Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
Sci Total Environ. 2019 Feb 10;650(Pt 2):2641-2647. doi: 10.1016/j.scitotenv.2018.09.362. Epub 2018 Oct 3.
Ambient air pollution may affect fetal growth restriction (FGR) through several mechanisms. However, prior studies of air pollution and small-for-gestational age (SGA), a common proxy for FGR, have reported inconsistent findings.
We assessed air pollution in relation to physician-diagnosed FGR and population-based SGA in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Consecutive Pregnancy Study (2002-2010).
Among 50,005 women (112,203 singleton births), FGR was captured from medical records and ICD-9 codes, and SGA determined by population standards for birthweight <10th, <5th and <3rd percentile. Community Multiscale Air Quality models estimated ambient levels of seven criteria pollutants for whole pregnancy, 3-months preconception, and 1st, 2nd and 3rd trimesters. Generalized estimating equations with robust standard errors accounted for interdependency of pregnancies within participant. Models adjusted for maternal age, race/ethnicity, pre-pregnancy body mass index, smoking, alcohol, parity, insurance, marital status, asthma and temperature.
FGR was diagnosed in 1.5% of infants, and 6.7% were <10th, 2.7% <5th and 1.5% <3rd percentile for SGA. Positive associations of SO, NO and PM and negative associations of O with FGR were observed throughout preconception and pregnancy. For example, an interquartile increase in whole pregnancy SO was associated with 16% (95% CI 8%, 25%) increased FGR risk, 17% for NO (95% CI 9%, 26%) and 12% for PM (95% CI 6%, 19%). Associations with SGA were less clear.
Chronic exposure to air pollution may be associated with FGR but not SGA in this low-risk population.
环境空气污染可能通过多种机制影响胎儿生长受限（FGR）。然而，先前关于空气污染和小于胎龄儿（SGA）的研究，作为 FGR 的常见替代指标，结果不一致。
我们评估了空气污染与儿科学会诊断的 FGR 和以人群为基础的 SGA 之间的关系，该研究是 Eunice Kennedy Shriver 国家儿童健康与人类发展研究所（NICHD）连续妊娠研究（2002-2010 年）的一部分。
在 50005 名妇女（112203 名单胎分娩）中，从医疗记录和国际疾病分类第 9 版（ICD-9）代码中捕捉到 FGR，SGA 则根据出生体重 <第 10、第 5 和第 3 百分位的人群标准确定。社区多尺度空气质量模型估计了整个孕期、受孕前 3 个月以及 1、2 和 3 个孕期的 7 种标准污染物的环境水平。广义估计方程使用稳健标准误差考虑了参与者内妊娠的相关性。模型调整了母亲的年龄、种族/民族、受孕前体重指数、吸烟、饮酒、产次、保险、婚姻状况、哮喘和温度。
1.5%的婴儿被诊断为 FGR，6.7%的婴儿为 SGA，出生体重<第 10 百分位，2.7%的婴儿<第 5 百分位，1.5%的婴儿<第 3 百分位。在受孕前和整个孕期，SO、NO 和 PM 的正相关与 O 的负相关与 FGR 有关。例如，整个孕期 SO 的四分位距增加与 FGR 风险增加 16%（95%CI 8%，25%）相关，NO 增加 17%（95%CI 9%，26%），PM 增加 12%（95%CI 6%，19%）。与 SGA 的关联则不太明确。
在这个低风险人群中，慢性暴露于空气污染可能与 FGR 相关，但与 SGA 无关。
