Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine.
JAMA Netw Open. 2023 Oct 2;6(10):e2338315. doi: 10.1001/jamanetworkopen.2023.38315.
Women are especially vulnerable to mental health matters post partum because of biological, emotional, and social changes during this period. However, epidemiologic evidence of an association between air pollution exposure and postpartum depression (PPD) is limited.
To examine the associations between antepartum and postpartum maternal air pollution exposure and PPD.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from Kaiser Permanente Southern California (KPSC) electronic health records and included women who had singleton live births at KPSC facilities between January 1, 2008, and December 31, 2016. Data were analyzed between January 1 and May 10, 2023.
Ambient air pollution exposures were assessed based on maternal residential addresses using monthly averages of particulate matter less than or equal to 2.5 μm (PM2.5), particulate matter less than or equal to 10 μm (PM10), nitrogen dioxide (NO2), and ozone (O3) from spatial interpolation of monitoring station measurements. Constituents of PM2.5 (sulfate, nitrate, ammonium, organic matter, and black carbon) were obtained from fine-resolution geoscience-derived models based on satellite, ground-based monitor, and chemical transport modeling data.
Participants with an Edinburgh Postnatal Depression Scale score of 10 or higher during the 6 months after giving birth were referred to a clinical interview for further assessment and diagnosis. Ascertainment of PPD was defined using a combination of diagnostic codes and prescription medications.
The study included 340 679 participants (mean [SD] age, 30.05 [5.81] years), with 25 674 having PPD (7.54%). Increased risks for PPD were observed to be associated with per-IQR increases in antepartum and postpartum exposures to O3 (adjusted odds ratio [AOR], 1.09; 95% CI, 1.06-1.12), PM10 (AOR, 1.02; 95% CI, 1.00-1.04), and PM2.5 (AOR, 1.02; 95% CI, 1. 00-1.03) but not with NO2; PPD risks were mainly associated with PM2.5 organic matter and black carbon. Overall, a higher risk of PPD was associated with O3 during the entire pregnancy and postpartum periods and with PM exposure during the late pregnancy and postpartum periods.
The study findings suggest that long-term exposure to antepartum and postpartum air pollution was associated with higher PPD risks. Identifying the modifiable environmental risk factors and developing interventions are important public health issues to improve maternal mental health and alleviate the disease burden of PPD.
由于女性在这一时期经历着生理、情感和社会变化，因此特别容易受到产后心理健康问题的影响。然而，有关空气污染暴露与产后抑郁症（PPD）之间关联的流行病学证据有限。
研究产前和产后母亲的空气污染暴露与 PPD 之间的关联。
设计、地点和参与者：这是一项回顾性队列研究，使用了 Kaiser Permanente Southern California（KPSC）电子健康记录中的数据，纳入了 2008 年 1 月 1 日至 2016 年 12 月 31 日期间在 KPSC 设施中单胎活产的女性。数据分析于 2023 年 1 月 1 日至 5 月 10 日进行。
根据母亲的居住地址，使用基于监测站测量的每月 PM2.5（细颗粒物，小于或等于 2.5μm）、PM10（细颗粒物，小于或等于 10μm）、二氧化氮（NO2）和臭氧（O3）的空间插值来评估大气污染暴露情况。PM2.5 的成分（硫酸盐、硝酸盐、铵盐、有机物和黑碳）是根据卫星、地面监测和化学输送模型数据的精细分辨率地球科学衍生模型获得的。
产后 6 个月内 Edinburgh Postnatal Depression Scale 评分达到 10 或更高的参与者被转介到临床访谈进行进一步评估和诊断。PPD 的确定是通过诊断代码和处方药物的组合来定义的。
该研究纳入了 340679 名参与者（平均[SD]年龄 30.05[5.81]岁），其中 25674 名患有 PPD（7.54%）。研究发现，产前和产后接触臭氧（调整后的优势比[OR]，1.09；95%置信区间[CI]，1.06-1.12）、PM10（OR，1.02；95%CI，1.00-1.04）和 PM2.5（OR，1.02；95%CI，1.00-1.03）与 PPD 风险增加有关，但与 NO2 无关；PPD 风险主要与 PM2.5 有机物和黑碳有关。总的来说，整个孕期和产后期间的 O3 暴露以及晚孕期和产后期间的 PM 暴露与 PPD 风险增加有关。
研究结果表明，产前和产后的长期空气污染暴露与更高的 PPD 风险有关。确定可改变的环境风险因素并制定干预措施是改善产妇心理健康和减轻 PPD 疾病负担的重要公共卫生问题。
