海南地区空气污染物暴露对妊娠不良结局的影响研究
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摘要
目的：分析海南地区出生缺陷的基本情况、影响因素及变化趋势，研究孕期空气污染物暴露与出生缺陷、早产以及低出生体重等妊娠不良结局的关系，探讨降低出生缺陷、早产和低出生体重等妊娠不良结局的预防策略，为公共卫生决策提供科学依据。
方法：1.利用海南省2000～2010年以医院为基础的出生缺陷监测资料，对海南地区出生缺陷总发生率、发生顺位、城乡的发生率、围产儿性别的发生率等特征进行描述；采用Poisson回归法对出生缺陷发生率的城乡差异、性别差异和在孕母年龄上的差异进行分析，了解海南地区出生缺陷的一般影响因素；利用海口、三亚两市2009～2011年的空气污染资料和出生登记资料，采用成组设计的病例-对照研究法，采用t检验和logistic回归法，分析孕期不同阶段空气污染物暴露与出生缺陷的关系；
2.利用海口市2009～2011年的空气污染资料、气象资料及出生登记系统的活产儿早产、低出生体重等出生情况资料，采用Poisson广义相加模型进行时间序列分析，研究空气污染物暴露与早产和低出生体重的关系。
结果：1.2001～2010年海南省出生缺陷总发生率99.13/万，低于全国平均水平；出生缺陷发生率城市低于农村(IRR=0.765，95%CI：0.715-0.819，P<0.001)；男性围产儿高于女性围产儿(IRR=1.092，95%CI：1.021-1.169，P=0.010)；出生缺陷发生率与孕母年龄相关，<20岁年龄组和≥35岁年龄组发病率较高，且组间没有差异(P>0.05)，其次为20～25岁年龄组(IRR=0.816，95%CI：0.701-0.949，P=0.008)、25～30岁(IRR=0.761，95%CI：0.655-0.883，P<0.001)及30～35岁年龄组(IRR=0.731，95%CI：0.623-0.858，P<0.001)。
2.孕早期空气污染物PM_(10)的暴露对出生缺陷有不良影响。海口市多污染物logistic回归调整模型结果显示，在控制了一般因素和另外两种污染物的影响后，妊娠第2月(OR=1.039，95%CI：1.016-1.063，P=0.001)与第3月(OR=1.066，95%CI：1.043-1.090，P<0.001)空气中PM_(10)的暴露对出生缺陷的总发生率有不良影响。三亚市多污染物logistic回归调整模型结果显示，妊娠第3月(OR=1.025，95%CI：1.006-1.044，P=0.009)空气中PM_(10)的暴露对出生缺陷总发生率有不良影响。海口市空气污染物暴露与先天性心脏病和唇腭裂的关系研究显示，海口市孕早期空气中PM_(10)的暴露为先天性心脏病的影响因素(OR=1.103，95%CI：1.023-1.190，P=0.011)。而所研究的三种污染物孕早期对婴儿唇腭裂发生的影响无统计学意义。
3.海口市大气主要污染物PM_(10)和SO_2浓度水平对早产发生率有不利影响，全污染物模型拟合分析结果显示，PM_(10)污染物滞后当天对新生儿日早产数影响的相对危险度为1.016(95%CI：1.003-1.030，P<0.05)；SO_2污染物累积6天对新生儿日早产数影响的相对危险度为1.141(95%CI：1.039-1.242，P<0.05)；大气主要污染物PM_(10)对低出生体重发生率有不利影响，PM_(10)污染物滞后1天对新生儿日低出生体重数影响的相对危险度为1.024(95%CI：1.011-1.038，P<0.05)；累积6天对新生儿日低出生体重数影响的相对危险度为1.064(95%CI：1.042-1.087，P<0.05)。
结论：孕早期空气污染物PM_(10)的暴露是出生缺陷和先天性心脏病的危险因素；大气主要污染物SO_2和PM_(10)的浓度水平与早产率发生有关，PM_(10)浓度水平与新生儿低出生体重率发生有关；一级预防是控制和减少妊娠不良结局最具成本效益的预防措施，要考虑探讨医疗保健部门与环境监控与保护部门联动的预防机制，努力发挥一级预防的效力。
Objective: To explore the relationship between the air pollutants exposure withadverse pregnancy outcomes such as birth defects, premature birth and low birth weight; toprovide scientific basis for proper intervention strategies to adverse pregnancy outcomes.
Methods:1. The prevalence and the rank of birth defects, the urban-rural differencesand sex differences in the prevalence of birth defects were analyzed on the base of birthdefects monitoring data of Hainan province during2000～2010. The methods ofPoisson-regression and Linear Chi-Square tests were used respectively to compare thedifferences in the prevalence of birth defects between male and female infants, urban andrural areas and the tendency of birth defects prevalence in Hainan province during the past11years according to the data from the monitoring program of birth defects in Hainanprovince. T-test and logistic regression was used to analyze the association between airpollutant exposure and birth defects.
