多溴联苯醚暴露与新生儿宫内发育迟缓的巢式病例-对照研究

宋琪; 何笑笑; 司婧; 金宇婷; 陈尚勤; 张蕴晖

doi:10.13213/j.cnki.jeom.2018.17583

多溴联苯醚暴露与新生儿宫内发育迟缓的巢式病例-对照研究

Prenatal exposure to polybrominated diphenyl ethers and intrauterine growth retardation in newborns: A nested case-control study

摘要

摘要:
目的运用巢式病例-对照研究探索多溴联苯醚（polybrominated diphenyl ethers，PBDEs）暴露与新生儿宫内发育迟缓（intrauterine growth retardation，IUGR）的关联。

方法本研究基于温州出生队列研究，从征募的孕妇及其分娩的新生儿中筛选出IUGR病例54例，并按母亲年龄及新生儿性别配对了67例健康新生儿作为对照。用气相色谱-质谱方法测定母血和脐血血清样本中19种PBDEs同系物的质量分数，结合基本人口学信息及新生儿出生结局信息，采用Spearman相关分析和二元logistic回归方法分析暴露-反应间的关联。

结果 IUGR病例组与对照组在家庭月收入水平、母亲受教育程度、母亲孕期增重、有无妊娠综合征的差异有统计学意义（P < 0.05），在其他基本人口学指标上无明显差异；IUGR病例组与对照组在新生儿的出生体重、出生体长、孕周、克托莱指数上的差异有统计学意义（P < 0.001）。在所检测的121份母血和脐血样本中，19种PBDEs同系物的平均检出率分别为61.16%和42.67%，∑PBDEs质量分数的中位数范围分别为ND~114.67 ng/g（以每g脂质质量计，余同）、ND~126.67 ng/g。IUGR病例组脐血中∑PBDEs、∑BDE154-209、∑BDE17-153及BDE-207质量分数高于对照组（P < 0.05），而在母血中未发现两组PBDEs的差异有统计学意义。二元logistic回归分析结果发现，校正前，相比于低暴露水平（< P₃₃），脐血中高暴露水平（> P₆₆）的BDE-207、BDE154-209及∑PBDEs的OR（95% CI）分别为2.513（1.019~6.198）、2.500（1.016~6.149）、3.462（1.379~8.691）（P < 0.05）；校正婴儿性别、母亲年龄和受教育程度后，脐血中总PBDEs的OR（95% CI）为3.130（1.180~8.305）（P < 0.05）。

结论脐血PBDEs水平与新生儿生长发育呈负相关关系，孕期PBDEs暴露可增加新生儿IUGR的发生风险。

Abstract:
Objective To explore the associations between polybrominated diphenyl ethers (PBDEs) exposure and intrauterine growth retardation (IUGR) in newborns by nested case-control study.

Methods Mother-newborn pairs selected from Wenzhou Birth Cohort were recruited in this study, including 54 IUGR newborns and 67 control newborns matched by maternal age and newborn sex. Maternal blood and umbilical cord blood samples were collected and measured for concentrations of 19 PBDE congeners by gas chromatography-mass spectrometry. The relationship between PBDEs exposure and IUGR were analyzed by Spearman correlation analysis and binary logistic regression analysis.

Results Significant differences were found between IUGR cases and controls in family monthly income, maternal education level, maternal weight gain during pregnancy, and pregnancy syndrome (P < 0.05), and no differences were found in other demographic indicators. Significant differences were also found in newborn's birth weight, birth length, gestational age, and Quetelet in dex (P < 0.001). The average positive rates of 19 PBDE congeners in maternal blood and umbilical cord blood samples were 61.16% and 42.67%, with a median range of ∑PBDEs being from not detected (ND) to 114.67ng/g (in terms of per gram of lipid, thereafter) and from ND to 126.67 ng/g, respectively. In umbilical cord blood samples, the mass fractions of ∑PBDEs, ∑BDE154-209, ∑BDE17-153, and BDE-207 were significantly higher in the IUGR cases than those in the controls (P < 0.05), while no differences were found in PBDEs in maternal blood samples. The binary logistic regression analysis results showed that the crude odd ratios (95%CI) of IUGR risk for high-level (> P₆₆) vs low-level (< P₃₃) BDE-207, ∑BDE154-209, and ∑PBDEs in umbilical cord blood were 2.513 (1.019-6.198), 2.500 (1.016-6.149), and 3.462 (1.379-8.691), respectively; the odd ratios (95%CI) for high-level (> P₆₆) vs low-level (< P₃₃) ∑PBDEs in umbilical cord blood changed to 3.130 (1.180-8.305) after adjusted for infant sex, maternal age, and maternal education level.

Conclusion PBDEs levels in umbilical cord blood are negatively associated with growth and development of newborns, and prenatal PBDEs exposure may be associated with elevated risk of IUGR in newborns.

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