Hebrew University-Hadassah School of Public Health, Hebrew University of Jerusalem, Israel.
Hebrew University of Jerusalem, Jerusalem, Israel.
Int J Hyg Environ Health. 2023 Sep;254:114269. doi: 10.1016/j.ijheh.2023.114269. Epub 2023 Oct 11.
A growing body of literature reports associations between exposure to particulate matter with aerodynamic diameters ≤2.5 μm (PM) and 2.5-10 μm (PM) during pregnancy and preterm birth (PTB). However, the role of ambient temperature in PM-PTB associations was rarely investigated. In Israel, we used Maccabi Healthcare Services data to establish a population-based cohort of 381,265 singleton births reaching 24-42 weeks' gestation and birth weight of 500-5000 g (2004-2015). Daily PM and ambient temperature predictions from a satellite-based spatiotemporal model, at a 1 × 1 km spatial resolution, were linked to the date of birth and maternal residence. Mixed effects Cox regression models, adjusted for covariates, with a random intercept at the mother level were used to assess associations between mean exposure during pregnancy and PTB. We found that exposure to PM was positively associated with PTB when the average exposure during pregnancy was either low (first quintile) or high (fifth quintile), compared to exposure in the 2nd-4th quintiles, with hazard ratios (HRs) 1.18 (95% confidence interval [CI], 1.13-1.24) and 1.07 (95% CI, 1.02-1.12), respectively. The results revealed effect modification of temperature. For mothers exposed to low (below median) average temperature during pregnancy, HRs of PTB were 0.93 (95% CI, 0.87-1.00) and 1.21 (95% CI, 1.14-1.29) for the first and fifth PM quintiles, respectively, when compared to the 2nd-4th quintiles. However, a reverse trend was indicated for high-temperature pregnancies, where the corresponding HRs were 1.48 (95% CI, 1.39-1.58) and 0.92, (95% CI, 0.96-0.98). In conclusion, consideration of climatic factors can provide new insights into the risk of PTB as a result of exposure to PM during pregnancy.
越来越多的文献报告表明，孕妇在怀孕期间接触空气动力学直径≤2.5μm（PM）和 2.5-10μm（PM）与早产（PTB）之间存在关联。然而，环境温度在 PM-PTB 关联中的作用很少被研究。在以色列，我们使用 Maccabi 医疗保健服务的数据，建立了一个基于人群的队列，其中包括 381265 名单胎妊娠达到 24-42 周妊娠和 500-5000g 出生体重的婴儿（2004-2015 年）。从基于卫星的时空模型中预测的每日 PM 和环境温度，空间分辨率为 1×1km，与出生日期和产妇居住地相关联。使用混合效应 Cox 回归模型，在母亲水平上进行随机截距调整，以评估怀孕期间平均暴露与 PTB 之间的关联。我们发现，与第 2-4 个五分位数相比，当怀孕期间的平均暴露处于低值（第 1 个五分位数）或高值（第 5 个五分位数）时，PM 暴露与 PTB 呈正相关，危险比（HRs）分别为 1.18（95%置信区间[CI]，1.13-1.24）和 1.07（95%CI，1.02-1.12）。结果显示温度存在效应修饰。对于怀孕期间暴露于低（低于中位数）平均温度的母亲，与第 2-4 个五分位数相比，第 1 和第 5 个 PM 五分位数的 PTB HRs 分别为 0.93（95%CI，0.87-1.00）和 1.21（95%CI，1.14-1.29）。然而，高温妊娠呈相反趋势，相应的 HRs 分别为 1.48（95%CI，1.39-1.58）和 0.92（95%CI，0.96-0.98）。总之，考虑气候因素可以为由于怀孕期间接触 PM 而导致的 PTB 风险提供新的见解。
