Su Yun-Fei, Li Cheng, Xu Jing-Jing, Zhou Fang-Yue, Li Tao, Liu Cong, Wu Yan-Ting, Huang He-Feng
The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China.
Chemosphere. 2023 Feb;313:137431. doi: 10.1016/j.chemosphere.2022.137431. Epub 2022 Nov 28.
Despite the longstanding evidence on the effect of air pollutants on preterm birth (PTB), few studies have focused on its subtypes, including spontaneous preterm birth (sPTB) and medically indicated preterm birth (miPTB). Most studies evaluated only the short-term or long-term effects of particulate matter (PM) on PTB. Thus, we designed this study, based on a cohort of 179,385 women, to evaluate both short- and long-term effects of PM with diameters ≤2.5 μm and ≤10 μm (PM and PM) on PTB, sPTB and miPTB in Shanghai. Generalized additive models (GAMs) were applied to evaluate short-term effects. Lagged effects were identified using different lag structures. Exposure-response correlation curves were plotted using GAMs after adjustment for confounders. ORs and 95% CIs were calculated using logistic regression to estimate the long-term effect after adjustment for confounders. There was 5.67%, 3.70% and 1.98% daily incidence of PTB, sPTB, and miPTB on average. Every 10 μg/m increase in PM and PM was positively associated with PTB and sPTB at lag 2 day. The exposure-response curves (lag 2 day) indicated a rapid increase in sPTB for PM and a linear increase for PM, in PTB for PM and PM at concentrations over 100 μg/m. Regarding long-term exposure, positive associations were found between 10 μg/m increases in PM and PM in 3rd trimester and greater odds of sPTB (aOR: 1.042, 95% CI: 1.018-1.065, and 1.018, 95% CI:1.002-1.034), and during the 3 months before conception and miPTB (aOR: 1.023, 95% CI: 1.003-1.042, and 1.017, 95% CI: 1.000-1.036). Acute exposure to PM and PM at lag 2 day and chronic exposure in 3rd trimester was significantly associated with sPTB, while miPTB was related to chronic exposure during the 3 months before pregnancy. These findings indicate that susceptibility windows of PM exposure can be influenced by different underlying etiologies of PTB.
尽管长期以来有证据表明空气污染物对早产有影响，但很少有研究关注其亚型，包括自发性早产（sPTB）和医学指征性早产（miPTB）。大多数研究仅评估了颗粒物（PM）对早产的短期或长期影响。因此，我们基于179,385名女性的队列设计了本研究，以评估直径≤2.5μm和≤10μm的PM（PM₂.₅和PM₁₀）对上海早产、sPTB和miPTB的短期和长期影响。应用广义相加模型（GAMs）评估短期影响。使用不同的滞后结构识别滞后效应。在调整混杂因素后，使用GAMs绘制暴露-反应相关曲线。使用逻辑回归计算比值比（OR）和95%置信区间（CI），以估计调整混杂因素后的长期影响。早产、sPTB和miPTB的平均每日发病率分别为5.67%、3.70%和1.98%。PM₂.₅和PM₁₀每增加10μg/m³，在滞后2天时与早产和sPTB呈正相关。暴露-反应曲线（滞后2天）表明，对于PM₂.₅，sPTB迅速增加；对于PM₁₀，在浓度超过100μg/m³时，早产呈线性增加。关于长期暴露，在孕晚期PM₂.₅和PM₁₀每增加10μg/m³与sPTB的更高几率相关（调整后比值比：1.042，95%CI：1.018 - 1.065，以及1.018，95%CI：1.002 - 1.034），在受孕前3个月与miPTB相关（调整后比值比：1.023，95%CI：1.003 - 1.042，以及1.017，95%CI：1.000 - 1.036）。在滞后2天急性暴露于PM₂.₅和PM₁₀以及在孕晚期慢性暴露与sPTB显著相关，而miPTB与妊娠前3个月的慢性暴露有关。这些发现表明，PM暴露的易感窗口可能受早产不同潜在病因的影响。
