Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK; Centre for Trophoblast Research, University of Cambridge, Cambridge, UK.
Placenta. 2021 Jan 15;104:188-194. doi: 10.1016/j.placenta.2020.12.009. Epub 2020 Dec 18.
Air pollution has significant negative health impacts, particularly on the cardiovascular system. The aims of this narrative review were to identify whether there is an association between air pollution and the incidence of pre-eclampsia, and the potential mechanisms by which any effects may be mediated.
We undertook a literature search using Google Scholar, PubMed, the Cochrane Library and NICE Evidence. The primary eligibility criterion was articles correlating exposure to air pollution with incidence of pre-eclampsia.
Meta-analyses currently show a positive association between pre-eclampsia and exposure to both particulate matter PM and nitrogen dioxide, but no significant associations with ambient ozone or carbon monoxide exposure. No meta-analysis has been performed for exposure to sulfur dioxide. Variability in terms of quantification of exposure, the exposure period and co-founders among the studies makes comparisons complex. Adverse effects on trophoblast invasion and placental vascularisation, and increases in oxidative stress and anti-angiogenic factors, such as sFlt-1, in response to air pollution provide pathways by which exposure may contribute to the pathophysiology of pre-eclampsia. So far, studies have not discriminated between the early- and late-onset forms of the syndrome.
Future prospective studies using personal air pollution monitors and blood biomarkers of pre-eclampsia would strengthen the associations. Interactions between pollutants are poorly documented, and at present there is minimal informed advice available to women on the need to avoid exposure to air pollutants during pregnancy.
空气污染对健康有重大负面影响，尤其对心血管系统影响显著。本综述旨在明确空气污染与子痫前期发病率之间是否存在关联，以及可能存在的介导机制。
我们使用谷歌学术、PubMed、Cochrane 图书馆和 NICE 证据库进行了文献检索。主要入选标准是将空气污染暴露与子痫前期发病率相关联的文章。
目前的荟萃分析显示，子痫前期与颗粒物（PM）和二氧化氮暴露呈正相关，但与环境臭氧或一氧化碳暴露无显著关联。尚未对二氧化硫暴露进行荟萃分析。研究之间在暴露量化、暴露期和共同因素方面的差异使得比较变得复杂。空气污染对滋养细胞浸润和胎盘血管生成的不良影响，以及氧化应激和抗血管生成因子（如 sFlt-1）的增加，为暴露可能导致子痫前期病理生理学的机制提供了途径。到目前为止，研究尚未区分该综合征的早发型和晚发型。
未来使用个人空气污染监测器和子痫前期血液生物标志物的前瞻性研究将加强这些关联。污染物之间的相互作用记录甚少，目前几乎没有为孕妇提供避免接触空气污染的相关信息。
