孕期温度暴露与早产儿发生的关联性研究
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摘要
目的分析温州市早产儿出生情况,探讨不同孕期温度暴露对早产儿发生的影响。方法收集温州市2012—2016年9月围生期保健和分娩监测系统的新生儿资料和环境温度资料,采用基于限制三次样条基函数的Logistic回归模型,在控制性别、出生年份、出生季节和登记住址等混杂因素后,分析孕期温度暴露与早产儿发生的关联性。结果纳入研究491 854名新生儿,2012—2016年早产儿平均发生率为4.56%,早产儿发生率呈逐年上升趋势(P<0.05),平均胎龄、平均出生体重呈逐年下降趋势(P<0.05)。夏季和冬季早产儿发生率较高,分别为4.69%和4.75%。孕早期温度暴露与早产儿发生风险呈现"U"型关系,相对于中位温度20℃,孕早期暴露在极端寒冷(7.5℃)和极端炎热温度(30.5℃)下,早产儿发生风险分别增加26.5%(95%CI:18.2%～35.6%)和15.1%(95%CI:7.9%～29.1%)。孕晚期暴露在极端炎热温度(30.5℃)下,早产儿发生风险增加11.9%(95%CI:7.3%～17.0%)。结论温州市早产儿发生率逐年上升,孕期极端温度暴露可增加早产儿发生风险,尤其是孕早期和孕晚期。
引文
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[4]DURRLEMAN S,SIMON R.Flexible regression models with cubic splines[J].Statistics in Medicine,1989,8(5):11.
[5]LAWN D J,COUSENS S,OESTERGAARD M Z,et al.National,regional,and worldwide estimates of preterm birth rates in the year2010 with time trends since 1990 for selected countries:a systematic analysis and implications[J].Lancet,2012,379(9832):2162-2172.
[6]王希,康楚云,高燕秋,等.中国3省市21家医院早产发生的相关因素及结局研究[J].中国生育健康杂志,2014,25(1):1-5.
[7]HUANG Z,LIN H,LIU Y,et al.Individual-level and community-level effect modifiers of the temperature-mortality relationship in66 Chinese communities[J].BMJ Open,2015,5(9):e009172.
[8]NGO N S,HORTON R M.Climate change and fetal health:the impacts of exposure to extreme temperatures in New York City[J].Environmental Research,2016,144(Pt A):158-164.
[9]CAROLAN-OLAH M,FRANKOWSKA D.High environmental temperature and preterm birth:a review of the evidence[J].Midwifery,2014,30(1):50-59.
[10]HE J R,LIU Y,XIA X Y,et al.Ambient temperature and the risk of preterm birth in Guangzhou,China(2001-2011)[J].Environmental Health Perspectives,2015,124(7):1509778.
[11]OLIVEIRA R R D,MELO E C,FUJIMORI E,et al.The inner state differences of preterm birth rates in Brazil:a time series study[J].Bmc Public Health,2016,16(1):1-9.
[12]STRAND L B,BARNETT A G,TONG S.The influence of season and ambient temperature on birth outcomes:a review of the epidemiological literature[J].Environmental Research,2011,111(3):451-462.
[13]MOAYERI M,HEIDA K Y,FRANX A,et al.Maternal lipid profile and the relation with spontaneous preterm delivery:a systematic review:[J].Archives of Gynecology&Obstetrics,2017,295(2):313-323.
[14]ACUFF L,FRISTOE K,HAMBLEN J,et al.Third-hand smoke:old smoke,new concerns[J].Journal of Community Health,2016,41(3):680-687.
[15]LINSELL L,MALOUF R,MORRIS J,et al.Risk factor models for neurodevelopmental outcomes in children born very preterm or with very low birth weight:a systematic review of methodology and reporting[J].American Journal of Epidemiology,2017,185(7):601-612.