRs comparing living <100 m vs. ≥200 m = 1.75 (95% CI: 0.82-3.76) and 1.71 (95% CI: 0.56-5.23), respectively). This study provides some support for the hypothesis that air pollution exposure adversely affects the risk of placental abruption and stillbirth; however, the results were imprecise due to the small number of cases, and may be impacted by non-differential exposure misclassification and selection bias.
暴露于空气污染中可能通过多种机制对胎盘功能产生不利影响；然而，流行病学研究结果不一。我们在美国马萨诸塞州科德角进行了一项回顾性队列研究，以检验交通暴露与胎盘相关产科疾病之间的关联。我们使用接近度指标（住所到主要道路的距离以及住所周围缓冲区内主要道路的长度）评估交通暴露情况。研究结果包括自我报告的缺血性胎盘疾病（存在以下至少一种情况：先兆子痫、胎盘早剥、小于胎龄儿）、死产和阴道出血。我们使用对数二项回归模型来估计风险比（RR）和95%置信区间（CI），并对潜在混杂因素进行了调整。我们发现交通暴露与缺血性胎盘疾病、小于胎龄儿、先兆子痫或阴道出血之间没有实质性关联。我们发现一些证据表明，居住在距离主要道路最近的女性中，死产和胎盘早剥的风险增加（比较居住在<100米与≥200米的RR分别为1.75（95%CI：0.82 - 3.76）和1.71（95%CI：0.56 - 5.23））。本研究为空气污染暴露会对胎盘早剥和死产风险产生不利影响这一假设提供了一些支持；然而，由于病例数量较少，结果并不精确，并且可能受到非差异性暴露错误分类和选择偏倚的影响。
