室外空气污染和不良出生结局的相关性研究:一项系统回顾和荟萃分析（英文）
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摘要
目的:孕期妇女暴露于室外空气污染与子代不良出生结局的发生风险有关,但是结果仍然有争议。本研究旨在定量评估这种相关性并探讨异质性的来源。创新点:报告了三种不良出生结局和七种污染物之间的联系,进行了一系列的亚组分析和敏感性分析。同时,考虑了之前荟萃(meta)分析中未涉及到的气象因素的作用。此外,首次使用系统回顾偏倚风险(ROBIS)工具评估相关领域meta分析的偏倚性。方法:收集已发表的评估室外空气污染与低出生体重、早产、小于胎龄儿关系的病例对照研究或队列研究,具体的纳入标准和分析方法已在PROSPERO网站(CRD42018085816)提供。本研究评估了混合效应和异质性,进一步进行了亚组分析和出版偏倚分析,并采用ROBIS工具评估总体的偏倚性。结论:这项系统回顾和荟萃分析是在低偏倚风险下完成的。结果发现高浓度的空气污染暴露与子代不良出生结局的发生风险有关,且研究间异质性较大。不同的暴露测量方式等亚组分析在一定程度上解释了异质性来源,但仍需进一步探讨。
Several reviews have assessed the relationship between exposure to ambient air pollution and adverse birth outcomes during pregnancy, but the results remain controversial. The objective of this study was to assess this correlation quantitatively and to explore sources of heterogeneity. We included all published case-control or cohort studies that evaluated the correlation between ambient air pollution and low birth weight(LBW), preterm birth(PTB), and small for gestational age(SGA). Analytical methods and inclusion criteria were provided on the PROSPERO website(CRD42018085816). We evaluated pooled effects and heterogeneity. Subgroup analyses(grouped by exposure period, study settings, study design, exposure types, data source, Newcastle-Ottawa quality score(NOS), and adjustment for smoking or meteorological factors) were also conducted and publication bias was examined. The risk of bias in systematic reviews(ROBIS) tool was used to evaluate the overall risk of bias in this review. Forty studies met the inclusion criteria. We observed pooled odds ratios(ORs) of 1.03–1.21 for LBW and 0.97–1.06 for PTB when mothers were exposed to CO, NO_2, NOx, O_3, PM_(2.5), PM10, or SO_2 throughout their pregnancy. For SGA, the pooled estimate was 1.02 in relation to NO_2 concentrations. Subgroup analysis and sensitivity analysis decreased the heterogeneity to some extent, such as the subgroups of continuous measures(OR=0.98(0.97–0.99), I2=0.0%) and NOS>7(OR=0.98(0.97–0.99), I~2=0.0%) in evaluating the association between PTB and NO_2. This review was completed with a low risk of bias. High concentrations of air pollution were significantly related to the higher risk of adverse birth outcomes. However, the sources of heterogeneity among studies should be further explored.
Several reviews have assessed the relationship between exposure to ambient air pollution and adverse birth outcomes during pregnancy, but the results remain controversial. The objective of this study was to assess this correlation quantitatively and to explore sources of heterogeneity. We included all published case-control or cohort studies that evaluated the correlation between ambient air pollution and low birth weight(LBW), preterm birth(PTB), and small for gestational age(SGA). Analytical methods and inclusion criteria were provided on the PROSPERO website(CRD42018085816). We evaluated pooled effects and heterogeneity. Subgroup analyses(grouped by exposure period, study settings, study design, exposure types, data source, Newcastle-Ottawa quality score(NOS), and adjustment for smoking or meteorological factors) were also conducted and publication bias was examined. The risk of bias in systematic reviews(ROBIS) tool was used to evaluate the overall risk of bias in this review. Forty studies met the inclusion criteria. We observed pooled odds ratios(ORs) of 1.03–1.21 for LBW and 0.97–1.06 for PTB when mothers were exposed to CO, NO_2, NOx, O_3, PM_(2.5), PM10, or SO_2 throughout their pregnancy. For SGA, the pooled estimate was 1.02 in relation to NO_2 concentrations. Subgroup analysis and sensitivity analysis decreased the heterogeneity to some extent, such as the subgroups of continuous measures(OR=0.98(0.97–0.99), I2=0.0%) and NOS>7(OR=0.98(0.97–0.99), I~2=0.0%) in evaluating the association between PTB and NO_2. This review was completed with a low risk of bias. High concentrations of air pollution were significantly related to the higher risk of adverse birth outcomes. However, the sources of heterogeneity among studies should be further explored.
引文
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Dugandzic R,Dodds L,Stieb D,et al.,2006.The association between low level exposures to ambient air pollution and term low birth weight:a retrospective cohort study.Environ Health,5(1):3.https://doi.org/10.1186/1476-069x-5-3
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Hannam K,McNamee R,Baker P,et al.,2014.Air pollution exposure and adverse pregnancy outcomes in a large UKbirth cohort:use of a novel spatio-temporal modelling technique.Scand J Work Environ Health,40(5):518-530.https://doi.org/10.5271/sjweh.3423
Hansen C,Neller A,Williams G,et al.,2006.Maternal exposure to low levels of ambient air pollution and preterm birth in Brisbane,Australia.BJOG,113(8):935-941.https://doi.org/10.1111/j.1471-0528.2006.01010.x
Harbord RM,Higgins J,2008.Meta-regression in Stata.Stata J,8(4):493-519.
