生命最初 1000 天接触环境空气污染物与儿童哮喘/喘息的相互关联：中国广州的前瞻性队列研究。

Mutual Associations of Exposure to Ambient Air Pollutants in the First 1000 Days of Life With Asthma/Wheezing in Children: Prospective Cohort Study in Guangzhou, China.

机构信息

Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.

China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China.

出版信息

JMIR Public Health Surveill. 2024 Apr 17;10:e52456. doi: 10.2196/52456.

DOI:10.2196/52456

PMID:38631029

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11063886/

Abstract

BACKGROUND

The first 1000 days of life, encompassing pregnancy and the first 2 years after birth, represent a critical period for human health development. Despite this significance, there has been limited research into the associations between mixed exposure to air pollutants during this period and the development of asthma/wheezing in children. Furthermore, the finer sensitivity window of exposure during this crucial developmental phase remains unclear.

OBJECTIVE

This study aims to assess the relationships between prenatal and postnatal exposures to various ambient air pollutants (particulate matter 2.5 [PM], carbon monoxide [CO], sulfur dioxide [SO], nitrogen dioxide [NO], and ozone [O]) and the incidence of childhood asthma/wheezing. In addition, we aimed to pinpoint the potential sensitivity window during which air pollution exerts its effects.

METHODS

We conducted a prospective birth cohort study wherein pregnant women were recruited during early pregnancy and followed up along with their children. Information regarding maternal and child characteristics was collected through questionnaires during each round of investigation. Diagnosis of asthma/wheezing was obtained from children's medical records. In addition, maternal and child exposures to air pollutants (PM CO, SO, NO, and O) were evaluated using a spatiotemporal land use regression model. To estimate the mutual associations of exposure to mixed air pollutants with the risk of asthma/wheezing in children, we used the quantile g-computation model.

RESULTS

In our study cohort of 3725 children, 392 (10.52%) were diagnosed with asthma/wheezing. After the follow-up period, the mean age of the children was 3.2 (SD 0.8) years, and a total of 14,982 person-years were successfully followed up for all study participants. We found that each quartile increase in exposure to mixed air pollutants (PM, CO, SO, NO, and O) during the second trimester of pregnancy was associated with an adjusted hazard ratio (HR) of 1.24 (95% CI 1.04-1.47). Notably, CO made the largest positive contribution (64.28%) to the mutual effect. After categorizing the exposure according to the embryonic respiratory development stages, we observed that each additional quartile of mixed exposure to air pollutants during the pseudoglandular and canalicular stages was associated with HRs of 1.24 (95% CI 1.03-1.51) and 1.23 (95% CI 1.01-1.51), respectively. Moreover, for the first year and first 2 years after birth, each quartile increment of exposure to mixed air pollutants was associated with HRs of 1.65 (95% CI 1.30-2.10) and 2.53 (95% CI 2.16-2.97), respectively. Notably, SO made the largest positive contribution in both phases, accounting for 50.30% and 74.70% of the association, respectively.

CONCLUSIONS

Exposure to elevated levels of mixed air pollutants during the first 1000 days of life appears to elevate the risk of childhood asthma/wheezing. Specifically, the second trimester, especially during the pseudoglandular and canalicular stages, and the initial 2 years after birth emerge as crucial susceptibility windows.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR-ROC-17013496; https://tinyurl.com/2ctufw8n.

摘要

背景

生命的头 1000 天，涵盖妊娠和出生后 2 年，是人类健康发展的关键时期。尽管这一点很重要，但对于这一期间混合暴露于空气污染物与儿童哮喘/喘息发展之间的关联，研究仍然有限。此外，在这一关键发育阶段，暴露的更精细敏感窗口尚不清楚。

目的

本研究旨在评估孕妇在妊娠早期和儿童期暴露于各种环境空气污染物（细颗粒物 2.5 [PM]、一氧化碳 [CO]、二氧化硫 [SO]、二氧化氮 [NO]和臭氧 [O]）与儿童哮喘/喘息发病之间的关系。此外，我们旨在确定空气污染物产生影响的潜在敏感窗口。

方法

我们进行了一项前瞻性出生队列研究，在妊娠早期招募孕妇，并对其及其子女进行随访。在每次调查中，通过问卷调查收集有关母婴特征的信息。通过儿童的医疗记录获得哮喘/喘息的诊断。此外，使用时空土地利用回归模型评估母婴暴露于空气污染物（PM、CO、SO、NO 和 O）的情况。为了估计混合空气污染物暴露与儿童哮喘/喘息风险的相互关联，我们使用了分位数 g 计算模型。

结果

在我们的 3725 名儿童研究队列中，有 392 名（10.52%）被诊断为哮喘/喘息。随访期结束后，儿童的平均年龄为 3.2（SD 0.8）岁，所有研究参与者共成功随访了 14982 人年。我们发现，妊娠中期混合空气污染物（PM、CO、SO、NO 和 O）每增加一个四分位，调整后的危险比（HR）为 1.24（95% CI 1.04-1.47）。值得注意的是，CO 对相互作用的正向贡献最大（64.28%）。根据胚胎呼吸发育阶段对暴露进行分类后，我们观察到在假腺和管腔阶段，每增加一个四分位混合暴露于空气污染物，HR 分别为 1.24（95% CI 1.03-1.51）和 1.23（95% CI 1.01-1.51）。此外，在出生后第一年和前两年，混合空气污染物暴露每增加一个四分位，HR 分别为 1.65（95% CI 1.30-2.10）和 2.53（95% CI 2.16-2.97）。值得注意的是，SO 在两个阶段均产生了最大的正向贡献，分别占关联的 50.30%和 74.70%。