孕期大气颗粒物暴露对新生儿低出生体重影响的Meta分析

Impact of atmospheric particulate matter at different period of gestation on low birth weight： a meta-analysis

目的 研究孕产妇不同妊娠阶段大气颗粒物（PM2.5和PM10）暴露对新生儿低出生体重的影响.方法 以＂大气污染＂、＂低出生体重＂、＂不良妊娠结局＂、＂air pollution＂、＂adverse birth outcomes＂、＂adverse pregnancy outcomes＂、＂low birth weight/LBW＂等为检索词,在线检索中国期刊全文数据库（CNKI）、万方科技信息数据库、维普中文科技期刊全文数据库、Pubmed、Cochrane Library、Web of Science、Science Direct数据库,系统收集2000年1月1日至2016年1月1日前公开发表的、有关大气颗粒物（PM2.5和PM10）对低出生体重影响的相关研究共2471篇,根据严格的纳入排除标准共纳入文献27篇,利用R 3.1.1的metafor包对入选文献进行异质性检验和相应的效应值合并,并对结果 进行敏感性分析、发表偏倚检验和校正.结果最终纳入分析的文献27篇.PM2.5每升高10μg/m^3,妊娠早、中、晚期和妊娠全期孕妇生产出低出生体重儿的合并OR值分别为1.02（95%CI：0.87-1.19）、1.03（95%CI：0.91-1.16）、1.07（95%CI：1.04-1.11）、1.09（95%CI：1.04-1.15）;PM10每升高10μg/m^3,妊娠早、中、晚期和妊娠全期孕妇生产出低出生体重儿的合并OR值分别为1.66（95%CI：1.06-2.61）、1.58（95%CI：1.28-1.95）、1.38（95%CI：1.23-1.56）、1.04（95%CI：0.99-1.09）.对文献的发表偏倚进行校正后,妊娠全期暴露的PM2.5的浓度每上升10μg/m^3,生产出低体重儿的风险的合并OR值为1.11（95%CI：1.02-1.21）.结论 妊娠期大气颗粒物的暴露可增加低出生体重的发生风险,且不同妊娠期对胎儿体重生长的损害不同.

Objective To analyze the influence of atmospheric particulate matters （PM2.5 and PM10） on low-birth-weight（LBW）infants at different periods of gestation. Methods We conducted a systematic literature search for 2471 articles related to particulate matter and LBW published from January 1st 2000 to January 1st 2016 using the PubMed, Cochrane Library, Web of Science, Science Direct, Chinese Web of Knowledge, Wanfang and Weipu, and the keywords were＂air pollution＂,＂adverse birth outcomes＂,＂adverse pregnancy outcomes＂,＂low birth weight/LBW＂. According to criteria, 27 literatures were selected and included. Metafor package of the R 3.1.1 Software was used to check the heterogeneity and merge the effect value of the selected literatures, and sensitivity analysis and publication bias were detected and adjusted. Results A total of 2471 studies selected form the databases, 27 enrolled in this analysis according to the inclusion and exclusion criteria. Each 10μg/m^3 increase in PM2.5 was associated with combined OR values of 1st trimester, 2nd trimester, 3rd trimester and entire gestation at 1.02（95%CI： 0.87-1.19）, 1.03 （95%CI：0.91-1.16） , 1.07 （95%CI：1.04-1.11） and 1.09 （95%CI：1.04-1.15）, respectively. And 10μg/m^3 increase in PM10 was associated with combined OR values of 1st trimester, 2nd trimester, 3rd trimester and entire gestation at 1.66 （95%CI：1.06-2.61）, 1.58 （95%CI：1.28-1.95） , 1.38 （95%CI：1.23-1.56） and 1.04 （95%CI：0.99-1.09）, respectively. After adjusting the bias of publication, each 10 μg/m^3 increase in PM2.5 was associated with the risk of low birth weight at 1.11（95%CI：1.02-1.21）. Conclusion This meta analysis supports an adverse impact of maternal exposure to particulate air pollution on low birth weight, varying in effects by exposure period.