北京市大气污染对不良妊娠结局影响的病例对照研究

Case-control study of ambient air pollution and adverse pregnancy outcomes of women in Beijing

目的定量分析和评价北京市大气污染对新生儿早产、低出生体重及出生缺陷等不良妊娠结局的影响。方法收集北京市海淀区妇幼保健院2007年7月—2009年7月分娩个案资料、同期北京市大气污染物二氧化硫(SO2)、二氧化氮(NO2)、可吸入颗粒物(PM10)及气象因素资料。采用多因素Logistic回归模型调整气象因素和妊娠期妇女个体信息的基础上,研究北京市大气污染物对不良妊娠结局的影响。结果控制气象因素、孕妇分娩次数、年龄、胎儿性别、不良接触史等因素后,妊娠后第1个月SO2浓度每升高100μg/m3,对低出生体重的影响的OR值为1.50(95%CI:1.09～2.05);妊娠后前3个月、分娩前第1个月SO2浓度每升高100μg/m3,对早产影响的OR值分别为1.50(95%CI:1.04～2.18)和1.79(95%CI:1.30～2.46);分娩前第2个月PM10浓度每升高100μg/m3,对早产的影响的OR值为1.45(95%CI:1.15～1.84);妊娠后3～8周内,NO2浓度每升高100μg/m3,对出生缺陷的影响的OR值为2.85(95%CI:1.08～7.50)。结论本次调查的北京市妊娠期妇女在妊娠后期的大气PM10暴露浓度、妊娠早期的大气SO2暴露浓度与早产的发生存在统计学关联;妊娠3～8周时NO2暴露浓度与出生缺陷的发生存在统计学关联。

Objective To quantitatively analyze and evaluate the health impacts of air pollution on the adverse pregnancy outcomes, such as preterm delivery, low birth weight, birth defects around Beijing. Methods The personal data of all delivery cases of Haidian Maternal and Child Health Hospital in July, 2007-July, 2009 were collected, the concentrations of the main three air pollutants： sulphur dioxide （SO2）, nitrogen dioxide （NO2） and particulate matter （PM10）, as well as the corresponding meteorological data. Logistic regression analysis was used to explore the health impacts of ambient air pollution on the adverse pregnancy outcomes of the exposed women. Results After adjustment for the influence of maternal parity, age, fetal gender, meteorological factors, with a 100 μg/m^3 increase in level of SO2 during the first month after pregnancy, the odd ratio of the occurrence of low birth weight was 1.50 （95%CI： 1.09-2.05）; With a 100μg/m^3 increase in level of SOs during the first trimester after pregnancy and the last month before delivery, the odd ratio of the occurrence of preterm delivery were 1.50（95%CI： 1.04- 2.18）, 1.79 （95%CI： 1.30-2.46） respectively; With a 100 μg/m^3 increase in level of PMIO during the second month before delivery, the odd ratio of the occurrence of preterm delivery was 1.45（95%CI： 1.15-1.84）; With a 100μg/m^3 increase in level of NO2 at the 3rd-8th week of pregnancy, the odd ratio of the occurrence of birth defect was 2.85（95%CI： 1.08-7.50）. Conclusion SO2 exposure during the early stage of pregnancy and PMIO exposure during the late stage of pregnancy are associated with preterm delivery, NO2 exposure during the 3rd-8th week of pregnancy are associated with birth defect statistically.