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孕前队列中暴露关键窗口期的环境空气污染与自然流产

Ambient air pollution in critical windows of exposure and spontaneous miscarriage in a preconception cohort.

作者信息

Jukic Anne Marie Z, Konrad Kathryn S, Buller Ian D, Jahnke Johanna R, Rosen Vollmar Ana, McConnaughey D Robert, Keil Alexander P, Steiner Anne Z

机构信息

Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, 27709, USA.

DLH, LLC, Bethesda, MD, 20817, USA.

出版信息

Environ Res. 2025 Sep 15;281:121965. doi: 10.1016/j.envres.2025.121965. Epub 2025 May 28.

Abstract

Air pollution may increase spontaneous miscarriage risk, potentially through inflammation. Prior studies are heterogeneous, and none have used a mixtures approach. We used data from participants who conceived in a prospective time-to-pregnancy study (N = 446) in North Carolina to examine spontaneous miscarriage, defined as a positive home pregnancy test and a self-reported pregnancy loss before gestational week 20 (N = 101). We characterized average and peak exposure to PM, PM, CO, NO, NO, SO, and O through linked residential addresses with fusion and chemical transport models. We used single pollutant and exposure mixtures models (quantile-based g-computation) to estimate associations in six exposure windows including spermatogenesis, early follicle development, and the follicular and luteal phases of the conception cycle. Sensitivity analyses stratified by vitamin D level (an anti-inflammatory). Multivariable Cox proportional hazards models estimated adjusted hazard ratios (HR) and 95 % confidence intervals (CI) per interquartile range increase in pollutant concentration. In exposure mixtures models, while the confidence intervals were wide, the magnitude and direction of several estimates were consistent with increased spontaneous miscarriage risk with increasing air pollutant exposure: spermatogenesis (HR [CI]: 1.2 [0.80, 1.8]), early follicle development (1.2 [0.80, 1.8]), and luteal phase (1.2 [0.80, 1.9]). Associations were stronger among those with low vitamin D, for example, increasing ozone was associated with increased spontaneous miscarriage only among those with low vitamin D (follicular phase HR [CI]: 3.1 [1.3, 7.4] vs. 0.84 [0.46, 1.5] for high vitamin D, p = 0.002). Air pollutants may be associated with small increases in miscarriage risk, but larger mixtures studies are needed. Further study of low vitamin D and air pollution risk is important for understanding the public health implications of vitamin D supplementation.

摘要

空气污染可能会增加自然流产风险,这可能是通过炎症反应实现的。先前的研究存在异质性,且均未采用混合物方法。我们使用了北卡罗来纳州一项前瞻性受孕时间研究中受孕参与者的数据(N = 446)来研究自然流产情况,自然流产定义为家庭妊娠试验呈阳性且自我报告在妊娠第20周前发生妊娠丢失(N = 101)。我们通过融合和化学传输模型,利用关联的居住地址来表征对细颗粒物(PM)、可吸入颗粒物(PM)、一氧化碳(CO)、一氧化氮(NO)、二氧化氮(NO₂)、二氧化硫(SO₂)和臭氧(O₃)的平均暴露量和峰值暴露量。我们使用单一污染物模型和暴露混合物模型(基于分位数的g计算)来估计在六个暴露窗口中的关联,这些窗口包括精子发生期、卵泡早期发育以及受孕周期的卵泡期和黄体期。敏感性分析按维生素D水平(一种抗炎物质)进行分层。多变量Cox比例风险模型估计了污染物浓度每增加一个四分位数间距时的调整风险比(HR)和95%置信区间(CI)。在暴露混合物模型中,虽然置信区间较宽,但几个估计值的大小和方向与随着空气污染物暴露增加自然流产风险增加是一致的:精子发生期(HR [CI]:1.2 [0.80, 1.8])、卵泡早期发育(1.2 [0.80, 1.8])和黄体期(1.2 [0.80, 1.9])。在维生素D水平低的人群中关联更强,例如,仅在维生素D水平低的人群中,臭氧增加与自然流产增加相关(卵泡期HR [CI]:3.1 [1.3, 7.4] vs. 维生素D水平高的人群为0.84 [0.46, 1.5],p = 0.002)。空气污染物可能与流产风险的小幅增加有关,但需要更大规模的混合物研究。进一步研究低维生素D水平与空气污染风险对于理解补充维生素D的公共卫生意义很重要。

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