Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Occupational and Environmental Medicine, WittyFit, Clermont-Ferrand, France.
INSERM, CIC 1405 CRECHE Unit, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Gynecological Surgery, Clermont-Ferrand, France.
Environ Pollut. 2021 Jun 1;278:116856. doi: 10.1016/j.envpol.2021.116856. Epub 2021 Mar 2.
Despite the widely-known effects of air pollution, pollutants exposure surrounding pregnancy and the risk for autism spectrum disorder (ASD) in newborns remains controversial. The purpose of our study was to carry out a systematic review and meta-analyses of the risk of ASD in newborns following air pollution exposure during the perinatal period (preconception to second year of life). The PubMed, Cochrane Library, Embase and ScienceDirect databases were searched for articles, published up to July 2020, with the keywords "air pollution" and "autism". Three models were used for each meta-analysis: a global model based on all risks listed in included articles, a pessimistic model based on less favorable data only, and an optimistic model based on the most favorable data only. 28 studies corresponding to a total of 758 997 newborns were included (47190 ASD and 703980 controls). Maternal exposure to all pollutants was associated with an increased risk of ASD in newborns by 3.9% using the global model and by 12.3% using the optimistic model, while the pessimistic model found no change. Each increase of 5 μg/m in particulate matter <2.5 μm (PM2.5) was associated with an increased risk of ASD in newborns, regardless of the model used (global +7%, pessimistic +5%, optimistic +15%). This risk increased during preconception (global +17%), during pregnancy (global +5%, and optimistic +16%), and during the postnatal period (global +11% and optimistic +16%). Evidence levels were poor for other pollutants (PM10, NOx, O3, metals, solvents, styrene, PAHs, pesticides). PM2.5 was associated with a greater risk than PM10 (coefficient 0.20, 95CI -0.02 to 0.42), NOx (0.29, 0.08 to 0.50) or solvents (0.24, 0.04 to 0.44). All models revealed that exposure to pollutants, notably PM2.5 during pregnancy, was associated with an increased risk of ASD in newborns. Pregnancy and postnatal periods seem to be the most at-risk periods.
尽管空气污染的影响众所周知，但围绕孕妇周围的污染物暴露以及新生儿自闭症谱系障碍（ASD）的风险仍存在争议。我们的研究目的是对围产期（受孕前至两岁）期间空气污染暴露与新生儿 ASD 风险进行系统评价和荟萃分析。我们在 PubMed、Cochrane Library、Embase 和 ScienceDirect 数据库中检索了截至 2020 年 7 月发表的使用“空气污染”和“自闭症”关键词的文章。对于每个荟萃分析，我们使用了三种模型：基于纳入文章中列出的所有风险的全局模型、仅基于较不利数据的悲观模型和仅基于最有利数据的乐观模型。共纳入了 28 项研究，共计 758997 名新生儿（47190 例 ASD 和 703980 例对照）。使用全局模型，母体暴露于所有污染物与新生儿 ASD 风险增加 3.9%，使用乐观模型则增加 12.3%，而悲观模型未发现变化。使用任何模型，PM2.5 每增加 5μg/m，新生儿 ASD 风险均增加（全局模型+7%，悲观模型+5%，乐观模型+15%）。无论使用哪种模型，这种风险在受孕前（全局模型+17%）、怀孕期间（全局模型+5%和乐观模型+16%）和产后期间（全局模型+11%和乐观模型+16%）均增加。对于其他污染物（PM10、NOx、O3、金属、溶剂、苯乙烯、多环芳烃、农药），证据水平较差。PM2.5 与 PM10（系数 0.20，95%CI-0.02 至 0.42）、NOx（0.29，0.08 至 0.50）或溶剂（0.24，0.04 至 0.44）相比，风险更高。所有模型都表明，孕妇暴露于污染物，尤其是怀孕期间的 PM2.5，与新生儿 ASD 风险增加有关。妊娠和产后时期似乎是风险最高的时期。
