Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, 03080, South Korea; Environmental Health Center, Seoul National University College of Medicine, Seoul, 03080, South Korea.
Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, 1014, Denmark; Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, 03080, South Korea.
Environ Res. 2020 Dec;191:110060. doi: 10.1016/j.envres.2020.110060. Epub 2020 Aug 15.
Previous studies have suggested links between exposure to ambient air pollutants and increased risk of congenital heart defects. However, few studies have investigated the association between other congenital diseases and traffic-related air pollution. In this study, we assessed the relationship between prenatal exposure to fine particulate matter (PM) and nitrogen dioxide (NO) with congenital diseases in South Korea.
Patients with one or more congenital diseases and a control group of patients with non-infective gastroenteritis and colitis with a case:control ratio of 1:3 were obtained from the National Health Insurance Service data for 2008-2013 in South Korea. We estimated the associations of PM and NO exposures with congenital diseases using generalized estimation equations after controlling for covariates.
Maternal PM exposure during the first and second trimester showed positive associations with overall congenital diseases, with changes of 14.7% (95% confidence intervals (CI), 9.3%, 20.3%) and 16.2% (95% CI, 11.0%, 21.7%), respectively, per 11.1 μg/m and 10.2 μg/m increase of PM interquartile range (IQR). Similarly, NO exposure during the first and second trimester was associated with increased numbers of overall congenital anomalies, with 8.2% (95% CI, 4.2%, 12.3%) and 15.6% (95% CI, 9.3%, 22.2%) more cases, respectively, per 10.6 ppb increase of NO. We found that maternal PM exposure during the first and second trimesters of pregnancy was significantly associated with increased risk of specific congenital diseases, including subtypes affecting the circulatory, genitourinary, and musculoskeletal system. However, no significant associations were observed during the third trimester. Maternal NO exposure across the entire pregnancy was associated with malformations of the musculoskeletal system.
Our study identified significant links between in utero exposure to PM and NO and certain congenital diseases, and suggests that stricter controls on PM and NO concentrations are required.
先前的研究表明，暴露于环境空气中的污染物与先天性心脏病风险增加之间存在关联。然而，很少有研究调查其他先天性疾病与交通相关的空气污染之间的关联。在这项研究中，我们评估了韩国产前暴露于细颗粒物（PM）和二氧化氮（NO）与先天性疾病之间的关系。
我们从韩国 2008 年至 2013 年的国家健康保险服务数据中获得了患有一种或多种先天性疾病的患者和患有非感染性胃肠炎和结肠炎的对照组患者，病例对照比为 1:3。我们使用广义估计方程控制了协变量后，估计了 PM 和 NO 暴露与先天性疾病的关联。
母亲在第一和第二孕期暴露于 PM 与整体先天性疾病呈正相关，每增加 11.1μg/m 和 10.2μg/m 的 PM 四分位距（IQR），分别增加 14.7%（95%置信区间（CI），9.3%，20.3%）和 16.2%（95% CI，11.0%，21.7%）。同样，第一和第二孕期暴露于 NO 也与整体先天性异常的数量增加有关，每增加 10.6ppb 的 NO，分别增加 8.2%（95% CI，4.2%，12.3%）和 15.6%（95% CI，9.3%，22.2%）。我们发现，母亲在妊娠第一和第二孕期暴露于 PM 与特定先天性疾病的风险增加显著相关，包括影响循环、泌尿生殖和肌肉骨骼系统的亚型。然而，在第三孕期未观察到显著关联。整个孕期母亲暴露于 NO 与肌肉骨骼系统的畸形有关。
我们的研究发现，胎儿期暴露于 PM 和 NO 与某些先天性疾病之间存在显著关联，这表明需要对 PM 和 NO 浓度进行更严格的控制。
