大气 PM2.5 暴露与中国早产风险之间的关联：一项回顾性队列研究。
The association between ambient PM2.5 exposure and the risk of preterm birth in China: A retrospective cohort study.
机构信息
National Research Institute for Family Planning, China; Graduate School of Peking Union Medical College, China.
National Research Institute for Family Planning, China; Graduate School of Peking Union Medical College, China; Environmental and Spatial Epidemiology Research Center, National Human Genetic Resources Center, China.
出版信息
Sci Total Environ. 2018 Aug 15;633:1453-1459. doi: 10.1016/j.scitotenv.2018.03.328. Epub 2018 Apr 4.
BACKGROUND
The relationship between PM2.5 exposure and preterm birth remains unclear.
OBJECTIVES
To explore the effect of exposure to PM2.5 on preterm birth in China.
METHODS
The birth outcomes of 426,246 pregnant women enrolled between January 2014 and December 2014 in NFPCP (National Free Pre-pregnancy Checkups Project) were collected, and their individual PM2.5 exposure values were estimated from the China National Environmental Monitoring Centre. The time of gestational exposure to PM2.5 was divided into four periods (the first trimester, the second trimester, the third trimester and the entire pregnancy). The average concentration and the corresponding quartiles of PM2.5 were calculated in these periods by the daily average PM2.5 data. Cox proportional hazards regression was used and he effects of maternal age, education level, occupation, second-hand smoking, alcohol use, pre-pregnancy BMI, baby's sex, number of previous pregnancies, coastal areas and season of conception were adjusted for.
RESULTS
A total of 426,246 singleton births were included, among which 35,261 (8.3%) were preterm birth. Effect of each 10μg/m increase of PM2.5 on preterm birth was most significant during the third trimester (HR, 1.06; 95%CI, 1.06-1.07), and also significant during the first trimester (HR, 1.04; 95%CI, 1.03-1.04), the second trimester (HR, 1.02; 95%CI, 1.02-1.02) and the entire pregnancy (HR, 1.06; 95%CI, 1.05-1.06). Compared with the lowest quartile of PM2.5, other quartiles increased the risk of preterm birth, and were most significant during the third trimester (HR, 1.87; 95%CI, 1.69-2.06). Subgroup analysis showed that compared with other subgroups, women who were older than 30years, had low education level, worked as farmers, had male baby, had previous pregnancies, not live in coastal areas and pregnant in winter were more sensitive to PM2.5 exposure.
CONCLUSIONS
Ambient PM2.5 exposure during pregnancy played an important role in the pregnancy process and increased the risk of preterm birth.
背景
PM2.5 暴露与早产之间的关系尚不清楚。
目的
探讨 PM2.5 暴露对中国早产的影响。
方法
收集了 2014 年 1 月至 12 月期间参加 NFPCP（国家免费孕前检查计划）的 426246 名孕妇的分娩结果，并从中国国家环境监测中心估算了她们的个体 PM2.5 暴露值。PM2.5 暴露的妊娠时间分为四个时期（孕早期、孕中期、孕晚期和整个孕期）。通过每日平均 PM2.5 数据，计算了这些时期内 PM2.5 的平均浓度及其相应四分位数。采用 Cox 比例风险回归模型，并对母亲年龄、教育水平、职业、二手烟、饮酒、孕前 BMI、婴儿性别、既往妊娠次数、沿海地区和受孕季节进行了调整。
结果
共纳入 426246 例单胎分娩，其中早产 35261 例（8.3%）。每增加 10μg/m 的 PM2.5 对早产的影响在孕晚期最为显著（HR，1.06；95%CI，1.06-1.07），在孕早期（HR，1.04；95%CI，1.03-1.04）、孕中期（HR，1.02；95%CI，1.02-1.02）和整个孕期（HR，1.06；95%CI，1.05-1.06）也有显著影响。与 PM2.5 的最低四分位相比，其他四分位均增加了早产的风险，且在孕晚期最为显著（HR，1.87；95%CI，1.69-2.06）。亚组分析显示，与其他亚组相比，年龄大于 30 岁、教育水平较低、从事农民职业、怀有男婴、有既往妊娠史、不住在沿海地区和冬季受孕的女性对 PM2.5 暴露更为敏感。
结论
妊娠期间的环境 PM2.5 暴露对妊娠过程有重要作用，并增加了早产的风险。
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