妊娠期PM_(2.5)暴露影响胎儿生长的前瞻性队列研究  

Association between prenatal exposure to PM_(2.5) and fetal growth:a prospective cohort study

作　　者：黄磊 吕红[1,3,4] 徐欣 孙天宇[1,3] 陈逸源 张彦杰 杨波 陆群 蒋杨倩[1,2] 蒋涛 杜江波[1,3,4] 王晓艳 马红霞 胡志斌[1,3,4] 林苑 Huang Lei;Lyu Hong;Xu Xin;Sun Tianyu;Chen Yiyuan;Zhang Yanjie;Yang Bo;Lu Qun;Jiang Yangqian;Jiang Tao;Du Jiangbo;Wang Xiaoyan;Ma Hongxia;Hu Zhibin;Lin Yuan(State Key Laboratory of Reproductive Medicine and Offspring Health,Nanjing Medical University,Nanjing 211166,China;Department of Maternal,Child and Adolescent Health,Center for Global Health,School of Public Health,Nanjing Medical University,Nanjing 211166,China;Department of Epidemiology,Center for Global Health,School of Public Health,Nanjing Medical University,Nanjing 211166,China;State Key Laboratory of Reproductive Medicine and Offspring Health(Suzhou Centre),the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Gusu School,Nanjing Medical University,Suzhou 215002,China;Department of Biostatistics,School of Public Health,Nanjing Medical University,Nanjing 211166,China;Department of Obstetrics,The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Gusu School,Nanjing Medical University,Suzhou 215002,China)

机构地区：[1]南京医科大学/生殖医学与子代健康全国重点实验室,南京211166 [2]南京医科大学公共卫生学院全球健康中心/儿少卫生与妇幼保健学系,南京211166 [3]南京医科大学公共卫生学院全球健康中心/流行病学系,南京211166 [4]南京医科大学姑苏学院/南京医科大学附属苏州医院(苏州市立医院)/生殖医学与子代健康全国重点实验室苏州分中心,苏州215002 [5]南京医科大学公共卫生学院生物统计学系,南京211166 [6]南京医科大学姑苏学院/南京医科大学附属苏州医院(苏州市立医院)产科,苏州215002

出　　处：《中华流行病学杂志》2024年第6期794-801,共8页Chinese Journal of Epidemiology

基　　金：国家重点研发计划(2021YFC2700705,2022YFC3702702);国家自然科学青年基金(82103854);江苏省自然科学基金青年基金(BK20210533)。

摘　　要：目的探讨妊娠期PM_(2.5)及其组分暴露对胎儿生长的影响,并进一步识别暴露效应窗口。方法选取江苏出生队列2016年1月至2019年10月招募的4089对母子对,收集其基线信息、妊娠期诊疗信息、妊娠期PM_(2.5)及其组分暴露信息、妊娠满20周后的胎儿B超检查(头围、腹围、股骨长和估计体重)信息。利用广义线性混合模型进行暴露效应的估计,利用分布滞后非线性模型探讨暴露效应窗口。结果妊娠期PM_(2.5)暴露浓度每升高10μg/m^(3),胎儿头围、腹围和估计体重Z评分分别减小0.025(β=-0.025,95%CI:-0.048~-0.001)、0.026(β=-0.026,95%CI:-0.049~-0.003)和0.028(β=-0.028,95%CI:-0.052~-0.004),头围和估计体重生长受限风险分别增加8.5%(RR=1.085,95%CI:1.010~1.165)和13.5%(RR=1.135,95%CI:1.016~1.268)。PM_(2.5)组分中黑碳、有机物、硝酸盐、硫酸盐、铵盐暴露浓度升高均与头围Z评分减小显著相关,同时硫酸盐暴露的增加还与股骨长的Z评分减小有关。妊娠期PM_(2.5)暴露影响胎儿头围生长效应窗口为第2~5周,腹围为第4~13周以及第19~40周,股骨长为第4~13周以及第23~37周,估计体重为第4~12周以及第20~40周。结论妊娠期PM_(2.5)及其组分暴露可能对胎儿生长产生不利影响,影响胎儿不同生长指标的效应窗口不完全一致。Objective To investigate the association of exposure to PM_(2.5) and its constituents during pregnancy and fetal growth and to further identify critical windows of exposure for fetal growth.Methods We included 4089 mother-child pairs from the Jiangsu Birth Cohort Study between January 2016 and October 2019.Data of general characteristics,clinical information,daily average PM_(2.5) exposure,and its constituents during pregnancy were collected.Fetal growth parameters,including head circumference(HC),abdominal circumference(AC),and femur length(FL),were measured by ultrasound after 20 weeks of gestation,and then estimated fetal weight(EFW)was calculated.Generalized linear mixed models were adopted to examine the associations of prenatal exposure to PM_(2.5) and its constituents with fetal growth.Distributed lag nonlinear models were used to identify critical exposure windows for each outcome.Results A 10μg/m^(3) increase in PM_(2.5) exposure during pregnancy was associated with a decrease of 0.025(β=-0.025,95%CI:-0.048--0.001)in HC Z-score,0.026(β=-0.026,95%CI:-0.049--0.003)in AC Z-score,and 0.028(β=-0.028,95%CI:-0.052--0.004)in EFW Z-score,along with an increased risk of 8.5%(RR=1.085,95%CI:1.010-1.165)and 13.5%(RR=1.135,95%CI:1.016-1.268)for undergrowth of HC and EFW,respectively.Regarding PM_(2.5) constituents,prenatal exposure to black carbon,organic matter,nitrate,sulfate(SO42-)and ammonium consistently correlated with decreased HC Z-score.SO42-exposure was also associated with decreased FL Z-scores.In addition,we found that gestational weeks 2-5 were critical windows for HC,weeks 4-13 and 19-40 for AC,weeks 4-13 and 23-37 for FL,and weeks 4-12 and 20-40 for EFW.Conclusions Our findings demonstrated that exposure to PM_(2.5) and its constituents during pregnancy could adversely affect fetal growth and the critical windows for different fetal growth parameters are not completely consistent.

关 键 词：胎儿生长 PM_(2.5) 组分 前瞻性队列 效应窗口 

分 类 号：R714.5[医药卫生—妇产科学]