广州孕妇孕期硒暴露水平与孕晚期胎儿头围的关系  

Associations between selenium exposure level during pregnancy and fetal head circumference in third trimester of pregnancy

作　　者：陈邓周 王嘉琪 周鹤 董墨染 刘欣 马文军[2] 张波 刘涛[2] 曾转萍 CHEN Dengzhou;WANG Jiaqi;ZHOU He;DONG Moran;LIU Xin;MA Wenjun;ZHANG Bo;LIU Tao;ZENG Zhuanping(School of Public Health,Guangdong Pharmaceutical University,Guangzhou,Guangdong 510310,China;Guangdong Provincial Institute of Public Health,Guangdong Provincial Center for Disease Control and Prevention,Guangzhou,Guangdong 511430,China;School of Public Health,Southern Medical University,Guangzhou,Guangdong 510515,China)

机构地区：[1]广东药科大学公共卫生学院,广东广州510310 [2]广东省疾病预防控制中心广东省公共卫生研究院,广东广州511430 [3]南方医科大学公共卫生学院,广东广州510515

出　　处：《环境与职业医学》2021年第4期361-367,共7页Journal of Environmental and Occupational Medicine

基　　金：国家自然科学基金(81874276,81502819);广东省自然科学基金-面上项目(2019A1515011264)。

摘　　要：[背景]硒(Se)是人体必需的元素,但过量的硒会产生毒性。孕妇孕期硒暴露水平与胎儿发育的关系目前尚不明确。[目的]了解广州市孕妇孕期硒暴露与孕晚期胎儿头围的关系。[方法]所有孕妇均来自2016年起在广州进行的产前环境与后代健康(PEOH)队列。研究对象分别在孕早期(孕周≤13周)完成基线调查并建立随访档案,在孕晚期(孕周≥28周)进行随访。调查包括面对面采访的问卷调查并从医院信息系统中提取孕妇的产前护理记录,另分别收集孕早期和孕晚期孕妇各15.0 mL尿液,孕晚期对胎儿进行超声检查,记录胎儿头围的生长发育情况。根据是否提供尿样及所有资料的完整性,孕早期和孕晚期分别剔除部分对象后,研究共纳入2739名孕妇;其中孕早期和孕晚期各纳入孕妇2138、1383名,分别分析孕早、晚期孕妇硒暴露与孕晚期胎儿头围的关系。尿硒浓度(ω_(Se))通过尿肌酐校正(计量单位为:μg·g^(-1),以肌酐计,后同),并经自然对数转换为lnω_(Se)。调整孕妇年龄、受教育程度、家庭收入和孕前体重指数、孕次、孕周数、胎儿性别、二手烟暴露、钙片的摄入、肉与海鲜的摄入等因素后,应用多重线性回归模型估算孕妇硒暴露水平与胎儿头围之间的关系,并进一步分性别进行分析。[结果]在2739名孕妇中,年龄≥30岁的有1926人(70.3%),男胎有1474人(53.8%),受教育程度在高中及以上的有2313人(84.4%),怀孕期间有二手烟暴露的871人(31.8%),孕周≥37周的有2637人(96.3%)。孕早期和孕晚期孕妇的硒暴露水平的中位数及第25、75百分位数分别为38.5(30.1,44.5)μg·g^(-1)和38.9(28.7,54.0)μg·g^(-1)。孕晚期胎儿头围为(218.1±41.4)mm。经多重线性回归模型分析,未观察到孕早期的硒暴露与孕晚期胎儿头围的关联有统计学意义。但孕晚期孕妇尿lnω_(Se)每增加一个单位,胎儿头围减小值及其95%可信区间(CI)为7.04(3.41~10.67[Background]Selenium(Se)is an essential element for humans,but an excessive intake can also produce toxic effects.The association between Se exposure and fetal growth is currently unclear.[Objective]The study is conducted to investigate the associations between exposure to Se during pregnancy and head circumference of fetus in the third trimester.[Methods]All participants were selected from the Prenatal Environment and Offspring Health(PEOH)cohort conducted since 2016 in Guangzhou,China.They completed face-to-face interviews at baseline in their first trimester(≤13 gestational weeks)and at follow-up visits in their third trimester(≥28 gestational weeks).Their prenatal records were retrieved from the hospital information system,and 15.0 m L spot urine samples were collected in the first and the third trimesters respectively.Fetal head circumference was measured by ultrasound examination in the third trimester.A total of 2739 pregnant women,including 2138 and 1383 participants in the first trimester and the third trimester respectively,were finally included to estimate the associations between fetal head circumference in the third trimester with Se exposure in the first and the third trimesters,respectively.The urinary Se concentrations(ω_(Se))were corrected by creatinine(μg·g^(-1),thereafter)and transformed by natural logarithm(lnω_(Se)).After adjusting the maternal age,education,family income,pre-pregnancy body mass index,gravidity,gestational weeks,fetal sex,second-hand smoke exposure,calcium intake,and meat and seafood intake,multiple linear regression models were applied to estimate the overall and sex-specific associations between Se exposure level and fetal head circumference.[Results]Among the 2739 pregnant women,there were 1926 pregnant women aged ≥30 years(70.3%),1474 male fetuses(53.8%),2313 pregnant women with high school education and above(84.4%),871 pregnant women exposed to passive smoke during pregnancy(31.8%),and 2637 pregnant women with gestational age≥37 weeks(95.6%).The median(P25,P

关 键 词：硒 微量元素 头围 出生队列研究 孕期 

分 类 号：R174[医药卫生—妇幼卫生保健]