Disease burden of gestational complications associated with ozone pollution in the Yangtze River Delta region
通过中国知网、万方、PubMed、Web of Science等中英文数据库，检索2010年1月1日至2023年2月28日涉及O3和妊娠期并发症的流行病学研究，依据主题的纳入和排除标准筛选文献，利用 Higgins
I 2统计量对纳入研究进行异质性检验确定，标准化暴露增量为10 µg·m−3，进行meta分析得到暴露-反应关系。结合长三角地区国控点O3监测数据、人口数据和相关疾病负担参数，采用空间分析和环境健康风险评价的方法评估2017年和2020年O3污染水平改善所带来的相关妊娠期并发症的疾病负担变化。 结果
In recent years, ozone (O3) has gradually become a key air pollutant affecting public health. Studies have been conducted to evaluate O3 pollution-associated disease burden for general population, but there is a lack of research on O3 pollution-associated disease burden of gestational complications.
To assess the disease burden of O3 pollution on pregnancy complications in the Yangtze River Delta region and the changes in the disease burden resulting from the improvement of O3 pollution levels.
Through Chinese databases such as China National Knowledge Infrastructure (CNKI) and Wanfang, as well as English databases including PubMed and Web of Science, a systematic search was conducted to retrieve epidemiological studies investigating the association between O3 exposure and pregnancy complications from January 1, 2010 to February 28, 2023. Using predetermined inclusion and exclusion criteria, retrieved studies were screened and assessed for heterogeneity using the Higgins
I 2statistic. The exposure increment was standardized to 10 µg·m−3, and a meta-analysis was conducted to evaluate the exposure-response relationship. Spatial analysis and environmental health risk assessment were then employed, using O3 monitoring data at national air monitoring stations, population data, and related disease burden parameters in the Yangtze River Delta region, to evaluate changes in the disease burden of pregnancy complications associated with improvements in O3 pollution levels. Results
The meta-analysis revealed a significant association between maternal O3 exposure and increased risks of gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP), particularly in early pregnancy, and the related odds ratios (OR) and 95% confidence intervals (CI) were 1.028 (1.002, 1.055) and 1.031 (1.023, 1.040), respectively. The cities with higher attribution fractions (AF) of GDM and HDP related to O3 exposure in 2017 and 2020 in the Yangtze River Delta region were Xuzhou, Huaibei, Suzhou (Anhui Province), Changzhou, and Wuxi, with most cities showing a significant decrease in AF in 2020. Except for Hefei, the cases of GDM and HDP attributable to O3 exposure in the remaining cities of the Yangtze River Delta region decreased by 16.31% to 57.41% in 2020 compared to 2017. In addition, except for Hefei, Suqian, Anqing, and Wuxi, the direct medical costs attributed to O3 exposure in the remaining cities decreased by 1.12% to 45.36% in 2020 compared to 2017.
Exposure to O3 during pregnancy is associated with increased risks of GDM and HDP. There are differences in the disease burden of GDM and HDP related to O3 pollution among cities in the Yangtze River Delta region in 2017 and 2020. In 2020, compared to 2017, the disease burden in most cities is decreased.