School of Public Health, Zhengzhou University, Zhengzhou, China; Shanghai Typhoon Institute, China Meteorological Administration, Shanghai, China; Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China.
The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Environ Pollut. 2021 Jun 1;278:116752. doi: 10.1016/j.envpol.2021.116752. Epub 2021 Feb 22.
Stillbirth has a great impact on contemporary and future generations. Increasing evidence show that ambient air pollution exposure is associated with stillbirth. However, previous studies showed inconsistent findings. To clarify the effect of maternal air pollution exposure on stillbirth, we searched for studies examining the associations between air pollutants, including particulate matter (diameter ≤ 2.5 μm [PM] and ≤10 μm [PM]) and gaseous pollutants (sulfur dioxide [SO], nitrogen dioxide [NO], carbon monoxide [CO] and ozone [O]), and stillbirth published in PubMed, Web of Science, Embase and Cochrane Library until December 11, 2020. The pooled effect estimates and 95% confidence intervals (CI) were calculated, and the heterogeneity was evaluated using Cochran's Q test and I statistic. Publication bias was assessed using funnel plots and Egger's tests. Of 7546 records, 15 eligible studies were included in this review. Results of long-term exposure showed that maternal third trimester PM and CO exposure (per 10 μg/m increment) increased the odds of stillbirth, with estimated odds ratios (ORs) of 1.094 (95% CI: 1.008-1.180) and 1.0009 (95% CI: 1.0001-1.0017), respectively. Entire pregnancy exposure to PM was also associated with stillbirth (OR: 1.103, 95% CI: 1.074-1.131). A 10 μg/m increment in O in the first trimester was associated with stillbirth, and the estimated OR was 1.028 (95% CI: 1.001-1.055). Short-term exposure (on lag day 4) to O was also associated with stillbirth (OR: 1.002, 95% CI: 1.001-1.004). PM, SO and NO exposure had no significant effects on the incidence of stillbirth. Additional well-designed cohort studies and investigations regarding potential biological mechanisms are warranted to elaborate the suggestive association that may help improve intergenerational inequality.
死产对当代和后代都有重大影响。越来越多的证据表明，环境空气污染暴露与死产有关。然而，先前的研究结果并不一致。为了明确母体空气污染暴露与死产的关系，我们检索了在 PubMed、Web of Science、Embase 和 Cochrane Library 中发表的研究，这些研究检查了空气污染物（包括直径≤2.5μm（PM）和≤10μm（PM）的颗粒物和二氧化硫[SO]、二氧化氮[NO]、一氧化碳[CO]和臭氧[O]）与死产之间的关联，截至 2020 年 12 月 11 日。计算了合并效应估计值和 95%置信区间（CI），并使用 Cochran's Q 检验和 I 统计量评估了异质性。使用漏斗图和 Egger 检验评估了发表偏倚。在 7546 条记录中，有 15 项符合条件的研究纳入了本综述。长期暴露的结果表明，母体妊娠晚期 PM 和 CO 暴露（每增加 10μg/m）增加了死产的几率，估计的比值比（OR）分别为 1.094（95%CI：1.008-1.180）和 1.0009（95%CI：1.0001-1.0017）。整个孕期暴露于 PM 也与死产有关（OR：1.103，95%CI：1.074-1.131）。第一孕期中 PM 浓度每增加 10μg/m，与死产相关，估计 OR 为 1.028（95%CI：1.001-1.055）。短期暴露（在滞后 4 天）到 O 也与死产有关（OR：1.002，95%CI：1.001-1.004）。PM、SO 和 NO 暴露对死产发生率没有显著影响。需要进行更多设计良好的队列研究和潜在生物学机制的调查，以详细阐述这种提示性关联，这可能有助于改善代际不平等。
