School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-sen University, Guangzhou, China.
Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA; Scripps Institution of Oceanography, University of California, San Diego, CA, USA.
Environ Int. 2018 Dec;121(Pt 1):317-324. doi: 10.1016/j.envint.2018.09.021. Epub 2018 Sep 18.
Maternal exposure to ambient air pollution has been associated with preterm birth (PTB), however, entire pregnancy or trimester-specific associations were generally reported, which may not sufficiently identify windows of susceptibility. Using birth registry data from Guangzhou, a megacity of southern China (population ~14.5 million), including 469,975 singleton live births between January 2015 and July 2017, we assessed the association between weekly air pollution exposure and PTB in a retrospective cohort study. Daily average concentrations of PM, PM, NO, SO, and O from 11 monitoring stations were used to estimate district-specific exposures for each participant based on their district residency during pregnancy. Distributed lag models (DLMs) incorporating Cox proportional hazard models were applied to estimate the association between weekly maternal exposure to air pollutant and PTB risk (as a time-to-event outcome), after controlling for temperature, seasonality, and individual-level covariates. We also considered moderate PTB (32-36 gestational weeks) and very PTB (28-31 gestational weeks) as outcomes of interest. Hazard ratios (HRs) and 95% confidential intervals (95% CIs) were calculated for an interquartile range (IQR) increase in air pollutants during the study period. An IQR increase in PM exposure during the 20th to 28th gestational weeks (27.0 μg/m) was significantly associated with PTB risk, with the strongest effect in the 25th week (HR = 1.034, 95% CI:1.010-1.059). The significant exposure windows were the 19th-28th weeks for PM, the 18th-31st weeks for NO, and the 23rd-31st weeks for O, respectively. The strongest associations were observed in the 25th week for PM (IQR = 37.0 μg/m; HR = 1.048, 95% CI:1.034-1.062), the 26th week for NO (IQR = 29.0 μg/m; HR = 1.060, 95% CI:1.028-1.094), and in the 28th week for O (IQR = 90.0 μg/m; HR = 1.063, 95% CI:1.046-1.081). Similar patterns were observed for moderate PTB (32-36 gestational weeks) and very PTB (28-31 gestational weeks) for PM, PM, NO exposure, but the effects were greater for very PTB. We did not observe any association between pregnancy SO exposure and the risk of PTB. Our results suggest that middle to late pregnancy is the most susceptible air pollution exposure window for air pollution and PTB among women in Guangzhou, China.
母亲暴露于环境空气污染与早产（PTB）有关，然而，通常报告的是整个孕期或特定孕期的关联，这可能无法充分确定易感窗口。利用来自中国南方大都市广州（人口约 1450 万）的出生登记数据，包括 2015 年 1 月至 2017 年 7 月期间的 469975 例单胎活产，我们在回顾性队列研究中评估了每周空气污染暴露与 PTB 之间的关联。根据孕妇在孕期的居住地，利用来自 11 个监测站的每日平均 PM、PM、NO、SO 和 O 浓度，为每位参与者估计了特定区域的暴露情况。基于 Cox 比例风险模型的分布式滞后模型（DLMs）用于在控制温度、季节性和个体水平协变量后，估计每周母体暴露于空气污染物与 PTB 风险（作为时间事件结局）之间的关联。我们还考虑了中度早产（32-36 孕周）和极早产（28-31 孕周）作为感兴趣的结局。对于研究期间的空气污染物每增加一个四分位间距（IQR），计算危害比（HR）和 95%置信区间（95%CI）。在妊娠第 20-28 周期间，PM 暴露增加一个 IQR（27.0μg/m）与 PTB 风险显著相关，在第 25 周时影响最强（HR=1.034，95%CI：1.010-1.059）。显著的暴露窗口分别是 PM 的第 19-28 周、NO 的第 18-31 周和 O 的第 23-31 周。PM 的第 25 周（IQR=37.0μg/m；HR=1.048，95%CI：1.034-1.062）、NO 的第 26 周（IQR=29.0μg/m；HR=1.060，95%CI：1.028-1.094）和 O 的第 28 周（IQR=90.0μg/m；HR=1.063，95%CI：1.046-1.081）观察到最强的关联。PM、PM、NO 暴露与中度早产（32-36 孕周）和极早产（28-31 孕周）的结果相似，但对极早产的影响更大。我们没有观察到妊娠 SO 暴露与 PTB 风险之间的任何关联。我们的结果表明，在中国广州，女性中空气污染与 PTB 之间最敏感的空气污染暴露窗口是妊娠中期至晚期。
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