居住环境绿化、空气污染与不良出生结局的关联：ELEFANT项目（2011 - 2021年）中61,762对母婴的研究结果
Association of residential greenness, air pollution with adverse birth outcomes: Results from 61,762 mother‑neonatal pairs in project ELEFANT (2011-2021).
作者信息
Yu Yuanyuan, Lin Huishu, Liu Qisijing, Ma Yuxuan, Zhao Lei, Li Weixia, Zhou Yan, Byun Hyang-Min, Li Penghui, Li Chen, Sun Congcong, Chen Xuemei, Liu Ziquan, Dong Wenlong, Chen Liqun, Deng Furong, Wu Shaowei, Hou Shike, Guo Liqiong
机构信息
Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China; Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou 325000, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China.
Research Institute of Public Health, School of Medicine, Nankai University, Tianjin, China.
出版信息
Sci Total Environ. 2024 Feb 20;912:169549. doi: 10.1016/j.scitotenv.2023.169549. Epub 2023 Dec 23.
BACKGROUND
Emerging evidence has demonstrated the benefits of greenness exposure on human health, while conflicts remain unsolved in issue of adverse birth outcomes.
METHODS
Utilizing data from project ELEFANT spanning the years 2011 to 2021, we assessed residential greenness using the NDVI from MODIS data and residential PM exposure level from CHAP data. Our primary concerns were PTD, LBW, LGA, and SGA. Cox proportional hazard regression model was used to examine the association of residential greenness and air pollution exposure with risk of adverse birth outcomes. We performed mediation and modification effect analyses between greenness and air pollutant.
RESULTS
We identified 61,762 mother‑neonatal pairs in final analysis. For per 10 μg/m increase in PM concentration during entire pregnancy was associated with 19.8 % and 20.7 % increased risk of PTD and LGA. In contrast, we identified that an 0.1 unit increment in NDVI were associated with 24 %, 43 %, 26.5 %, and 39.5 % lower risk for PTD, LBW, LGA, and SGA, respectively. According to mediation analysis, NDVI mediated 7.70 % and 7.89 % of the associations between PM and PTD and LGA. Residential greenness could reduce the risk of PTD among mothers under 35 years old, living in rural areas, primigravidae and primiparity..
CONCLUSIONS
In summary, our results highlighted the potential of residential greenness to mitigate the risk of adverse birth outcomes, while also pointing to the adverse impact of PM on increased risk of multiple adverse birth outcomes (PTD and LGA). The significant mediation effect of NDVI emphasizes its potential as an important protective factor of PM exposure. Additionally, the identification of susceptible subgroups can inform targeted interventions to reduce adverse birth outcomes related to air pollution and lack of green spaces. Further research and understanding of these associations can contribute to better public health strategies aimed at promoting healthier pregnancies and birth outcomes.
背景
新出现的证据表明绿色环境暴露对人类健康有益，但不良出生结局问题上的矛盾仍未解决。
方法
利用2011年至2021年大象项目的数据，我们使用来自中分辨率成像光谱仪（MODIS）数据的归一化植被指数（NDVI）评估居住绿地情况，并使用来自社区空气污染物浓度（CHAP）数据的居住颗粒物暴露水平。我们主要关注的是早产（PTD）、低体重儿（LBW）、大于胎龄儿（LGA）和小于胎龄儿（SGA）。采用Cox比例风险回归模型来检验居住绿地情况和空气污染暴露与不良出生结局风险之间的关联。我们对绿地情况和空气污染物之间进行了中介效应和调节效应分析。
结果
最终分析中我们确定了61762对母婴。整个孕期颗粒物浓度每增加10μg/m³与早产和大于胎龄儿风险分别增加19.8%和20.7%相关。相比之下，我们发现归一化植被指数每增加0.1个单位，早产、低体重儿、大于胎龄儿和小于胎龄儿的风险分别降低24%、43%、26.5%和39.5%。根据中介效应分析，归一化植被指数介导了颗粒物与早产和大于胎龄儿之间关联的7.70%和7.89%。居住绿地情况可降低35岁以下、居住在农村地区、初产妇和首次生育母亲的早产风险。
结论
总之，我们的结果突出了居住绿地情况减轻不良出生结局风险的潜力，同时也指出了颗粒物对多种不良出生结局（早产和大于胎龄儿）风险增加的不利影响。归一化植被指数的显著中介效应强调了其作为颗粒物暴露重要保护因素的潜力。此外，确定易感亚组可为有针对性的干预措施提供依据，以减少与空气污染和缺乏绿地相关的不良出生结局。对这些关联进行进一步研究和了解有助于制定更好的公共卫生策略，以促进更健康的怀孕和出生结局。
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