Zhao Yuanfang, Qu Yanhong, Huang Xin, Wu Fan, Sun Siyuan, Qin Rongrong, Yu Zengli, Zhang Huanhuan, Wang Qiong, Huang Cunrui
School of Public Health, Zhengzhou University, Zhengzhou, China.
The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Environ Res. 2025 Apr 1;270:120996. doi: 10.1016/j.envres.2025.120996. Epub 2025 Jan 28.
Ambient ozone pollution is becoming a global health threat under global warming. Evidence on the association between ambient ozone and pregnancy complications and adverse birth outcomes has grown enormously. To provide a comprehensive assessment of the evidence, we performed a systematic review and meta-analysis to outline current epidemiological evidence.
A systematic literature search up to January 2024 was conducted in PubMed, Web of Science, Cochrane Library and Embase. We included studies that examined the association of ambient ozone exposure with pregnancy complications and birth outcomes. Data extraction was performed independently. All eligible studies were synthesized qualitatively. A random-effects meta-analysis was used to summarize the available effect estimates that calculated with a 10 μg/m exposure. We further evaluated whether geographic location, study design, study quality, and exposure assessments explain the heterogeneity. This study protocol was registered with PROSPERO (CRD42024499445).
A total of 10,940 records were originally searched, 65 articles were finally included. Our results showed that first trimester ozone exposure significantly increased the risk of preeclampsia (pooled odds ratio (OR) = 1.018, 95%CI: 1.006-1.030). For birth outcomes, short-term ozone exposure was associated with the risk of preterm birth, with the pooled OR of 1.005 (95%CI: 1.002-1.008) and 1.003(95%CI:1.000-1.005). First trimester and whole pregnancy ozone exposure were associated with the risk of small for gestational age, with the pooled OR of 1.007 (95%CI: 1.002-1.012) and 1.030 (95%CI: 1.010-1.050), respectively.
First trimester ozone exposure was associated with adverse pregnancy complications and adverse birth outcomes. Future investigations that considering local climates and population characteristics are warranted to explore the vulnerability at local and regional levels for tailored preventions.
在全球变暖的背景下，环境臭氧污染正成为全球健康威胁。关于环境臭氧与妊娠并发症及不良出生结局之间关联的证据已大量增加。为全面评估这些证据，我们进行了一项系统综述和荟萃分析，以梳理当前的流行病学证据。
截至2024年1月，在PubMed、科学网、考克兰图书馆和Embase进行了系统的文献检索。我们纳入了研究环境臭氧暴露与妊娠并发症及出生结局之间关联的研究。数据提取由独立人员进行。所有符合条件的研究进行了定性综合。采用随机效应荟萃分析来汇总以10μg/m³暴露计算的可用效应估计值。我们进一步评估地理位置、研究设计、研究质量和暴露评估是否能解释异质性。本研究方案已在国际前瞻性系统评价注册库（PROSPERO）注册（注册号：CRD42024499445）。
最初共检索到10940条记录，最终纳入65篇文章。我们的结果显示，孕早期臭氧暴露显著增加了先兆子痫的风险（合并比值比（OR）=1.018，95%置信区间：1.006 - 1.030）。对于出生结局，短期臭氧暴露与早产风险相关，合并OR分别为1.005（95%置信区间：1.002 - 1.008）和1.003（95%置信区间：1.000 - 1.005）。孕早期和整个孕期的臭氧暴露与小于胎龄儿风险相关，合并OR分别为1.007（95%置信区间：1.002 - 1.012）和1.030（95%置信区间：1.010 - 1.050）。
孕早期臭氧暴露与不良妊娠并发症和不良出生结局相关。未来有必要开展考虑当地气候和人群特征的调查，以探索地方和区域层面的脆弱性，从而制定针对性的预防措施。
