妊娠期重金属暴露水平对母儿的影响及相关因素分析

The impact of heavy metal exposure on mother-infant health during pregnancy and its related factors

目的 研究孕妇和脐血中血汞、砷的暴露水平及其对妊娠结局、妊娠并发症的影响,分析脐血中血汞、砷暴露水平的影响因素,用以指导孕产妇优生优育.方法 选取本院分娩的400例病例,采用微波消解和质谱分析方法测定孕妇和脐血中血砷含量,利用原子吸收法测定血汞含量.对孕妇居住环境、生活方式、膳食等情况等进行问卷调查,分析产妇血及胎儿脐血汞、砷暴露水平与妊娠结局的影响.结果 新生儿脐血汞、砷水平[（4.42±1.11）μg/L,（3.75±4.28）μg/L]与其母血汞、砷水平[（2.47±1.09）μg/L,（3.61±2.92）μg/L]呈正相关（r=0.88,0.91,P＜0.05）.血汞、砷升高组的妊娠不良结局发生率（36.78%,31.11%）和妊娠并发症发生率（36.77%,28.90%）分别高于血汞、砷正常组（11.50%,12.90%,14.68%,15.13%,χ2=7.07、9.94,P＜0.01）.多元线性回归结果显示食海鱼为汞暴露的危险因素（χ2=8.28,P＜0.01）,孕期摄入水果和开窗通风换气为预防汞暴露的保护性因素（χ2=9.02、6.05,P＜0.05）;使用化妆品和食用罐装食品为砷暴露的危险因素（χ2=7.35、10.38,P＜0.05）,孕妇高文化程度为预防砷暴露的保护性因素（χ2=8.87,P＜0.05）.结论 新生儿脐血汞、砷水平与母亲血汞、砷水平及环境因素、孕期保健等因素有关.加强健康教育和孕妇孕期保健是预防新生儿汞、砷中毒的有效途径.

Objective To measure the blood levels of mercury and arsenic of mother and umbilical cord, and analyze the relationship between these levels and outcome of pregnancy and complications. To explore the influential factors in order to guide a good birth and good care in pregnancy and lying-in women.Methods A total of 400 cases who were hospitalized in Xinhua hospital from March 2009 to August 2009 were included in this study. The blood levels of arsenic of mother and umbilical cord were determined by microwave digestion method and inductively coupled plasma emission mass spectroscopy method （ ICP-MS）,while mercury determination was made using flame atomic absorption spectrophotometer （AAS）. In addition, pregnant women were required to fill the questionnaire including their living environments, life styles,diet habits and etc. Results The newborn cord blood levels of mercury and arsenic were positively related to those of their mothers（ r =0.88,0.91 respectively, P ＜0.05）. The adverse pregnancy rates and complications rates in blood elevated mercury and arsenic groups were significantly higher than in the normal groups（ x2 =7.07, 9. 94 respectively, P ＜ 0.01 ）. Multiple regression analysis showed that the newborn blood mercury levels were significantly correlated to sea-fish eating, fruits supplement and ventilation during pregnancy. The former was a risk factor（ Wald χ2 =8.28, P ＜0.01 ） and the later two were protective factors（ Wald χ2 = 9.02, 6.05 respectively, P ＜ 0.05 ）. Multiple regression analysis also showed that the newborn blood arsenic levels were significantly correlated to eating canned food, using cosmetics and education degree. Eating canned food and using cosmetics were risk factors（Wald χ2 =7.35, 10.38 respectively,P ＜ 0.05 ） while high education degree was protective factor（ Wald χ2 = 8.87, P ＜ 0.05 ）. Conclusion The newborn cord blood levels of mercury and arsenic were related to those of their mothers, environmental factors and health care during pregnancy. Health education and care during pregnancy were effective approaches for preventing mercury and arsenic poisoning.