Pepper Maxine, Rebouças Poliana, Falcão Ila R, Sanchez Clemente Nuria, Lowe Rachel, Schneider Rochelle, Pescarini Julia M, Santos Gervásio F Dos, Andrade Roberto Fs, Cortes Taísa R, Ranzani Otavio T, Brickley Elizabeth B, Barreto Mauricio L, Paixao Enny S
Department of Infectious Disease Epidemiology & International Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Centro de Integração de Dados e Conhecimentos para Saúde (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil.
Int J Hyg Environ Health. 2025 Jan;263:114473. doi: 10.1016/j.ijheh.2024.114473. Epub 2024 Oct 5.
Pregnancy represents a critical window of vulnerability to the harmful effects of air pollution on health. However, long-term consequences such as risk of having lower respiratory tract infections (LRTIs) are less explored. This systematic review aims to synthesize previous research on prenatal exposure to ambient (outdoor) air pollution and LRTIs in childhood and adolescence.
We systematically searched Embase, MEDLINE, Web of Science Core Collection, CINAHL, and Global Health up to May 17, 2024. We included peer-reviewed publications of studies which investigated the association between prenatal exposure to ambient air pollution and LRTIs up to the age of 19. We excluded conference abstracts, study protocols, review articles, and grey literature. Screening and data extraction was conducted by two reviewers independently. We used the Office of Health Assessment and Translation tool to assess risk of bias and conducted a narrative synthesis.
The search yielded 6056 records, of which 16 publications describing 12 research studies were eligible for the synthesis. All studies were conducted in high- or upper-middle-income countries in Europe or Asia. Half (6) of the studies focused on LRTIs occurring within the first three years of life, and the others also included LRTIs in older children (up to age 14). Air pollutants investigated included nitrogen dioxide, sulphur dioxide, particulate matter (PM: diameter ≤2.5 μm and PM: diameter ≤10 μm), carbon monoxide, ozone, and benzene. Findings on a potential association between prenatal ambient air pollution exposure and LRTIs were inconclusive, without a clear and consistent direction. There was some suggestion of a positive association with prenatal PM exposure. The small number of studies identified, their poor geographical representation, and their methodological limitations including concerns for risk of bias preclude more definitive conclusions.
The available published evidence is insufficient to establish whether prenatal exposure to ambient air pollution increases risk of LRTIs in children and adolescents. With many populations exposed to high levels of air pollution, there is an urgent need for research in more diverse settings, more transparent reporting of methods, and exploring how, when, and for whom prenatal exposure to ambient air pollution leads to the greatest health risks.
CRD42023407689.
孕期是空气污染对健康产生有害影响的关键脆弱期。然而，诸如患下呼吸道感染（LRTIs）风险等长期后果的研究较少。本系统评价旨在综合以往关于产前暴露于环境（室外）空气污染与儿童及青少年期下呼吸道感染的研究。
我们系统检索了截至2024年5月17日的Embase、MEDLINE、Web of Science核心合集、CINAHL和Global Health。我们纳入了经同行评审的研究出版物，这些研究调查了产前暴露于环境空气污染与19岁之前下呼吸道感染之间的关联。我们排除了会议摘要、研究方案、综述文章和灰色文献。由两名评审员独立进行筛选和数据提取。我们使用健康评估与翻译办公室工具评估偏倚风险并进行叙述性综合分析。
检索得到6056条记录，其中16篇描述12项研究的出版物符合综合分析的条件。所有研究均在欧洲或亚洲的高收入或中高收入国家进行。一半（6项）研究关注生命最初三年发生的下呼吸道感染，其他研究还包括大龄儿童（至14岁）的下呼吸道感染。所调查的空气污染物包括二氧化氮、二氧化硫、颗粒物（PM：直径≤2.5μm和PM：直径≤10μm）、一氧化碳、臭氧和苯。关于产前环境空气污染暴露与下呼吸道感染之间潜在关联的研究结果尚无定论，没有明确一致的方向。有一些迹象表明与产前PM暴露呈正相关。已确定的研究数量较少，地理代表性差，且存在包括偏倚风险担忧在内的方法学局限性，因此无法得出更明确的结论。
现有已发表的证据不足以确定产前暴露于环境空气污染是否会增加儿童和青少年患下呼吸道感染的风险。鉴于许多人群暴露于高水平空气污染中，迫切需要在更多样化的环境中开展研究，更透明地报告方法，并探索产前暴露于环境空气污染如何、何时以及对谁会导致最大的健康风险。
PROSPERO注册号：CRD42023407689。
