背景:尽管人们越来越意识到空气污染与早产之间的关系,关于与自发性早产和严重新生儿结局的关系的数据有限.
目的:本研究旨在探讨孕期交通相关空气污染暴露与不良围产期结局(包括极端早产)之间的关系。新生儿重症监护室入院,低出生体重,新生儿呼吸道诊断,新生儿呼吸支持,和新生儿败血症评估。
方法:这是一项针对居住在美国南部大都市地区的患者单胎妊娠的回顾性队列研究。使用战略上位于整个地区的监视器,平均二氧化氮浓度是从环境保护局空气质量系统数据库获得的。对于住在监测站10英里范围内的病人,估计每个妊娠患者的平均二氧化氮暴露量。采用Logistic回归模型评估污染物暴露对出生胎龄的影响,指示与自发分娩,和新生儿结局,同时调整产妇年龄,自我报告的种族,奇偶校验,受孕的季节,糖尿病,身体质量指数,注册健康权益指数,和二氧化氮监测区。计算了平均二氧化氮暴露的四分位数增加的调整后的优势比和95%的置信区间。
结果:在2013年1月1日至2021年12月31日之间,93,164名患者分娩了单胎婴儿。其中,62,189人从附近的监测站测量了怀孕期间的二氧化氮暴露。整个怀孕期间较高的平均二氧化氮暴露与早产显着相关(调整后的比值比,1.94;95%置信区间,1.77-2.12)和新生儿重症监护病房入院人数的增加,低出生体重婴儿,新生儿呼吸道诊断,新生儿呼吸支持,和新生儿败血症评估。这种关系在未产妇和自发性早产患者中持续存在,并且与早期早产有更大的关联。
结论:在大都市地区,妊娠期暴露于空气污染物二氧化氮的增加与自发性早产相关,与极早产的相关性更大.与新生儿重症监护病房入院的联系更大,低出生体重婴儿,新生儿呼吸道诊断,新生儿呼吸支持,甚至在足月婴儿中也发现了新生儿败血症评估。
Although there is growing awareness of the relationship between air pollution and preterm birth, limited data exist regarding the relationship with spontaneous preterm birth and severe neonatal outcomes.
This study aimed to examine the association between traffic-associated air pollution exposure in pregnancy and adverse perinatal outcomes including extremes of preterm birth, neonatal intensive care unit admissions, low birthweight, neonatal respiratory diagnosis, neonatal respiratory support, and neonatal sepsis evaluation.
This was a retrospective cohort study of singleton pregnancies of patients residing in a metropolitan area in the southern United States. Using monitors strategically located across the region, average nitrogen dioxide concentrations were obtained from the Environmental Protection Agency Air Quality System database. For patients living within 10 miles of a monitoring station, average exposure to nitrogen dioxide was estimated for individual patients\' pregnancy by trimester. Logistic regression models were used to assess the effect of pollutant exposure on gestational age at birth, indicated vs spontaneous delivery, and neonatal outcomes while adjusting for maternal age, self-reported race, parity, season of conception, diabetes mellitus, body mass index, registered Health Equity Index, and nitrogen dioxide monitor region. Adjusted odds ratios and 95% confidence intervals were calculated for an interquartile increase in average nitrogen dioxide exposure.
Between January 1, 2013 and December 31, 2021, 93,164 patients delivered a singleton infant. Of these, 62,189 had measured nitrogen dioxide exposure during the pregnancy from a nearby monitoring station. Higher average nitrogen dioxide exposure throughout pregnancy was significantly associated with preterm birth (adjusted odds ratio, 1.94; 95% confidence interval, 1.77-2.12) and an increase in neonatal intensive care unit admissions, low birthweight infants, neonatal respiratory diagnosis, neonatal respiratory support, and neonatal sepsis evaluation. This relationship persisted for nulliparous patients and spontaneous preterm birth, and had a greater association with earlier preterm birth.
In a metropolitan area, increased exposure to the air pollutant nitrogen dioxide in pregnancy was associated with spontaneous preterm birth and had a greater association with extremely preterm birth. A greater association with neonatal intensive care unit admissions, low-birthweight infants, neonatal respiratory diagnosis, neonatal respiratory support, and neonatal sepsis evaluation was found even in term infants.