He Wen, Feng Baihe, He Qinglin, Chen Renjie, Wang Qing, Wang Libo, Cao Yun, Zhang Lan, Zhou Jianguo, Qi Yuanyuan, Wang Jiayu, Wang Yingwen, Guo Jiayu, Yuan Lin, Zhang Xiaobo
Department of Respiratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
School of Information Engineering, Shanghai Maritime University, Shanghai, China.
BMJ Open. 2025 Aug 13;15(8):e100549. doi: 10.1136/bmjopen-2025-100549.
To investigate the associations between maternal fine particulate matter (PM) and PM<10 µm in aerodynamic diameter (PM) exposure during pregnancy and bronchopulmonary dysplasia (BPD) incidence in very preterm infants (VPIs, gestational age (GA)<32 weeks), with emphasis on trimester-specific susceptibility and effect modification by clinical and environmental factors.
Retrospective observational cohort study.
A tertiary neonatal intensive care unit in China, 2016-2022.
2223 VPIs hospitalised during the study were enrolled after excluding infants with severe congenital malformations, those who abandoned treatment and those who died before discharge. Of these, 59.8% were male.
We evaluated the effect of maternal PM and PM exposure on BPD, adjusted for additional ambient air pollutants (ozone and nitrogen dioxide) as well as demographic and clinical characteristics. We also calculated trimester-specific PM exposure effects and conducted stratified analyses by sex, GA, birth weight (BW) and conception season, with formal interaction testing.
Among 2223 VPIs included in this study, 684 (30.8%) were diagnosed with BPD. Strong correlations were observed between PM exposure and BPD, with each IQR increase during the entire gestational period associated with ORs of 1.254 (95% CI 1.062 to 1.484) for PM and 1.350 (95% CI 1.142 to 1.596) for PM in the single-pollutant model. The strongest associations were observed during the second trimester, and the same association was also identified in the two-pollutant model. Stratified analysis revealed a larger OR estimate in subgroups with lower BW (<1500 g) and smaller GA (<28 weeks).
Maternal PM exposure, particularly during the second trimester, is significantly associated with BPD in VPIs, with heightened vulnerability in males and infants with lower GA and BW. These findings underscore the need for prenatal air quality interventions and targeted monitoring of high-risk subgroups. Future research should explore PM-induced mechanisms of fetal lung injury and validate these associations in multicentre cohorts.
探讨孕期母亲暴露于细颗粒物（PM）和空气动力学直径小于10微米的颗粒物（PM₁₀）与极早产儿（VPI，胎龄（GA）<32周）支气管肺发育不良（BPD）发病率之间的关联，重点关注孕期各阶段的易感性以及临床和环境因素的效应修正。
回顾性观察队列研究。
中国一家三级新生儿重症监护病房，2016 - 2022年。
研究期间住院的2223例VPI在排除患有严重先天性畸形、放弃治疗及出院前死亡的婴儿后纳入。其中，59.8%为男性。
我们评估了母亲PM和PM₁₀暴露对BPD的影响，并对其他环境空气污染物（臭氧和二氧化氮）以及人口统计学和临床特征进行了调整。我们还计算了孕期各阶段的PM暴露效应，并按性别、GA、出生体重（BW）和受孕季节进行分层分析，并进行了正式的交互作用检验。
本研究纳入的2223例VPI中，684例（30.8%）被诊断为BPD。观察到PM暴露与BPD之间存在强相关性，在单污染物模型中，整个孕期每增加一个四分位数间距，PM的比值比（OR）为1.254（95%置信区间1.062至1.484），PM₁₀的OR为1.350（95%置信区间1.142至1.596）。在孕中期观察到最强的关联，在双污染物模型中也发现了相同的关联。分层分析显示，在BW较低（<1500克）和GA较小（<28周）的亚组中OR估计值更大。
母亲PM暴露，尤其是在孕中期，与VPI的BPD显著相关，男性以及GA和BW较低的婴儿易感性更高。这些发现强调了产前空气质量干预和对高危亚组进行针对性监测的必要性。未来的研究应探索PM诱导胎儿肺损伤的机制，并在多中心队列中验证这些关联。
