Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
Environ Health. 2021 Jul 5;20(1):78. doi: 10.1186/s12940-021-00763-6.
Developmental exposure to particulate matter (PM) air pollution may impair children's behaviors. Our objectives were to quantify the impact of reducing indoor PM using portable HEPA filter air cleaners during pregnancy on behavioral problems in children and to assess associations between indoor fine PM (PM) concentrations during pregnancy and children's behavior.
This is a secondary analysis of a single-blind parallel-group randomized controlled trial in which we randomly assigned 540 non-smoking pregnant women to receive 1 or 2 HEPA filter air cleaners or no air cleaners. We administered the Behavior Assessment System for Children (BASC-3) to caregivers when children were a mean age of 23 months, and again at a mean age of 48 months. Primary outcomes were the four BASC-3 composite scales: externalizing problems, internalizing problems, adaptive skills, and the behavioral symptoms index. We imputed missing data using multiple imputation with chained equations. The primary analysis was by intention-to-treat. In a secondary analysis, we evaluated associations between BASC-3 composite indices and modeled trimester-specific PM concentrations inside residences.
We enrolled participants at a median of 11 weeks gestation. After excluding miscarriages, still births and neonatal deaths, our analysis included 478 children (233 control and 245 intervention). We observed no differences in the mean BASC-3 scores between treatment groups. An interquartile increase (20.1 µg/m) in first trimester PM concentration was associated with higher externalizing problem scores (2.4 units, 95% CI: 0.7, 4.1), higher internalizing problem scores (2.4 units, 95% CI: 0.7, 4.0), lower adaptive skills scores (-1.5 units, 95% CI: -3.0, 0.0), and higher behavior symptoms index scores (2.3 units, 95% CI: 0.7, 3.9). Third trimester PM concentrations were also associated with some behavioral indices at age 4, but effect estimates were smaller. No significant associations were observed with PM concentrations during the second trimester or for any of the BASC indices when children were 2 years old.
We found no benefit of reducing indoor particulate air pollution during pregnancy on parent-reported behaviors in children. Associations between indoor PM concentrations in the first trimester and behavioral scores among 4-year old children suggest that it may be necessary to intervene early in pregnancy to protect children, but these exploratory findings should be interpreted cautiously.
ClinicalTrials.gov: NCT01741051.
发育过程中接触颗粒物（PM）空气污染可能会损害儿童的行为。我们的目的是量化在怀孕期间使用便携式高效空气过滤器（HEPA）空气净化器减少室内 PM 对儿童行为问题的影响，并评估怀孕期间室内细颗粒物（PM）浓度与儿童行为之间的关系。
这是一项单盲平行组随机对照试验的二次分析，我们将 540 名不吸烟的孕妇随机分为接受 1 或 2 台高效空气过滤器空气净化器或不使用空气净化器的三组。当儿童平均年龄为 23 个月和 48 个月时，我们使用儿童行为评估系统（BASC-3）向照顾者进行评估。主要结局是 BASC-3 的四个综合量表：外化问题、内化问题、适应技能和行为症状指数。我们使用链方程的多重插补法对缺失数据进行了插补。主要分析是意向治疗。在二次分析中，我们评估了 BASC-3 综合指数与模型化的妊娠期住宅内特定 PM 浓度之间的关系。
我们在妊娠 11 周左右纳入参与者。排除流产、死胎和新生儿死亡后，我们的分析包括 478 名儿童（对照组 233 名，干预组 245 名）。我们在治疗组之间未观察到 BASC-3 评分的差异。在第一个三个月中 PM 浓度每增加一个四分位距（20.1μg/m），外化问题评分就会升高（2.4 分，95%CI：0.7，4.1），内化问题评分升高（2.4 分，95%CI：0.7，4.0），适应技能评分降低（-1.5 分，95%CI：-3.0，0.0），行为症状指数评分升高（2.3 分，95%CI：0.7，3.9）。第三个三个月的 PM 浓度也与 4 岁时的一些行为指数相关，但效应估计值较小。在第二个三个月或儿童 2 岁时，我们没有观察到与 PM 浓度或任何 BASC 指数之间的显著关联。
我们没有发现怀孕期间减少室内颗粒物空气污染对儿童家长报告的行为有任何益处。在第一个三个月中室内 PM 浓度与 4 岁儿童行为评分之间的关联表明，可能有必要在妊娠早期进行干预以保护儿童，但这些探索性发现应谨慎解释。
ClinicalTrials.gov：NCT01741051。
