Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden.
Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden.
Environ Int. 2022 Jun;164:107251. doi: 10.1016/j.envint.2022.107251. Epub 2022 Apr 20.
Air pollution poses a threat to human health, with pregnant women and their developing fetuses being particularly vulnerable. A high dual burden of ambient and indoor air pollution exposure has been identified in Ethiopia, but studies investigating their effects on adverse birth outcomes are currently lacking. This study explores the association between ambient air pollution (NO and NO) and indoor air pollution (cooking fuel type) and fetal and neonatal death in Adama, Ethiopia. A prospective cohort of mothers and their babies was used, into which pregnant women were recruited at their first antenatal visit (n = 2085) from November 2015 to February 2018. Previously developed land-use regression models were utilized to assess ambient concentrations of NO and NO at the residential address, whereas data on cooking fuel type was derived from questionnaires. Birth outcome data was obtained from self-reported questionnaire responses during the participant's postnatal visit or by phone if an in-person meeting was not possible. Binary logistic regression was employed to assess associations within the final study population (n = 1616) using both univariate and multivariate models; the latter of which adjusted for age, education, parity, and HIV status. Odds ratios (OR) and their corresponding 95% confidence intervals (CI) were reported. Within the cohort, 69 instances of fetal death (n = 16 miscarriages; n = 53 stillbirths) and 16 cases of neonatal death were identified. The findings suggest a tendency towards an association between ambient NO and NO exposure during pregnancy and an increased risk of fetal death overall as well as stillbirth, specifically. However, statistical significance was not observed. Results for indoor air pollution and neonatal death were inconclusive. As limited evidence on the effects of exposure to ambient air pollution on adverse birth outcomes exists in Sub-Saharan Africa and Ethiopia, additional studies with larger study populations should be conducted.
空气污染对人类健康构成威胁，孕妇及其发育中的胎儿尤其脆弱。埃塞俄比亚存在较高的环境和室内空气污染双重负担，但目前缺乏研究调查其对不良出生结局的影响。本研究探讨了埃塞俄比亚阿达玛的环境空气污染（NO 和 NO）和室内空气污染（烹饪燃料类型）与胎儿和新生儿死亡之间的关联。采用前瞻性队列研究，在 2015 年 11 月至 2018 年 2 月期间，首次产前检查时招募孕妇（n=2085）入组。先前开发的基于土地利用的回归模型用于评估住宅地址处的环境 NO 和 NO 浓度，而烹饪燃料类型的数据则来自问卷调查。出生结局数据来自参与者产后访视期间的自我报告问卷或如果无法当面访谈则通过电话获得。使用单变量和多变量模型，在最终研究人群（n=1616）中采用二元逻辑回归评估关联；后者调整了年龄、教育、产次和 HIV 状况。报告了比值比（OR）及其相应的 95%置信区间（CI）。在队列中，有 69 例胎儿死亡（n=16 例流产；n=53 例死产）和 16 例新生儿死亡。研究结果表明，怀孕期间环境 NO 和 NO 暴露与胎儿死亡风险增加之间存在关联趋势，特别是与整体死产和死产有关。然而，未观察到统计学意义。室内空气污染与新生儿死亡的结果尚无定论。由于撒哈拉以南非洲和埃塞俄比亚对环境空气污染对不良出生结局影响的证据有限，应开展更多具有更大研究人群的研究。
