孕妇产前空气污染物暴露与大于胎龄儿的关联研究

Relationship between prenatal air pollutants exposure among pregnant women and large for gestational age

目的探讨孕妇孕前和孕期空气污染物暴露与大于胎龄儿(large for gestational age,LGA)发生风险的关系。方法于2015—2018年在合肥市3家医院招募孕中期孕妇5 184人,收集孕妇一般人口学特征、生活方式、健康状况及产前主要空气污染物暴露情况,随访至分娩获得出生结局指标。采用多因素logistic回归分析主要空气污染物暴露与LGA发生风险的关系。结果合肥市LGA总发生率为13.6%。与低水平污染物暴露的孕妇相比,孕前PM_(2.5)、PM_(10)、SO_(2)、CO及孕晚期SO_(2)、CO高水平暴露的孕妇LGA发生风险分别增加25%(OR=1.25,95%CI:1.04~1.51),30%(OR=1.30,95%CI:1.08~1.56),29%(OR=1.29,95%CI:1.07~1.55),23%(OR=1.23,95%CI:1.03~1.47),以及25%(OR=1.25,95%CI:1.04~1.50),21%(OR=1.21,95%CI:1.01~1.44),且污染物暴露浓度越高,LGA发生风险越高。但其他孕期主要空气污染物暴露与LGA发生风险的增加无统计学关联(P>0.05)。以孕前BMI进行分层分析,在孕前非超重或肥胖的孕妇中,与孕前PM_(2.5)、PM_(10)、SO_(2)、CO以及孕晚期SO_(2)、CO低水平暴露相比,高水平暴露的孕妇LGA发生风险均增加(P<0.05);在孕前超重或肥胖的孕妇中,未发现高水平污染物暴露与LGA发生风险的统计学关联(P>0.05)。无论孕前体重如何,孕前高水平空气污染暴露均可使孕中期妊娠期糖尿病(gestational diabetes mellitus,GDM)的发生风险增加(在孕前超重或肥胖人群中SO_(2)的暴露除外)。与孕前超重或肥胖的孕妇相比,非超重或肥胖孕妇的孕前空气污染物暴露与GDM的关联强度更高(PM_(10)除外)。结论孕前空气污染物暴露可能通过增加孕中期GDM发生风险而导致子代LGA发生风险增加,特别是孕前非超重或肥胖孕妇可能风险更高。

Objective To understand the relationship between air pollutant exposure before and during pregnancy and the risk of large for gestational age(LGA). Methods From 2015 to 2018,5 184 pregnant women in the second trimester of pregnancy were recruited in three hospitals in Hefei,Anhui province. The general demographic characteristics,life style,health status and prenatal exposure to major air pollutants were collected and followed up until the birth outcome index was obtained.Multivariate logistic regression was used to analyze the association between major air pollutants exposure and the risk of LGA.Results The total incidence of LGA was 13.6% in Hefei. Compared with the pregnant women exposed to low levels of air pollutants,in the pregnant women with high levels of exposure to PM_(2.5),PM_(10),SO_(2) and CO before pregnancy and SO_(2) and CO in the third trimester of pregnancy,the risk of LGA increased significantly by 25%(OR =1.25,95% CI:1.04-1.51),30%(OR =1.30,95% CI:1.08-1.56),29%(OR =1.29,95% CI:1.07-1.55),23%(OR =1.23,95% CI:1.03-1.47),25%(OR =1.25,95% CI:1.04-1.50),21%(OR =1.21,95% CI:1.01-1.44),the higher the concentration of pollutants was,the higher the risk of LGA became.However,there was no significant association between major air pollutants exposure during other pregnancy periods and the increased risk of LGA(P>0.05). Stratified analysis of BMI before pregnancy showed that the risk of LGA was increased among pregnant women non-overweight or non-obese before pregnancy with higher exposure to PM_(2.5),PM_(10),SO_(2),and CO during pre-pregnancy as well as SO_(2) and CO during the third trimester compared with those with lower exposure to the related air pollutants during the same period(P<0.05);No significant association between higher levels of pollutants exposure and the risk of LGA was observed among pregnant women overweight or obese before pregnancy(P>0.05).No matter how a pregnant woman was overweight or not before pregnancy,higher levels of air pollution exposure before pregnancy were significantly associated with the increased risk of gestational diabetes mellitus(GDM) during the second trimester of pregnancy with the exception of SO_(2) exposure in overweight and obese women before pregnancy.Compared with pregnant women overweight and obese before pregnancy,higher association between pregestational air pollutant exposure and GDM was seen among pregnant women non-overweight and non-obese,with the exception of PM_(10). Conclusion Exposure to air pollutants before pregnancy may increase the risk of LGA in offspring by increasing the risk of GDM in the second trimester of pregnancy,in particular,for the pregnant women non-overweight and non-obese before pregnancy,the risk will be in higher level.