Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
Occup Environ Med. 2020 Oct;77(10):721-727. doi: 10.1136/oemed-2020-106434. Epub 2020 Jul 31.
Current literature describes limited and controversial evidence on the associations between maternal preconception and first trimester exposure to particulate matter with a diameter ≤10 µm (PM) and the risk of oral cleft (OC).
We conducted a case-control study involving 3086 OC cases and 7950 controls, registered in the Maternal and Child Health Certificate Registry in Liaoning Province between 2010 and 2015. PM concentrations were obtained from the Environment Protection Bureau. The exposure windows included the 3 months before pregnancy, the first trimester and the individual months. Unconditional logistic regression model was performed to estimate the OR and 95% CI for the association between PM exposure and the risk of OC, cleft lip only (CLO), cleft palate only (CPO), and cleft lip and palate (CLP).
Maternal PM exposure was positively associated with an increased risk for OC during the 3 months preconception (per 10 µg/m increment: OR=1.04, 95% CI 1.01 to 1.07; highest vs lowest quartile: OR=1.23, 95% CI 1.04 to 1.45) and the first trimester (per 10 µg/m increment: OR=1.05, 95% CI 1.02 to 1.08; highest vs lowest quartile: OR=1.37, 95% CI 1.15 to 1.64). Analyses based on individual months presented similar positive associations, particularly in the second month of pregnancy (OR=1.77, 95% CI 1.51 to 2.09) for highest versus lowest quartile. In the subtype analysis, stronger associations were observed for CLO, whereas there was negligible evidence for CPO and CLP. Sensitivity analyses using propensity score matching generated similar findings.
Our study provides evidence that PM exposure during the 3 months preconception and the first trimester increases the risk of OC.
目前的文献描述了母体受孕前和妊娠早期暴露于直径≤10 µm 的颗粒物（PM）与口腔裂（OC）风险之间的关联的有限且有争议的证据。
我们进行了一项病例对照研究，涉及 2010 年至 2015 年期间在辽宁省母婴健康证书登记处登记的 3086 例 OC 病例和 7950 例对照。PM 浓度来自环境保护局。暴露窗口包括怀孕前 3 个月、妊娠早期和个别月份。采用非条件逻辑回归模型估计 PM 暴露与 OC、单纯唇裂（CLO）、单纯腭裂（CPO）和唇裂和腭裂（CLP）风险之间的关联的 OR 和 95%CI。
母体 PM 暴露与 OC 在受孕前 3 个月（每增加 10 µg/m：OR=1.04，95%CI 1.01 至 1.07；最高与最低四分位数：OR=1.23，95%CI 1.04 至 1.45）和妊娠早期（每增加 10 µg/m：OR=1.05，95%CI 1.02 至 1.08；最高与最低四分位数：OR=1.37，95%CI 1.15 至 1.64）呈正相关。基于个别月份的分析呈现出类似的正相关，特别是在妊娠第二个月（最高与最低四分位数：OR=1.77，95%CI 1.51 至 2.09）。在亚型分析中，CLO 观察到更强的关联，而 CPO 和 CLP 则几乎没有证据。使用倾向评分匹配进行的敏感性分析得出了类似的发现。
我们的研究提供了证据表明，受孕前 3 个月和妊娠早期暴露于 PM 会增加 OC 的风险。
