大气可吸入颗粒物暴露致胎儿畸形的病例对照研究

Fetal congenital deformity resulting from ambient inhalable particulate matters： a case-control study

目的探讨妊娠早期大气可吸入颗粒物（inhalable particulate matter，PM10）暴露与胎儿畸形的关系。方法采用病例对照研究。收集2007年5月14日至2012年4月30日期间在南京军区福州总医院分娩或终止妊娠的203例胎儿畸形孕妇资料，针对胎儿不同畸形类型，在同时期（估计受孕日期相差〈30d）的病例资料中，按照1：2的比例随机抽取正常活产孕妇作为相应对照组。采用两配对样本￡检验比较各畸形组与相应对照组妊娠第1、2、3个月和1～3个月PM10暴露的差异。采用Logistic回归分析孕妇年龄、孕次、产次及PM10暴露对胎儿心血管畸形的影响。结果根据病例组的入选和排除标准，纳入分析的畸形病例178例、对照组356例。其中心血管畸形胎儿72例，孕妇妊娠l～3个月PM10的暴露浓度高于144例对照组孕妇[（73．80±11．55）μg／m^3与（70．49±10．83）μg／m^3，t=2．066，P=0．040）]，但2组孕妇妊娠第1、2、3个月PM10暴露浓度比较差异无统计学意义[（74．00±17．34）μg／m^3与（71．70±15．39）μg／m^3，t=0．992，P=0．322；（75．15±16．80）μg／m^3与（71．38±15．66）μg／m^3，t=1．625，P=0．106；（70．28±15．84）μg／m^3与（69．41±15．84）μg／m^3，t=0．383，P=0．702]。所有畸形胎儿、面颈部畸形胎儿及神经系统畸形胎儿孕妇与各自相应对照组孕妇妊娠早期PM10的暴露浓度差异无统计学意义（P均〉0．05）。妊娠1～3个月PM10暴露浓度越高，胎儿心血管畸形的危险性越高。暴露浓度每增加1个四分位数，胎儿心血管畸形的危险性增加1．218倍（OR=2．218，95％CI：1．232～3．994，P：0．008）。纳入孕妇年龄和孕产次的多因素配对Logistic回归分析显示，妊娠1～3个月PM10暴露浓度与胎儿心血管畸形呈显著正相关（OR=1.106，95％CI：1．035～1．183，P=0．003）。结论妊娠早期PM10暴露对胎儿心血管畸形发生可能存在不良效应。

Objective To investigate the relationship between maternal exposure to airborne inhalable particulate matters （PM10） in the first trimester of pregnancy and the risk of fetal congenital deformity. Methods Relationship between exposure to airborne PM10 during the 1st, 2nd, 3rd and 1-3 months of gestation and the risk of fetal anomalies in 203 pregnant women with deformed fetuses, which paralleled to normal pregnant women with discrepancy of conception date 〈30 days （control）, were retrospectively analyzed by a case control study from May 14, 2007 to April 30, 2012 in Fujian Medical University and Fuzhou General Hospital. Multivariate Logistic regression adjusted for potential confounders including maternal age, gravidity and parity was performed for data analysis. Results According to the inclusion and exclusion criteria, 178 pregnant women with deformed fetuses and 356 controlled cases were enrolled. The average levels of PMlo exposed in pregnant women with fetal cardiovascular anomalies during 1-3 months of gestation were significantly higher than in the controls [（73.80±11.55） μg/m^3 vs （70.49＋10.83） μg/m^3] （t 2.066, P=0.040）,but PM10 exposure in the 1st, 2nd and the 3rd month of pregnancy were comparable between the observed and control groups [（74.00±17.34） ±g/m：3 vs （71.70±15.39）μg/m^3,t 0. 992,P=0. 322;（75.15±16. 80） μg/m^3 vs （71.38±15.66） μg/m^3 ,t=1. 625,P=0. 106 （70.28± 15.84） μg/m^3vs （69.41± 15.84） μg/m^3,t= 0. 383,P 0. 702]. There were no significant differences of PM10 exposure levels when compared between facial cervical anomalies, neurologic anomalies and total anomalies and their corresponding controls （P〈0.05）. Each increased quartile of the PM10 exposure levels was associated with an elevated risk of fetal cardiovascular anomalies by 1.218 folds （OR=2.218, 95%CI： 1.232 3. 994, P=0. 008）. Paired multivariate Logistic regression analysis revealed, a positive correlation between PM10, levels at 1-3 months of gestation and fetal cardiovascular anomalies （OR = 1. 106, 95% CI： 1. 035 1. 183, P = 0. 003）. Conclusions Maternal exposure to PM10 in the first trimester of pregnancy possibly exerts negative effects on fetal cardiovascular anomalies.