孕晚期室内烟气暴露对自发性早产的影响研究

The effect of indoor smoke exposure on spontaneous preterm birth during 28-40 weeks of pregnancy

目的 探讨孕晚期室内空气烟气污染(室内燃料、吸烟等)对自发性早产(spontaneous preterm birth, sPTB)的影响。方法 采用病例对照研究,纳入2021年2月—10月在甘肃省省属医疗机构分娩确诊为sPTB的孕产妇作为病例组,同期以年龄为匹配条件,1∶3匹配获得正常妊娠结局的健康孕产妇作为对照组,就孕晚期(孕28~40周)家居烟气暴露情况进行回顾性问卷调查,分析室内烹饪及主动/被动吸烟等室内烟气暴露因素对sPTB结局的影响。结果 sPTB病例组145例和正常妊娠对照435例,经条件多因素logistic回归模型分析发现,校正收入、学历、居住地、生育情况等混杂因素后,不使用抽油烟机(OR=2.32,95%CI:1.28~4.22)和使用木柴(OR=3.13,95%CI:1.02~9.60)是sPTB的危险因素。结论 孕期接触燃料类型及抽油烟机使用率均可影响sPTB发病结局,生殖健康领域医护应关注孕期女性室内环境问题,做好宣教,防患于未然。

Objective To explore the impact of indoor air smoke exposure on the spontaneous preterm birth(sPTB) during the third trimester of pregnancy. Methods A case-control study was conducted among 145 women with confirmed sPTB randomly enrolled using a cluster sampling method in a provincial-level hospital in Gansu from March 2021 to September 2021.Meanwhile, 435 age-matched pregnant women with normal birth were also recruited in the study as controls.A retrospective questionnaire survey regarding the indoor smoke exposure during 28-40 weeks of gestation was performed. Results The baselines of the two groups were comparable.The single factor analysis showed that fuel type and range hood might be the influencing factors of sPTB.There were no correlation between the active/passive smoking, frequency of personal cooking and the incidence of sPTB.After adjusting the indoor smoke exposure confounding factors as corrected income, education, residence and number of birth, the unconditional multivariate logistic regression showed that not turning on range hood(OR=2.32, 95%CI: 1.28-4.22) while cooking and firewood cooking(OR=3.13, 95%CI: 1.02-9.60) were major risk factors for sPTB. Conclusions The type of fuel exposed during pregnancy and the use rate of range hood can affect the outcome of sPTB.Healthcare workers in the field of reproductive health should educate pregnant women being aware of indoor environment especially indoor smoke exposure to avoid sPTB.