暴露于多种空气污染物混合物与妊娠高血压疾病亚型：一项多中心研究。
Exposure to multiple air pollutant mixtures and the subtypes of hypertensive disorders in pregnancy: A multicenter study.
机构信息
Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China; School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China; Global Centre for Asian Women's Health, Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
出版信息
Int J Hyg Environ Health. 2023 Aug;253:114238. doi: 10.1016/j.ijheh.2023.114238. Epub 2023 Jul 31.
BACKGROUND
Hypertensive disorders in pregnancy (HDP) have heterogeneous etiologies. Previous studies have linked individual air pollutants to overall HDP with inconsistent results. Moreover, it has not been explored how exposure to a mixture of multiple air pollutants may affect the risks of the subtypes of the disorders.
OBJECTIVES
To investigate the associations of exposure to air pollutant mixture in the 1st and 2nd trimesters of pregnancy with the risks of HDP and its subtypes.
METHODS
Pregnancy data were obtained from the China Labor and Delivery Survey, a nationwide cross-sectional survey in 2015 and 2016. Levels of air pollutants [including fine particulate matter (PM), carbon monoxide (CO), nitrogen dioxide (NO), ozone (O), and sulfur dioxide (SO)] in the 1 and 2 trimesters were estimated based on the model developed by the Institution of Atmospheric Physics, Chinese Academy of Science. Generalized linear mixed models were built to assess the single-exposure effects of air pollutants in early gestation on HDP. The restricted cubic spline function was further applied to assess the potential non-linearity. The weighted quantile sum (WQS) regression was used to investigate the effects of co-exposure to multiple air pollutants.
RESULTS
A total of 67,512 pregnancies were included, and 2,834 were HDP cases. The single-effect analysis showed that CO, PM, and SO exposure in the 2 trimester was positively associated with the risks of gestational hypertension (GH), with adjusted odds ratios (aORs) and 95% confidence intervals (CI) of 1.16 (1.04, 1.28), 1.19 (1.04, 1.37), and 1.13 (1.04, 1.22), respectively. The first-trimester O exposure was also associated with an increased preeclampsia/eclampsia (PE) risk (aOR = 1.17; 95%CI: 1.02, 1.33). WQS regression confirmed positive associations of air pollutant mixture with HDP subtypes, with PM as the main contributing pollutant to GH, and CO and O as the main pollutants to PE.
CONCLUSIONS
Exposure to multiple air pollutant mixtures in early pregnancy was associated with increased risks of hypertensive disorders in pregnancy.
背景
妊娠高血压疾病（HDP）的病因具有异质性。先前的研究已经将个体空气污染物与整体 HDP 联系起来，但结果不一致。此外，尚未探讨暴露于多种空气污染物混合物会如何影响疾病亚型的风险。
目的
调查妊娠 1 期和 2 期暴露于空气污染物混合物与 HDP 及其亚型风险之间的关联。
方法
妊娠数据来自于 2015 年和 2016 年进行的全国性横断面中国劳动力与分娩调查。根据中国科学院大气物理研究所开发的模型，估算了妊娠 1 期和 2 期空气污染物（包括细颗粒物（PM）、一氧化碳（CO）、二氧化氮（NO）、臭氧（O）和二氧化硫（SO））的水平。采用广义线性混合模型评估早孕期空气污染物的单一暴露对 HDP 的影响。进一步应用限制立方样条函数来评估潜在的非线性。加权分位数总和（WQS）回归用于研究多种空气污染物的共同暴露的影响。
结果
共纳入 67512 例妊娠，其中 2834 例为 HDP 病例。单因素分析显示，妊娠 2 期 CO、PM 和 SO 的暴露与妊娠期高血压（GH）的风险呈正相关，调整后的比值比（aOR）和 95%置信区间（CI）分别为 1.16（1.04，1.28）、1.19（1.04，1.37）和 1.13（1.04，1.22）。妊娠 1 期 O 的暴露也与子痫前期/子痫（PE）风险增加相关（aOR=1.17；95%CI：1.02，1.33）。WQS 回归证实了空气污染物混合物与 HDP 亚型之间存在正相关，PM 是 GH 的主要贡献污染物，而 CO 和 O 是 PE 的主要污染物。
结论
妊娠早期暴露于多种空气污染物混合物与妊娠高血压疾病的风险增加有关。
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