Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No. 100 Hongkong Road, Jiangan District, Wuhan, 430016, Hubei, China.
School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Qiaokou District, Wuhan, 430030, Hubei, China.
Environ Res. 2023 Jul 1;228:115841. doi: 10.1016/j.envres.2023.115841. Epub 2023 Apr 5.
The existing studies on the relationships of prenatal ambient air pollutants exposure with stillbirth in the Chinese population are very limited and the results are inconsistent, and the susceptible windows and potential modifiers for air pollutants exposure on stillbirth remain unanswered.
We aimed to determine the relationships between exposure to ambient air pollutants and stillbirth, and explored the susceptible windows and potential modifiers for air pollutants exposure on stillbirth.
A population-based cohort was established through the Wuhan Maternal and Child Health Management Information System involving 509,057 mother-infant pairs in Wuhan from January 1, 2011 through September 30, 2017. Personal exposure concentrations of fine particles (PM), inhalable particles (PM), sulfur dioxide (SO), nitrogen dioxide (NO), carbon monoxide (CO), and ozone (O) for mothers were estimated based on their residential address during pregnancy using the inverse distance weighted (IDW) method. We used the logistic regression models to determine the associations at different stages of pregnancy with adjustment for confounding factors.
There were 3218 stillbirths and 505,839 live births among the participants. For each 100 μg/m of CO and 10 μg/m of O increase in the first trimester (conception to 13 weeks), the risk of stillbirth increased by 1.0% (OR = 1.01, 95%CI: 1.00-1.03) and 7.0% (OR = 1.07, 95%CI: 1.05-1.09). In the second trimester (14 weeks-27 weeks), PM, PM, CO, and O exposure were closely related to the risk of stillbirth (P＜0.05). In the third trimester (28 weeks to delivery), for each 10 μg/m increase in exposure concentrations of PM, SO, and O, the risk of stillbirth increased by 3.4%, 5.9%, and 4.0%, respectively. O exposure was positively relevant to the risk of stillbirth (OR = 1.11, 95%CI: 1.08-1.14) in the whole pregnancy. Exposure to NO was not significantly associated with the risk of stillbirth. Stratified analyses also presented a stronger association among mothers with boy infant, living in rural areas, delivering between 2011 and 2013, and those without gestational hypertension and history of stillbirth.
This study provides evidence that maternal exposure to PM, PM, SO, CO, and O were related to the increased risk of stillbirth. Both the second and third trimesters might be vital susceptible windows for stillbirth. Our findings expand the evidence base for the important impacts of air pollution on fetal growth.
现有研究表明，在中国人群中，产前环境空气污染物暴露与死胎之间的关系非常有限，结果也不一致，而空气污染物暴露对死胎的易感窗口和潜在修饰因子仍未得到解答。
本研究旨在确定环境空气污染物暴露与死胎之间的关系，并探讨空气污染物暴露对死胎的易感窗口和潜在修饰因子。
本研究通过武汉市妇幼保健管理信息系统建立了一个基于人群的队列，该队列纳入了 2011 年 1 月 1 日至 2017 年 9 月 30 日期间武汉市的 509057 对母婴。采用逆距离加权（IDW）法，根据母亲孕期的居住地址，估算母亲个体的细颗粒物（PM）、可吸入颗粒物（PM）、二氧化硫（SO）、二氧化氮（NO）、一氧化碳（CO）和臭氧（O）的浓度。我们使用逻辑回归模型，在调整混杂因素后，确定不同孕期阶段的关联。
在研究对象中，有 3218 例死胎和 505839 例活产。与第一孕期（受孕至 13 周）相比，CO 每增加 100μg/m 和 O 每增加 10μg/m，死胎风险分别增加 1.0%（OR=1.01，95%CI：1.00-1.03）和 7.0%（OR=1.07，95%CI：1.05-1.09）。在第二孕期（14 周至 27 周），PM、PM、CO 和 O 暴露与死胎风险密切相关（P＜0.05）。在第三孕期（28 周至分娩），暴露于 PM、SO 和 O 的浓度每增加 10μg/m，死胎风险分别增加 3.4%、5.9%和 4.0%。O 暴露与整个孕期的死胎风险呈正相关（OR=1.11，95%CI：1.08-1.14）。NO 暴露与死胎风险无显著相关性。分层分析还表明，男孩、农村居住、2011 年至 2013 年分娩以及无妊娠期高血压和死胎史的母亲，两者之间的相关性更强。
本研究提供了证据表明，母亲暴露于 PM、PM、SO、CO 和 O 与死胎风险增加有关。第二和第三孕期可能是死胎的重要易感窗口。我们的研究结果为空气污染对胎儿生长的重要影响提供了更多的证据。
