妊娠期NO2暴露与子痫前期患病相关性

Correlation between exposure to nitrogen dioxide during pregnancy and preeclampsia

目的探讨孕期各阶段NO2暴露与子痫前期患病风险的关系。方法收集2015—2017年在河北省石家庄、承德及张家口市妊娠并在河北省孕产妇监测系统10家医院中分娩的63625名孕产妇住院资料,并收集其孕期各阶段的空气质量监测数据;根据是否患子痫前期,将总人群分为子痫前期组(PE组)和非子痫前期组(非PE组),比较2组人群及不同城市的孕期NO2暴露情况,采用logistic回归模型分析其对子痫前期患病的影响。结果在纳入的63625人中,PE组共2006人(3.2%),非PE组共61619人(96.8%)。PE组孕期各阶段NO2暴露水平明显高于非PE组;石家庄市妊娠妇女孕期各阶段NO2暴露水平明显高于承德和张家口市;石家庄市孕产妇子痫前期患病率明显高于承德及张家口;妊娠各阶段暴露于NO2会增加子痫前期的患病;孕早、中、晚期NO2每增加10μg/m3,子痫前期的患病风险分别增加1.168、1.105、1.293倍(P<0.001);高龄及低龄、低文化程度、受孕季节寒冷均为子痫前期患病的危险因素。结论NO2为子痫前期患病的危险因素,且作用于妊娠的各个阶段,对有高危因素的妊娠妇女应注重产前检查。

Objective To investigate the relationship between exposure to nitrogen dioxide (NO2) during all stages of pregnancy and the risk of preeclampsia. Methods We collected data on 63 625 pregnant and parturient women having their deliveries between 2015 and 2017 in 10 hospitals covered by the Pregnant and Parturient Women Surveillance System in Shijiazhuang, Chengde and Zhangjiakou city of Hebei province and then divided the women into a preeclampsia (PE) group and a non preeclampsia (non PE) group based on their medical history;the monitoring data on ambient air quality of the three cities during the 3-year period were collected simultaneously. Exposure to NO2 during pregnancy and in different cities among the two groups of the women were described and compared. Logistic regression model was adopted to analyze the impact of NO2 exposure on preeclampsia incidence. Results Among all the women, significantly higher NO2 exposure during pregnancy in PE group (n = 2 006, 3.2%) than that in non PE group (n = 61 619, 96.8%) was observed. The women in Shijiazhuang city had obviously both a higher NO2 exposure and an incidence rate of preeclampsia compared to the women in other two cities, suggesting that exposure to NO2 during all stages of pregnancy could increase the risk of preeclampsia. The risk of preeclampsia increased by 1.168, 1.105, and 1.293 times with an increment of 10 μg/m3 in NO2 exposure during early, middle and late of pregnancy, respectively (P < 0.001). Other risk factors for preeclampsia included at an elder age, at a young age, with a low education, and having a pregnancy in cold season. Conclusion Exposure to NO2 in all stages of a pregnancy is a risk factor for preeclampsia and pregnant women with the exposure and other risk factors should pay an attention to prenatal examination.