Higgins JP,Green S,2011.Cochrane Handbook for Systematic Reviews of Interventions,Version 5.1.0.The Cochrane Collaboration.http://handbook.cochrane.org[Accessed on Mar.19,2018].
Higgins JP,Thompson SG,Deeks JJ,et al.,2003.Measuring inconsistency in meta-analyses.Br Med J,327(7414):557-560.https://doi.org/10.1136/bmj.327.7414.557
Huynh M,Woodruff TJ,Parker JD,et al.,2006.Relationships between air pollution and preterm birth in California.Paediatr Perinat Epidemiol,20(6):454-461.https://doi.org/10.1111/j.1365-3016.2006.00759.x
Jalaludin B,Mannes T,Morgan G,et al.,2007.Impact of ambient air pollution on gestational age is modified by season in Sydney,Australia.Environ Health,6(1):16.https://doi.org/10.1186/1476-069X-6-16
Kim OJ,Ha EH,Kim BM,et al.,2007.PM10 and pregnancy outcomes:a hospital-based cohort study of pregnant women in Seoul.J Occup Environ Med,49(12):1394-1402.https://doi.org/10.1097/JOM.0b013e3181594859
Laden F,Neas LM,Dockery DW,et al.,2000.Association of fine particulate matter from different sources with daily mortality in six U.S.cities.Environ Health Perspect,108(10):941-947.https://doi.org/10.1289/ehp.00108941
Lai HK,Tsang H,Wong CM,2013.Meta-analysis of adverse health effects due to air pollution in Chinese populations.BMC Public Health,13:360.https://doi.org/10.1186/1471-2458-13-360
Lamichhane DK,Leem JH,Lee JY,et al.,2015.A metaanalysis of exposure to particulate matter and adverse birth outcomes.Environ Health Toxicol,30:e2015011.https://doi.org/10.5620/eht.e2015011
Lawn JE,Gravett MG,Nunes TM,et al.,2010.Global report on preterm birth and stillbirth(1 of 7):definitions,description of the burden and opportunities to improve data.BMCPregnancy Childbirth,10(Suppl 1):S1.https://doi.org/10.1186/1471-2393-10-S1-S1
Lee PC,Roberts JM,Catov JM,et al.,2013.First trimester exposure to ambient air pollution,pregnancy complications and adverse birth outcomes in Allegheny county,PA.Matern Child Health J,17(3):545-555.https://doi.org/10.1007/s10995-012-1028-5
Leem JH,Kaplan BM,Shim YK,et al.,2006.Exposures to air pollutants during pregnancy and preterm delivery.Environ Health Perspect,114(6):905-910.https://doi.org/10.1289/ehp.8733
Lin CC,Santolaya-Forgas J,1998.Current concepts of fetal growth restriction:part I.Causes,classification,and pathophysiology.Obstetr Gynecol,92(6):1044-1055.https://doi.org/10.1016/S0029-7844(98)00328-7
Lin CM,Li CY,Yang GY,et al.,2004.Association between maternal exposure to elevated ambient sulfur dioxide during pregnancy and term low birth weight.Environ Res,96(1):41-50.https://doi.org/10.1016/j.envres.2004.03.005
Llop S,Ballester F,Estarlich M,et al.,2010.Preterm birth and exposure to air pollutants during pregnancy.Environ Res,110(8):778-785.https://doi.org/10.1016/j.envres.2010.09.009
Madsen C,Gehring U,Walker SE,et al.,2010.Ambient air pollution exposure,residential mobility and term birth weight in Oslo,Norway.Environ Res,110(4):363-371.https://doi.org/10.1016/j.envres.2010.02.005
Nieuwenhuijsen MJ,Dadvand P,Grellier J,et al.,2013.Environmental risk factors of pregnancy outcomes:a summary of recent meta-analyses of epidemiological studies.Environ Health,12(1):6.https://doi.org/10.1186/1476-069X-12-6
Pedersen M,Giorgis-Allemand L,Bernard C,et al.,2013.Ambient air pollution and low birthweight:a European cohort study(ESCAPE).Lancet Respir Med,1(9):695-704.https://doi.org/10.1016/s2213-2600(13)70192-9
Poirier A,Dodds L,Dummer T,et al.,2015.Maternal exposure to air pollution and adverse birth outcomes in Halifax,Nova Scotia.J Occup Environ Med,57(12):1291-1298.https://doi.org/10.1097/JOM.0000000000000604
Qian ZM,Liang SW,Yang SP,et al.,2016.Ambient air pollution and preterm birth:a prospective birth cohort study in Wuhan,China.Int J Hyg Environ Health,219(2):195-203.https://doi.org/10.1016/j.ijheh.2015.11.003
Ritz B,Wilhelm M,Hoggatt KJ,et al.,2007.Ambient air pollution and preterm birth in the environment and pregnancy outcomes study at the University of California,Los Angeles.Am J Epidemiol,166(9):1045-1052.https://doi.org/10.1093/aje/kwm181
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