Ahmad Wiessam Abu, Nirel Ronit, Golan Rachel, Jolles Maya, Kloog Itai, Rotem Ran, Negev Maya, Koren Gideon, Levine Hagai
Hebrew University-Hadassah, Jerusalem, Israel.
Hebrew University of Jerusalem, Jerusalem, Israel.
Environ Res. 2022 Jul;210:112974. doi: 10.1016/j.envres.2022.112974. Epub 2022 Feb 19.
A growing body of literature reports associations between exposure to particulate matter with diameter ≤2.5 μm (PM) during pregnancy and birth outcomes. However, findings are inconsistent across studies.
To assess the association between PM and birth outcomes of fetal growth in a cohort with high prevalence of siblings by multilevel models accounting for geographical- and mother-level correlations.
In Israel, we used Maccabi Healthcare Services data to establish a population-based cohort of 381,265 singleton births reaching 24-42 weeks' gestation and birth weight of 500-5000 g (2004-2015). Daily PM predictions from a satellite-based spatiotemporal model were linked to the date of birth and maternal residence. We generated mean PM values for the entire pregnancy and for exposure periods during pregnancy. Associations between exposure and birth outcomes were modeled by using multilevel logistic regression with random effects for maternal locality of residence, administrative census area (ACA) and mother.
In fully adjusted models with a mother-level random intercept only, a 10-μg/m increase in PM over the entire pregnancy was positively associated with term low birth weight (TLBW) (Odds ratio, OR = 1.25, 95% confidence interval, CI: 1.09,1.43) and small for gestational age (SGA) (OR = 1.15, 95% CI: 1.06,1.26). Locality- and ACA-level effects accounted for <0.4% of the variance while mother-level effects explained ∼50% of the variability. Associations varied by exposure period, infants' sex, birth order, and maternal pre-pregnancy BMI.
Consideration of mother-level variability in a region with high fertility rates provides new insights on the strength of associations between PM and birth outcomes.
越来越多的文献报道了孕期暴露于直径≤2.5微米的颗粒物（PM）与出生结局之间的关联。然而，各研究的结果并不一致。
通过考虑地理和母亲层面相关性的多水平模型，评估在同胞患病率较高的队列中PM与胎儿生长出生结局之间的关联。
在以色列，我们使用了马卡比医疗服务公司的数据，建立了一个基于人群的队列，其中包括381265例单胎出生，孕周为24 - 42周，出生体重为500 - 5000克（2004 - 2015年）。基于卫星的时空模型的每日PM预测值与出生日期和母亲居住地相关联。我们生成了整个孕期以及孕期暴露期的平均PM值。通过使用多水平逻辑回归模型，并对母亲居住地区、行政区普查区（ACA）和母亲进行随机效应分析，来模拟暴露与出生结局之间的关联。
在仅包含母亲层面随机截距的完全调整模型中，整个孕期PM每增加10微克/立方米，与足月低出生体重（TLBW）呈正相关（比值比，OR = 1.25，95%置信区间，CI：1.09，1.43）以及小于胎龄儿（SGA）（OR = 1.15，95% CI：1.06，1.26）。地区和ACA层面的效应占方差的比例小于0.4%，而母亲层面的效应解释了约50%的变异性。关联因暴露期、婴儿性别、出生顺序和母亲孕前BMI而异。
在高生育率地区考虑母亲层面的变异性，为PM与出生结局之间关联的强度提供了新的见解。
