背景:贫血在低收入和中等收入国家(LMICs)很常见,造成重大的健康问题和社会负担。由于使用生物质燃料烹饪和取暖而暴露于家庭空气污染与贫血有关,但暴露-反应关联尚未研究。
目的:我们在一项多国随机对照试验中评估了孕妇个人暴露于空气污染与血红蛋白水平和贫血患病率之间的关系。
方法:我们研究了3,163名年龄在18-35岁之间、妊娠9-20周的孕妇,作为危地马拉家庭空气污染干预网络(HAPIN)随机对照试验的一部分,印度,秘鲁,卢旺达。我们评估了24小时的个人暴露于细颗粒物(PM2.5),黑碳(BC),一氧化碳(CO),并在基线(妊娠15±3周)测量血红蛋白水平。使用线性和逻辑回归模型来检查测得的污染物与血红蛋白水平和贫血患病率之间的关联。适应混淆。
结果:单污染物模型显示CO与血红蛋白水平升高和贫血患病率降低有关。涉及CO和PM2.5的双污染物模型还显示,CO浓度(2.26ppm)的四分位数间距(IQR)增加与更高的血红蛋白水平有关[β=0.04;95%置信区间(CI):0.01,0.07],贫血患病率较低[比值比(OR)=0.90;95%CI:0.83,0.98]。PM2.5与血红蛋白呈负相关,与贫血呈正相关,但结果在0.05α水平上没有统计学意义.特定县的结果显示,4个国家中的3个显示出CO和血红蛋白之间的相似关联。我们发现BC水平与血红蛋白水平或贫血患病率无关。
结论:我们的研究结果表明,孕妇接触一氧化碳与血红蛋白升高和贫血患病率降低有关。而PM2.5则表现出相反的关联。
BACKGROUND: Anemia is common in low- and middle-income countries (LMICs), causing significant health issues and social burdens. Exposure to household air pollution from using biomass fuels for cooking and heating has been associated with anemia, but the exposure-response association has not been studied.
OBJECTIVE: We evaluated the associations between personal exposure to air pollution and both hemoglobin levels and anemia prevalence among pregnant women in a multi-country randomized controlled trial.
METHODS: We studied 3,163 pregnant women aged 18-35 years with 9-20 weeks of gestation, recruited as part of the Household Air Pollution Intervention Network (HAPIN) randomized controlled trial in Guatemala, India, Peru, and Rwanda. We assessed 24-hour personal exposures to fine particulate matter (PM2.5), black carbon (BC), and carbon monoxide (CO), and measured hemoglobin levels at baseline (15 ± 3 weeks gestation). Linear and logistic regression models were used to examine the associations of measured pollutants with hemoglobin levels and anemia prevalence, adjusting for confounding.
RESULTS: Single-pollutant models showed associations of CO with higher hemoglobin levels and lower anemia prevalence. Bipollutant models involving CO and PM2.5 also revealed that an interquartile range (IQR) increase in CO concentrations (2.26 ppm) was associated with higher hemoglobin levels [β = 0.04; 95 % confidence interval (CI): 0.01, 0.07], and a lower odds of anemia prevalence [odds ratios (OR) = 0.90; 95 % CI: 0.83, 0.98]. PM2.5 was inversely related to hemoglobin and positively associated with anemia, but results were not statistically significant at the 0.05 alpha level. County-specific results showed that 3 of 4 countries showed a similar association between CO and hemoglobin. We found no association of BC levels with hemoglobin levels or with anemia prevalence.
CONCLUSIONS: Our findings suggest that exposure to CO is associated with higher hemoglobin and lower anemia prevalence among pregnant women, whereas PM2.5 showed the opposite associations.