广东省孕产妇孕期大气臭氧暴露与新生儿早产的关联研究

Association between ambient ozone exposure during pregnancy and risk of preterm birth in Guangdong Province

  • 摘要:
    背景 大气污染暴露会对母婴健康产生重要影响,而孕产妇孕期臭氧暴露与早产风险的研究有限且结论不一。
    目的 本研究旨在探讨广东省孕产妇孕期大气臭氧暴露与新生儿早产发生风险的关联。
    方法 本研究收集广东省广州市2013—2019年和广东省佛山市2018—2023年孕产妇数据,根据孕产妇居住地址评估不同孕期臭氧暴露浓度,大气污染暴露评估采用双线性插值法进行。采用队列研究设计,利用限制性立方样条曲线评估臭氧暴露与早产风险的暴露-反应关系,探究暴露阈值,并在此基础上采用多因素logistic回归模型拟合孕期臭氧暴露与新生儿早产风险的关联。
    结果 本研究共纳入702924名孕产妇,其中早产者43051例,早产率为6.12%。研究期间孕产妇在孕早期、孕中期、孕晚期和全孕期的平均臭氧暴露质量浓度(后简称为浓度)分别为95.51、97.51、100.60和97.87 μg·m−3。限制性立方样条曲线显示,孕产妇孕中期、孕晚期和全孕期臭氧暴露与早产风险呈“J”型曲线关系;本研究发现不同孕期臭氧暴露与早产风险之间存在阈值浓度,孕早期、孕中期、孕晚期和全孕期的阈值浓度分别为112.32、99.83、111.74和112.46 μg·m−3。多因素logistic回归模型显示,孕产妇孕中期、孕晚期和全孕期中,在调整了产妇年龄、婴儿性别、孕前体质指数、分娩方式、婴儿出生体重、妊娠期糖尿病和妊娠期高血压后,超过臭氧阈值浓度后,臭氧浓度每升高10 μg·m−3,新生儿早产风险的比值比(OR)分别为1.02(95%CI:1.01~1.04)、1.02(95%CI:1.00~1.03)和1.17(95%CI:1.13~1.21);研究未发现孕早期臭氧暴露与新生儿早产风险之间存在统计学关联。
    结论 孕产妇孕期臭氧暴露与早产风险呈非线性关联,孕期较高浓度的臭氧暴露与早产风险存在关联,尤其是在孕中期和孕晚期。高于孕中期、孕晚期和全孕期阈值浓度后,臭氧浓度越高,早产风险越高。

     

    Abstract:
    Background Air pollution exposure has a significant impact on maternal and child health. However, the research on the association between ambient ozone (O3) exposure during pregnancy and the risk of premature birth in newborns is limited, and the conclusions are inconsistent.
    Objective To investigate the association of ambient O3 exposure during pregnancy with the risk of preterm birth in Guangdong Province.
    Methods Data of pregnant women in Guangzhou from 2013 to 2019 and Foshan from 2018 to 2023 were collected, and O3 concentrations during different trimesters were assessed according to maternal residential addresses. Bilinear interpolation was used to evaluate the concentrations of air pollution. A cohort study design was adopted in our study. Restricted cubic spline curves were used to evaluate the exposure-response relationship between O3 exposure and preterm birth risk and explore potential exposure threshold of O3. Logistic regression models were used to evaluate the association of O3 exposure with preterm birth.
    Results A total of 702 924 pregnant women were included in this study, of whom 43 051 (6.12%) were preterm. The average O3 exposure concentrations of pregnant women during the first, second, third, and whole trimesters were 95.51, 97.51, 100.60, and 97.87 μg·m−3, respectively. We observed J-shaped associations between O3 exposure and preterm birth risk during the second, third, and whole trimesters of pregnancy using restricted cubic spline curves. This study found that there were threshold concentrations between O3 exposure and preterm birth risk during different gestational periods, and the threshold concentrations in the first, second, third, and whole trimesters were 112.32, 99.83, 111.74, and 112.46 μg·m−3, respectively. During the second, third, and whole trimesters of pregnancy, after adjusting for maternal age, baby sex, pre-pregnancy body mass index, mode of delivery, baby birth weight, gestational diabetes, and gestational hypertension, the odds ratios (OR) of preterm birth were 1.02 (95%CI: 1.01, 1.04), 1.02 (95%CI: 1.00, 1.03), and 1.17 (95%CI: 1.13, 1.21) for each 10 μg·m−3 increase in O3 concentration above the O3 threshold. No significant association was found between O3 exposure and the risk of preterm birth during the first trimester.
    Conclusion There is a nonlinear association between the risk of preterm birth and O3 exposure during pregnancy, and higher concentrations of O3 exposure during pregnancy are associated with the risk of preterm birth. Above the O3 threshold concentration during pregnancy, especially during the second, third, and whole trimesters, the risk of preterm birth elevates with the increase of O3 exposure concentrations.

     

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