Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin Province, China.
Key Laboratory of Chemical Safety and Health, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China.
Environ Res. 2020 Jun;185:109471. doi: 10.1016/j.envres.2020.109471. Epub 2020 Apr 3.
Pregnancy complications, such as gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP), have a great impact on public health. Exposure to ambient air pollution during pregnancy may cause pregnancy complications. The aim of our study is to explore the risk of trimester-specific maternal exposure to air pollutants on complications of pregnancy.
PubMed, EMBASE, Web of Science, and Cochrane were systematically searched for cohort studies published before October 27, 2019 which reported the association between ambient air pollutants (PM, PM, CO, NO, NO, NO, O, and SO) and pregnancy complications (GDM, HDP, preeclampsia, and gestational hypertension) during different exposure windows. A meta-analysis was applied to combine relative risks (RRs) and their confidence intervals (CIs) from eligible studies. Quality assessment was conducted and Egger test was used to evaluate the publication bias. All statistical analyses were performed by STATA software (Version 15, StataCorp, College Station, Texas, USA).
This meta-analysis consisted of 33 cohort studies conducted on 22,253,277 pregnant women. Meta-analyses showed during the first trimester, there were significant associations of PM with gestational hypertension (RR = 1.07, 95% CI: 1.02-1.12 per 10 μg/m, I = 0.0%), of SO with GDM (RR = 1.04, 95% CI: 1.00-1.08 per 1 ppb increment, I = 54.1%), of PM with preeclampsia (RR = 0.97, 95% CI: 0.95-1.00 per 5 μg/m, I = 4.1%). During the entire pregnancy, PM significantly increased the risk of hypertensive disorders of pregnancy (RR = 1.18, 95% CI: 1.02-1.34 per 5 μg/m, I = 85.1%). Egger test indicated that wide-scale publication bias was unlikely.
Maternal exposure to ambient air pollutants is associated with pregnancy complications especially during the first trimester. Further large multicenter cohort studies considering different constituents of pollutants, levels of disease severity, sensitive populations, and various exposure windows are warranted in the future research.
妊娠并发症，如妊娠期糖尿病（GDM）和妊娠高血压疾病（HDP），对公共健康有重大影响。孕妇暴露于环境空气污染可能会导致妊娠并发症。我们的研究目的是探讨妊娠期间特定孕期母体暴露于空气污染物与妊娠并发症的关系。
系统检索了 2019 年 10 月 27 日前发表的队列研究，这些研究报告了环境空气污染物（PM、PM、CO、NO、NO、NO、O 和 SO）与不同暴露窗口下妊娠并发症（GDM、HDP、子痫前期和妊娠期高血压）之间的关系。应用荟萃分析合并来自合格研究的相对风险（RR）及其置信区间（CI）。进行质量评估并使用 Egger 检验评估发表偏倚。所有统计分析均使用 STATA 软件（版本 15，StataCorp，College Station，Texas，USA）进行。
本荟萃分析纳入了 33 项队列研究，共涉及 22253277 名孕妇。荟萃分析显示，在妊娠早期，PM 与妊娠期高血压（RR=1.07，95%CI：10μg/m 每增加 10μg/m，I=0.0%）、SO 与 GDM（RR=1.04，95%CI：1ppb 每增加 1 个单位，I=54.1%）、PM 与子痫前期（RR=0.97，95%CI：5μg/m 每增加 5μg/m，I=4.1%）之间存在显著相关性。在整个孕期，PM 显著增加了妊娠高血压疾病的风险（RR=1.18，95%CI：每增加 5μg/m，I=85.1%）。Egger 检验表明，广泛的发表偏倚不太可能。
母体暴露于环境空气污染物与妊娠并发症有关，尤其是在妊娠早期。未来的研究需要进一步进行大型多中心队列研究，考虑污染物的不同成分、疾病严重程度水平、敏感人群和各种暴露窗口。
