Chen Xin, Chen Sidi, Zhu Zhenghong, Luo Jiajun, Wang Huailin, Wulayin Maimaitiminjiang, Huang Cunrui, Zhao Wei, Wang Qiong
School of Public Health, Sun Yat-sen University, Guangzhou, China.
National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.
Environ Int. 2023 Mar;173:107832. doi: 10.1016/j.envint.2023.107832. Epub 2023 Feb 18.
The potential critical windows for extreme ambient temperature, air pollution exposure and small for gestational age (SGA) are still unclear, and no study has explored their joint effects on SGA. In a national multi-center prospective cohort, we included 179,761 pairs of mother-infant from 16 counties of 8 provinces in China during 2014-2018. Daily averaged temperature and PM concentration were matched to the maternal residential address to estimate personal exposure. Extreme temperature exposures were categorized by a series of percentile in each meteorological and geographic division for the entire pregnancy, each trimester and gestational week (GA-week). Generalized linear mixed models (GLMMs) and distributed lag nonlinear models (DLNMs) were used to estimate the whole pregnancy-, trimester-specific, and weekly-specific associations of extreme temperature and PM exposures with SGA. Combined effects were evaluated with the relative excess risk due to interaction (RERI) and proportion attributable to interaction (AP). We observed that by referring to temperature at the 41st - 50th percentile, heat (>90th percentile) exposure during 13th - 29th GA-weeks was associated with SGA; odds ratio (OR) and 95 % confidence intervals (CI) was 1.16 (1.06, 1.28). For cold (<=10th percentile), inverse associations were observed during the 1st - 8th GA-weeks. PM exposure during the 2nd - 5th and 19th - 27th GA-weeks was associated with SGA, with the strongest association in the 2nd GA-week (OR = 1.0017, 95 %CI: 1.0001, 1.0034, for a 10 μg/m increase). No interactive effects between ambient temperature and PM on SGA were observed. Our findings suggest the weekly susceptibility windows for heat and PM exposure were primarily the gestational weeks within the 2nd trimester, therefore, corresponding protective measures should be conveyed to pregnant women during routine prenatal visits to reduce exposures.
极端环境温度、空气污染暴露与小于胎龄儿（SGA）之间潜在的关键窗口期仍不明确，且尚无研究探讨它们对SGA的联合影响。在一项全国多中心前瞻性队列研究中，我们纳入了2014年至2018年期间来自中国8个省份16个县的179,761对母婴。将每日平均温度和PM浓度与母亲的居住地址进行匹配，以估算个人暴露情况。在每个气象和地理区域，根据整个孕期、各孕期和孕周（GA周）的一系列百分位数对极端温度暴露进行分类。采用广义线性混合模型（GLMMs）和分布滞后非线性模型（DLNMs）来估计极端温度和PM暴露与SGA在整个孕期、特定孕期和每周的关联。通过交互作用引起的相对超额风险（RERI）和交互作用归因比例（AP）来评估联合效应。我们观察到，以第41至50百分位数的温度为参照，孕13至29周期间的高温（>第90百分位数）暴露与SGA相关；优势比（OR）及95%置信区间（CI）为1.16（1.06，1.28）。对于低温（<=第10百分位数），在孕1至8周期间观察到负相关。孕2至5周和19至27周期间的PM暴露与SGA相关，在孕2周时关联最强（每增加10μg/m，OR = 1.0017，95%CI：1.0001，1.0034）。未观察到环境温度和PM对SGA的交互作用。我们的研究结果表明，高温和PM暴露的每周易感性窗口期主要在孕中期的孕周内，因此，应在常规产前检查期间向孕妇传达相应的保护措施，以减少暴露。
