产前砷暴露与出生结局和妊娠并发症的关联：国家儿童研究队列内的观察性研究。
Association between prenatal arsenic exposure, birth outcomes, and pregnancy complications: An observational study within the National Children's Study cohort.
机构信息
Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, 60612, USA.
Institute for Minority Health Research, College of Medicine, University of Illinois at Chicago, Chicago, IL, 60612, USA.
出版信息
Environ Res. 2020 Apr;183:109182. doi: 10.1016/j.envres.2020.109182. Epub 2020 Jan 24.
BACKGROUND
Chronic arsenic exposure has been associated with pregnancy complications and reduced fetal growth in populations where total arsenic exposure exceeds 50 μg/L. However, the potential effect on pregnancy outcomes remains unclear at lower levels of arsenic exposure, such as those most commonly observed in the United States.
OBJECTIVES
We evaluated the associations between arsenic exposure during pregnancy with fetal growth and risk of pregnancy complications using data from mother-infant pairs participating in the National Children's Study.
METHODS
Prenatal arsenic exposure was measured using maternal urine collected during the third trimester. Information about pregnancy complications was abstracted from medical records. Fetal growth, including gestational age, birth weight, birth length, head circumference, and ponderal index, was ascertained through physical measurement at birth and extracted from medical records.
RESULTS
Medians [interquartile range (IQR)] of maternal urinary total arsenic and dimethylarsinic acid (DMA) were 7.77 μg/L (7.98) and 3.44 μg/L (3.13), respectively. Each increase in IQR of prenatal total arsenic level was associated with greater birth length (+0.28 cm; 95% CI: 0.14, 0.42), greater head circumference (+0.12 cm; 95% CI: 0.04, 0.21), and lower ponderal index (-0.37 kg/m; 95% CI: -0.58, -0.17). Similar results were obtained for levels of prenatal DMA. Tests for multiplicative interaction indicate that prenatal urinary DMA was negatively associated with gestational age among female infants (-0.44 week decrease in gestational age estimated for each IQR increase in DMA; 95% CI: -0.84, -0.05), while no association was observed among male infants (p = 0.02). No significant associations were detected between arsenic and birth weight or pregnancy complications.
CONCLUSIONS
Higher prenatal arsenic exposure was associated with longer birth length, greater head circumference, and lower ponderal index. Associations between arsenic and gestational age may be modified by infant sex.
背景
在砷总暴露量超过 50μg/L 的人群中，慢性砷暴露与妊娠并发症和胎儿生长受限有关。然而，在砷暴露水平较低的情况下，其对妊娠结局的潜在影响尚不清楚，而这在如美国等国家是最常见的。
目的
我们利用参与国家儿童研究的母婴对的数据，评估了妊娠期间砷暴露与胎儿生长和妊娠并发症风险之间的关联。
方法
在妊娠晚期采集母亲尿液来测量产前砷暴露。从医疗记录中提取妊娠并发症信息。通过出生时的体格测量和从医疗记录中提取，确定胎儿生长指标，包括胎龄、出生体重、出生身长、头围和体重指数。
结果
母亲尿液中总砷和二甲基砷酸（DMA）的中位数[四分位距（IQR）]分别为 7.77μg/L（7.98）和 3.44μg/L（3.13）。产前总砷水平每增加一个 IQR，出生身长增加 0.28cm（95%CI：0.14，0.42），头围增加 0.12cm（95%CI：0.04，0.21），体重指数降低 0.37kg/m（95%CI：-0.58，-0.17）。产前 DMA 水平也得到了类似的结果。基于乘法交互作用的检验表明，产前尿液 DMA 与女婴的胎龄呈负相关（DMA 每增加一个 IQR，胎龄估计减少 0.44 周；95%CI：-0.84，-0.05），而在男婴中则无关联（p=0.02）。未发现砷与出生体重或妊娠并发症之间存在显著关联。
结论
较高的产前砷暴露与出生身长较长、头围较大和体重指数较低有关。砷与胎龄之间的关联可能受婴儿性别影响。
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