妊娠期PM2.5暴露对早产影响

Impact of maternal PM2.5 exposure on preterm birth in Hebei province:a retrospective analysis

目的分析孕妇妊娠期空气中细颗粒物(PM2.5)的暴露水平与早产发生风险的关系。方法收集河北省22个危重孕产妇监测点在2015—2016年分娩的91756名单胎产妇资料,利用其所在城市的每日空气质量数据测算不同妊娠阶段PM2.5的暴露水平,并采用logistic回归模型分析妊娠期PM2.5暴露水平对早产的影响。结果早产组孕期各时期PM2.5暴露值均高于足月组,整个妊娠期、孕早期(孕13+6周以前)、孕晚期(孕28周以后)、妊娠开始第1个月、分娩前第1个月、第2个月PM2.5平均暴露值每增加10μg/m^3,早产的发生风险分别增加9.9%、4.2%、7.4%、2.9%、3.4%、3.6%。高龄妊娠、多孕次、妊娠期高血压疾病、妊娠期糖尿病、低孕检次数、高文化程度、胎儿性别为男孩也是发生早产的危险因素。结论妊娠期PM2.5高浓度暴露会显著增加早产发生的风险,尤其是孕早期和孕晚期,应注意做好孕期防护。

Objective To evaluate the association between maternal exposure to particulate matter≤2.5μm in aerodynamic diameter(PM2.5)and the risk of preterm birth,and to provide a reference for the prevention of adverse pregnancy outcomes.Methods We collected data on 91756 puerperas having their singleton deliveries during 2015–2016 at 22 medical institutions covered by a critical maternal surveillance system in 10 cities of Hebei province;the puerperas′exposures to PM2.5 were estimated based on average daily PM2.5 concentration from ambient air quality monitoring of the 10 cities.Multivariate logistic regression model was used to explore the association between maternal PM2.5 exposure and the risk of preterm birth in different gestational weeks.Results The estimated PM2.5 exposure during whole and various pregnancy periods were all significantly higher for the puerperas with preterm birth than for those with full-term birth.A 10μg/m^3 increase in PM2.5 exposure during entire pregnancy,first trimester(<14 gestation weeks),the third trimester(≥28 gestation weeks),the first month of pregnancy,the first month before delivery,and the second month before delivery were associated with a 9.9%,4.2%,7.4%,2.9%,3.4%,and 3.6%increment in preterm birth risk,respectively.Other risk factors for preterm birth included at an elder age,more pregnancies,pregnancy induced hypertension(PIH),gestational diabetes mellitus(GDM),less antenatal cares,with a higher education,and having a male fetus.Conclusion Maternal exposure to high level of PM2.5 during pregnancy,especially during the first and the third trimester,can significantly increase preterm birth risk and protective measures against the exposure should be adopted among pregnant women.