Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Coordinating Centre for Paediatric Rare Diseases, Meyer Children's University Hospital, Florence, Italy.
Environ Health. 2021 Apr 17;20(1):46. doi: 10.1186/s12940-021-00728-9.
The first 1000 days of life -including pregnancy and the first 2 years after birth- represent a critical window for health interventions. This systematic review aimed to summarize the evidence on the relationship between traffic-related air pollutants exposure in the first 1000 days of life and the development of wheezing and asthma, with a particular focus on windows of exposure.
Medline and Embase were searched from January 2000 to May 2020 to retrieve population-based birth-cohort studies, including registries, providing quantitative information on the association between exposure to traffic-related air pollutants during pregnancy or early life, and the risk of developing wheezing and asthma in childhood. Screening and selection of the articles were completed independently by three reviewers. The quality of studies was assessed using the Newcastle-Ottawa scale.
Out of 9681 records retrieved, 26 studies from 21 cohorts were included. The most common traffic-related air pollutant markers were particulate matter (PM) and nitric oxides (NOx). The variability in terms of pollutants, exposure assessment methods, and exposure levels chosen to present the results did not allow a meta-analysis. Exposure to PM and NOx in pregnancy (10 cohorts) was consistently associated with an increased risk of asthma development, while the association with wheezing development was unclear. The second trimester of pregnancy seemed to be particularly critical for asthma risk. As for exposure during early life (15 cohorts), most studies found a positive association between PM (7/10 studies) and NOx (11/13 studies) and the risk of asthma development, while the risk of wheezing development was controversial. The period of postnatal exposure, however, was less precisely defined and a partial overlap between the period of exposure measurement and that of outcome development was present in a consistent number of studies (14 out of 15) raising doubts on the associations found.
Traffic-related air pollution during pregnancy is associated with an increased risk of asthma development among children and adolescents. The relationship between exposure in the first two years of life and the development of wheezing and asthma needs to be confirmed in studies with more precise exposure assessment.
生命的头 1000 天——包括怀孕和出生后的头 2 年——是进行健康干预的关键时期。本系统综述旨在总结生命头 1000 天内接触交通相关空气污染物与喘息和哮喘发展之间关系的证据，重点关注暴露窗口。
从 2000 年 1 月至 2020 年 5 月，我们在 Medline 和 Embase 上检索了基于人群的出生队列研究，包括登记处，提供了关于怀孕期间或生命早期接触交通相关空气污染物与儿童时期喘息和哮喘发展风险之间关联的定量信息。三位评审员独立完成了文章的筛选和选择。使用纽卡斯尔-渥太华量表评估研究质量。
在检索到的 9681 条记录中，有 26 项来自 21 项队列的研究被纳入。最常见的交通相关空气污染物标志物是颗粒物 (PM) 和氮氧化物 (NOx)。由于污染物、暴露评估方法和选择呈现结果的暴露水平存在差异，因此无法进行荟萃分析。妊娠期间接触 PM 和 NOx（10 项队列）与哮喘发展风险增加一致相关，而与喘息发展的关系尚不清楚。妊娠中期似乎对哮喘风险特别关键。至于生命早期的暴露（15 项队列），大多数研究发现 PM（7/10 项研究）和 NOx（11/13 项研究）与哮喘发展风险呈正相关，而喘息发展的风险存在争议。然而，产后暴露期定义不太准确，在相当数量的研究中（15 项中的 14 项），暴露测量期和结果发展期之间存在部分重叠，这对发现的关联提出了质疑。
妊娠期间接触交通相关空气污染与儿童和青少年哮喘发展风险增加有关。生命头两年暴露与喘息和哮喘发展之间的关系需要在暴露评估更精确的研究中得到证实。
