School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Qiaokou District, Wuhan, 430030, Hubei, China; Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No. 100 Hongkong Road, Jiangan District, Wuhan, 430016, Hubei, China.
West China School of Public Health, Sichuan University, No. 17 People's South Road, Wuhou District, Chengdu, 610041, China.
Environ Res. 2021 Mar;194:110627. doi: 10.1016/j.envres.2020.110627. Epub 2020 Dec 17.
Air pollution exposure during pregnancy has been documented to be associated with impaired fetal growth and adverse birth outcomes, but the evidence regarding the effects of air pollution on early childhood growth is still limited.
We aimed to explore the associations of exposure to air pollutants during pregnancy with childhood growth trajectories from birth to age of 6 years.
A prospective cohort study based on the administrative registration system was conducted covering 62,540 births in Wuhan, China between January 1, 2011 and December 31, 2013 and followed for 6 years. Inverse distance weighted method was used to estimate the concentrations of air pollutants exposure for pregnant women. Group-based trajectory models (GBTM) were used to identify growth patterns of children: slow growth, normal growth, and rapid growth. Multinomial logistic regression models were used to examine the associations between prenatal exposure to air pollutants and childhood growth trajectories with adjustment for maternal age, educational status, pre-pregnancy BMI, residential areas, gestational diabetes, birth type, gender of infant, and breastfeeding duration.
The mean (SD) of prenatal exposure concentrations for PM, SO, NO, CO, and O were 107.9 (30.4), 32.8(12.6), 55.8(13.1), 1081.2(293.1), and 81.6(31.0) μg/m respectively. Compared with normal growth trajectory, increased PM and CO exposure were significantly associated with higher risk of slow growth trajectory but lower risk of rapid growth trajectory. An increase in prenatal exposure to NO significantly increased both the risk of slow growth trajectory and rapid growth trajectory. Increased prenatal SO exposure was significantly associated with rapid growth trajectory and was not associated with low growth trajectory. With O exposure levels increased, risk to be rapid growth trajectory decreased. Prenatal air pollutants exposure had a greater impact on childhood growth of children who were girls, and those mothers lived in rural areas and were normal weight before pregnancy.
High levels of air pollutants exposure during pregnancy were associated with the risk of being in a trajectory with the deviation of BMI gain from birth to 6 years old. These findings suggest that efforts to identify children at risk of growth deviation in early childhood should pay attention to environmental exposure during pregnancy for their mothers.
已有研究证实，孕期暴露于空气污染会影响胎儿生长并导致不良的出生结局，但有关空气污染对儿童早期生长影响的证据仍然有限。
本研究旨在探讨孕期暴露于空气污染物与儿童从出生到 6 岁时的生长轨迹之间的关系。
本研究采用基于行政登记系统的前瞻性队列研究，纳入了 2011 年 1 月 1 日至 2013 年 12 月 31 日期间在中国武汉出生的 62540 名婴儿，并对其随访 6 年。采用逆距离加权法估算孕妇的空气污染物暴露浓度。采用群组轨迹模型（GBTM）识别儿童的生长模式：缓慢生长、正常生长和快速生长。采用多项逻辑回归模型检验孕期暴露于空气污染物与儿童生长轨迹之间的关系，并对母亲年龄、教育程度、孕前 BMI、居住区域、妊娠期糖尿病、分娩方式、婴儿性别和母乳喂养持续时间进行了调整。
孕期暴露于 PM、SO、NO、CO 和 O 的平均（SD）浓度分别为 107.9（30.4）μg/m、32.8（12.6）μg/m、55.8（13.1）μg/m、1081.2（293.1）μg/m 和 81.6（31.0）μg/m。与正常生长轨迹相比，PM 和 CO 暴露增加与生长缓慢轨迹的风险增加显著相关，而与快速生长轨迹的风险降低显著相关。NO 暴露增加与生长缓慢和快速生长轨迹的风险均增加显著相关。SO 暴露增加与快速生长轨迹显著相关，与生长缓慢轨迹不相关。O 暴露水平增加，快速生长轨迹的风险降低。孕期空气污染物暴露对女孩和居住在农村地区且孕前体重正常的儿童的生长影响更大。
孕期高水平的空气污染物暴露与从出生到 6 岁时 BMI 增长偏离的轨迹风险相关。这些发现提示，为了识别儿童在早期生长过程中出现生长偏离的风险，对于其母亲在孕期应注意环境暴露。
