妊娠期细颗粒物(PM2.5)暴露对早产发生的影响

The association of fine particulate matter exposure during pregnancy with preterm birth

目的使用反距离加权插值法估计PM2.5暴露浓度,探索妊娠期PM2.5暴露对早产发生的影响。方法利用北京市某城区妇幼保健院的病例采集系统,由档案室工作人员、妇幼保健科室医生经过统一培训后,对384例孕产妇和新生儿信息进行收集,完成自设问卷填写,问卷内容包括孕产妇社会人口学信息、婚育史、产前检查情况以及新生儿分娩情况等。其中,病例组有166例,对照组有218例。此外,通过反距离加权插值法对孕妇妊娠期PM2.5暴露进行估计。利用非条件Logistic回归进行分析。结果多因素分析结果显示,妊娠合并症胎膜早破(OR=7.11,95%CI:4.12～12.25)、子痫或子痫前期(OR=10.23,95%CI:3.39～30.88)、孕期增重不足(OR=2.88,95%CI:1.55～5.36)是早产发生的危险因素;孕晚期PM2.5暴露每增加1μg/m^3,早产发生风险增加2%(OR=1.02,95%CI:1.01～1.04)。而产前检查(OR=0.15,95%CI:0.04～0.58)是早产发生的保护因素。结论妊娠期PM2.5暴露与早产发生有关,特别是孕晚期PM2.5暴露会增加早产发生的风险,孕妇妊娠期应更重视自我防护,避免增加早产发生风险。

Objective To investigate the association between PM2.5 exposure in pregnancy and preterm birth. Methods On the basis of the patients＇ data management system of a maternal and child health hospital, data on social- demographic characteristics, marriage and reproductive history, prenatal health care examinations, and birth and delivery, for 166 preterm patients and 218 controls, were collected via a self-designed questionnaire by the trained staffs from the medical records department or the maternity and child care department. PM2.5 exposure during pregnancy was estimated by Inverse Distance Weighted （IDW） interpolation, and unconditional logistic regression was used to adjust for potential confounders. Results In muhivariate analysis, every 1 μg/m^3 increase of exposure of PM2.5 in the third trimester was associated with a 2% increased risk of preterm birth （ OR = 1.02, 95% CI： 1.01-1.04）. Besides, premature rupture of membranes （ OR =7.11, 95% CI：4.12-12. 25 ） , eclampsia or preeclampsia （ OR = 10.23, 95% CI：3.39-30.88） , and inadequate weight gain during pregnancy （ OR = 2.88, 95% CI： 1.55-5.36） were associated with increased risk of preternl birth, while prenatal health care examination was a protective factor of preterm birth （ OR =0.15, 95% CI：0. 04-0.58）. Conclusion PM2.5 exposure, especially PM2.5 exposure in the third trimester during pregnancy, is associated with increased risk of preterm birth. Pregnant women should reduce the exposure of PM2.5 during pregnancy to minimize the associated risks.