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[背景]流行病学文献表明,空气污染物暴露与胎儿的发育相关联。[目的]探讨产妇在妊娠2~8周期间的空气污染物暴露及其与先天性心脏缺陷的关联。[方法]此项出生缺陷预防研究是一项由9个州参加的病例对照研究。给参加这项研究的妊娠妇女分配1周和7周里一氧化碳、二氧化氮、臭氧、二氧化硫的每日最高浓度平均值,以及细颗粒物和粗颗粒物的24 h测量值,采用的方法是在妊娠早期收集这些妇女住所50 km内最接近的空气监测点的测量值。根据不同的污染物,最多4 632例活产对照和3 328例活产、死胎或流产病例有空气污染暴露的数据。应用分层回归模型,并以产妇的人口统计学、烟草和酒精使用情况进行调整。对于多污染物共同暴露的情况,则采用主成分分析来评估这些关联。[结果]二氧化氮暴露与主动脉缩窄及肺动脉瓣狭窄之间存在正性关联。细颗粒物暴露与左室发育不良心脏综合征呈正性相关,但与房间隔缺损呈负性相关。检测个体的暴露周数表明,使用7周的平均水平未观察到污染物与缺陷之间的关联。多污染物分析的结果支持左室流出道阻塞与二氧化氮之间、左室发育不良心脏综合征与颗粒物之间存在关联,尽管在最高的暴露水平时估计值是下降的。[结论]采用每日最高污染物水平探讨个体暴露周数揭示了某些污染物与心脏缺陷之间存在一些正向关联,并且提示在妊娠期间存在潜在的敏感性窗口期。
[Background] Epidemiological literature shows that air pollutant exposure is associated with fetal development. [Objective] To investigate the exposure of air pollutants and their association with congenital heart defects during 2 ~ 8 weeks of gestation. [Method] This birth defect prevention study is a case-control study involving nine states. Pregnant women in the study were assigned the highest daily mean concentrations of carbon monoxide, nitrogen dioxide, ozone, and sulfur dioxide for 1 week and 7 weeks, as well as 24-h measurements of fine and coarse particulates in pregnant women The measurements of the closest air monitoring points within 50 km of these women’s homes were collected early. According to different pollutants, up to 4,632 live births controls and 3 328 live births, stillbirths or abortions cases have data on air pollution exposure. Stratified regression models were applied and adjusted for maternal demographics, tobacco and alcohol use. For co-exposure of multiple pollutants, principal component analysis is used to assess these associations. [Results] There was a positive correlation between exposure of nitrogen dioxide and aortic constriction and pulmonary valve stenosis. Fine particulate exposure was positively correlated with left ventricular dysplastic cardiac syndrome, but negatively correlated with atrial septal defect. The number of weeks exposed to the test indicated that no correlation between contaminant and defect was observed using the 7-week average. The results of the multi-pollutant analysis support a link between left ventricular outflow tract obstruction and nitrogen dioxide, LV dysfuntion heart syndrome and particulate matter although the estimates are declining at the highest exposure levels. [Conclusion] The use of the highest daily contaminant level to explore individual exposure weeks reveals some positive associations between certain contaminants and cardiac defects, and suggests that there is a potential window of sensitivity during pregnancy.