安大略省西南部不良生育结局的地理空间分析：环境因素影响的研究
Geospatial analyses of adverse birth outcomes in Southwestern Ontario: Examining the impact of environmental factors.
机构信息
School of Food and Nutritional Sciences, Brescia University College, 1285 Western Road, London, Ontario, Canada, N6G 1H2; Department of Paediatrics, Western University, 800 Commissioners Road East, London, Ontario, Canada, N6A 5W9; Department of Epidemiology and Biostatistics, Western University, 1151 Richmond Street, London, Ontario, Canada, N6A 5C1; Children's Health Research Institute, 800 Commissioners Road East, London, Ontario, Canada, N6C 2V5; Lawson Health Research Institute, 750 Base Line Road East, London, Ontario, Canada, N6C 2R5; Human Environments Analysis Laboratory, Western University, 1151 Richmond Street, London, Ontario, Canada, N6A 3K7.
School of Food and Nutritional Sciences, Brescia University College, 1285 Western Road, London, Ontario, Canada, N6G 1H2.
出版信息
Environ Res. 2019 May;172:18-26. doi: 10.1016/j.envres.2018.12.068. Epub 2018 Dec 31.
BACKGROUND
A growing body of research has examined the association between exposure to environmental factors during pregnancy and adverse birth outcomes; however, many studies do not control for potential covariates and findings vary considerably.
OBJECTIVE
To test the relative influence of environmental factors including exposure to air pollution, major roads, highways, industry, parks, greenspaces, and food retailers on low birth weight (LBW) and preterm birth (PTB) in Southwestern Ontario (SWO), Canada, while accounting for medical (e.g., previous preterm birth, gestational diabetes), behavioral (e.g., alcohol, smoking), demographic (e.g., maternal age, body mass index), and neighborhood-level socioeconomic (e.g., household income, education) factors.
METHODS
This retrospective cohort study consisted of a large sample of pregnant women from SWO who gave birth to singleton newborns between February 2009 and February 2014 at London Health Sciences Centre. Data on maternal postal codes were entered into a Geographic Information System to map the distribution of maternal residences and determine selected characteristics of their neighborhood environments (i.e., socioeconomic, built, natural). These variables were developed based on postal codes where the mothers lived prior to giving birth. Logistic regression was used to assess the relative effects of the physical environment, socioeconomic status, clinical history, and behavioral risk factors on mothers having a LBW or PTB infant.
RESULTS
Out of 25,263 live births, 5.7% were LBW and 7.5% were PTB. Exposure to sulfur dioxide was a top predictor of both LBW and PTB. For every one-unit increase in sulfur dioxide, the odds of a LBW and PTB were 3.4 (95% CI: 2.2, 5.2) and 2.0 (95% CI: 1.4, 3.0) times higher, after controlling for other variables in the model, respectively (p < 0.001). Previous PTB was also highly associated with both birth outcomes.
CONCLUSIONS
Health care providers should be informed about the hazards of air pollution to developing fetuses so that recommendations can be made to their pregnant patients about limiting exposure when air quality is poor.
背景
越来越多的研究探讨了孕妇在怀孕期间接触环境因素与不良出生结局之间的关系；然而，许多研究没有控制潜在的混杂因素，并且研究结果差异很大。
目的
在考虑到医疗（例如，既往早产、妊娠期糖尿病）、行为（例如，饮酒、吸烟）、人口统计学（例如，产妇年龄、体重指数）和邻里社会经济（例如，家庭收入、教育）因素的情况下，检验环境因素（包括接触空气污染、主要道路、高速公路、工业、公园、绿地和食品零售商）对加拿大安大略省西南部（SWO）低出生体重（LBW）和早产（PTB）的相对影响。
方法
这项回顾性队列研究由来自 SWO 的大量孕妇组成，她们于 2009 年 2 月至 2014 年 2 月期间在伦敦健康科学中心生下单胎新生儿。将母亲的邮政编码数据输入地理信息系统，以绘制母亲居住地的分布并确定其邻里环境的选定特征（即社会经济、建筑、自然）。这些变量是基于母亲分娩前居住的邮政编码开发的。逻辑回归用于评估物理环境、社会经济地位、临床病史和行为危险因素对母亲生育 LBW 或 PTB 婴儿的相对影响。
结果
在 25263 例活产中，5.7%为 LBW，7.5%为 PTB。二氧化硫暴露是 LBW 和 PTB 的主要预测因素。在控制模型中其他变量的情况下，每增加一个单位的二氧化硫，LBW 和 PTB 的几率分别增加 3.4 倍（95%CI：2.2，5.2）和 2.0 倍（95%CI：1.4，3.0）（p<0.001）。既往早产也与这两种出生结局高度相关。
结论
应告知医疗保健提供者空气污染对发育中胎儿的危害，以便向其孕妇患者提出在空气质量差时限制暴露的建议。
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