Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
Am J Obstet Gynecol. 2023 Oct;229(4):455.e1-455.e7. doi: 10.1016/j.ajog.2023.07.040. Epub 2023 Jul 27.
Although there is growing awareness of the relationship between air pollution and preterm birth, limited data exist regarding the relationship with spontaneous preterm birth and severe neonatal outcomes.
This study aimed to examine the association between traffic-associated air pollution exposure in pregnancy and adverse perinatal outcomes including extremes of preterm birth, neonatal intensive care unit admissions, low birthweight, neonatal respiratory diagnosis, neonatal respiratory support, and neonatal sepsis evaluation.
This was a retrospective cohort study of singleton pregnancies of patients residing in a metropolitan area in the southern United States. Using monitors strategically located across the region, average nitrogen dioxide concentrations were obtained from the Environmental Protection Agency Air Quality System database. For patients living within 10 miles of a monitoring station, average exposure to nitrogen dioxide was estimated for individual patients' pregnancy by trimester. Logistic regression models were used to assess the effect of pollutant exposure on gestational age at birth, indicated vs spontaneous delivery, and neonatal outcomes while adjusting for maternal age, self-reported race, parity, season of conception, diabetes mellitus, body mass index, registered Health Equity Index, and nitrogen dioxide monitor region. Adjusted odds ratios and 95% confidence intervals were calculated for an interquartile increase in average nitrogen dioxide exposure.
Between January 1, 2013 and December 31, 2021, 93,164 patients delivered a singleton infant. Of these, 62,189 had measured nitrogen dioxide exposure during the pregnancy from a nearby monitoring station. Higher average nitrogen dioxide exposure throughout pregnancy was significantly associated with preterm birth (adjusted odds ratio, 1.94; 95% confidence interval, 1.77-2.12) and an increase in neonatal intensive care unit admissions, low birthweight infants, neonatal respiratory diagnosis, neonatal respiratory support, and neonatal sepsis evaluation. This relationship persisted for nulliparous patients and spontaneous preterm birth, and had a greater association with earlier preterm birth.
In a metropolitan area, increased exposure to the air pollutant nitrogen dioxide in pregnancy was associated with spontaneous preterm birth and had a greater association with extremely preterm birth. A greater association with neonatal intensive care unit admissions, low-birthweight infants, neonatal respiratory diagnosis, neonatal respiratory support, and neonatal sepsis evaluation was found even in term infants.
尽管人们越来越意识到空气污染与早产之间的关系，但关于空气污染与自发性早产和严重新生儿结局之间关系的数据有限。
本研究旨在探讨妊娠期间与交通相关的空气污染暴露与不良围产期结局之间的关联，包括早产极值、新生儿重症监护病房入院、低出生体重、新生儿呼吸诊断、新生儿呼吸支持和新生儿败血症评估。
这是一项在美国南部大都市地区的单胎妊娠患者的回顾性队列研究。利用分布在整个区域的监测器，从环境保护署空气质量系统数据库中获得平均二氧化氮浓度。对于居住在监测站 10 英里范围内的患者，通过个体患者妊娠的每个三个月估计二氧化氮的平均暴露量。使用逻辑回归模型评估污染物暴露对出生时胎龄、指示性分娩与自发性分娩以及新生儿结局的影响，同时调整母亲年龄、自我报告种族、产次、受孕季节、糖尿病、体重指数、注册健康公平指数和二氧化氮监测区域。计算平均二氧化氮暴露量每增加一个四分位距的调整比值比和 95%置信区间。
2013 年 1 月 1 日至 2021 年 12 月 31 日，93164 名患者分娩了单胎婴儿。其中，62189 名患者在妊娠期间从附近的监测站测量到了二氧化氮暴露。整个妊娠期间平均二氧化氮暴露量较高与早产（调整比值比，1.94；95%置信区间，1.77-2.12）和新生儿重症监护病房入院、低出生体重儿、新生儿呼吸诊断、新生儿呼吸支持和新生儿败血症评估增加显著相关。这种关系在初产妇和自发性早产中仍然存在，且与极早产的相关性更强。
在大都市地区，妊娠期间暴露于空气污染物二氧化氮与自发性早产有关，与极早产的相关性更强。即使在足月婴儿中，也发现与新生儿重症监护病房入院、低出生体重儿、新生儿呼吸诊断、新生儿呼吸支持和新生儿败血症评估的关联更大。