2. Generalized Additive Model extended Poisson regression model were used toanalyze the relationship between air pollutant exposure and premature and low birth weightduring2009to2011.
Results:1. The prevalence of birth defects in Hainan area from2000~2011was99.13/10000, which was lower than the prevalence of our country. The prevalence of birthdefects in urban area was lower than that of rural area (IRR=0.765,95%CI:0.715-0.819,P<0.001); the prevalence of birth defect of male infants was lower than that of femaleinfants (IRR=1.092,95%CI:1.021-1.169, P=0.010); our study showed the birth defectswere associated with maternal age: women less than20years old and the age group greaterthan35had more higher prevalence, there were no difference between the twogroup(P>0.05), following by age group of20～25(IRR=0.816,95%CI:0.701-0.949, P=0.008), age group of25～30(IRR=0.761,95%CI:0.655-0.883, P<0.001) and age groupof30～35(IRR=0.731,95%CI:0.623-0.858, P<0.001)；
2. Peri-gestational exposure to air pollutants of PM_(10)was associated with birth defects.The multiple logistic regression analysis showed that the effect of PM_(10)on the secondmonth (OR=1.039,95%CI:1.016-1.063, P=0.001) and third month (OR=1.066,95%CI:1.043-1.090, P<0.001) of pregnancy was statistically significant associated with birthdefects according to the data from Haikou city. The multiple logistic regression analysisshowed that the effect of PM_(10)on the third month (OR=1.025,95%CI:1.006-1.044,P=0.009) of pregnancy was statistically significant associated with birth defects accordingto the data from Sanya city. The multiple logistic regression analysis showed that the effectof PM_(10)on first trimester was statistically significant with congenital heart diseases(OR=1.103,95%CI:1.023-1.190, P=0.011) according to the data from Haikou city and theeffect of studied air pollutants on the cleft lips had no statistical significance.
3. Exposure to PM_(10)and SO_2was a risk factor of preterm delivery in Haikou city. Theresults of model fitting with all pollutants showed that on the same day, exposure to PM_(10)was significantly associated with increased risk of preterm delivery (RR=1.016,95%CI:1.003-1.030, P<0.05) and on the cumulative6days, exposure to SO_2was significantlyassociated with increased risk of preterm delivery (RR=1.141,95%CI:1.039-1.242,P<0.05). Exposure to PM_(10)was a risk factor of low birth weight. The results of modelfitting with all pollutants showed that on the first day, exposure to PM_(10)was significantlyassociated with increased risk of low birth weight (RR=1.024,95%CI:1.011-1.038,P<0.05) and on the cumulative6days, was significantly associated with increased risk oflow birth weight (RR=1.064,95%CI:1.042-1.087, P<0.05).
Conclusions: Exposure to PM_(10)during the early stages of pregnancy was a risk factorof birth defects and congenital heart disease. Exposure to SO_2and PM_(10)was associated withpreterm delivery. And exposure to PM_(10)during the pregnancy was a risk factor of low birthweight. Primary prevention should be strengthened in order to control and reduce theprevalence of birth defects and adverse pregnancy outcomes, and it is necessary to explorea linkage mechanism between departments of medical health care and environmentalprotection so as to bring out the full effectiveness of primary prevention.
方法：1.利用海南省2000～2010年以医院为基础的出生缺陷监测资料，对海南地区出生缺陷总发生率、发生顺位、城乡的发生率、围产儿性别的发生率等特征进行描述；采用Poisson回归法对出生缺陷发生率的城乡差异、性别差异和在孕母年龄上的差异进行分析，了解海南地区出生缺陷的一般影响因素；利用海口、三亚两市2009～2011年的空气污染资料和出生登记资料，采用成组设计的病例-对照研究法，采用t检验和logistic回归法，分析孕期不同阶段空气污染物暴露与出生缺陷的关系；
2.利用海口市2009～2011年的空气污染资料、气象资料及出生登记系统的活产儿早产、低出生体重等出生情况资料，采用Poisson广义相加模型进行时间序列分析，研究空气污染物暴露与早产和低出生体重的关系。
结果：1.2001～2010年海南省出生缺陷总发生率99.13/万，低于全国平均水平；出生缺陷发生率城市低于农村(IRR=0.765，95%CI：0.715-0.819，P<0.001)；男性围产儿高于女性围产儿(IRR=1.092，95%CI：1.021-1.169，P=0.010)；出生缺陷发生率与孕母年龄相关，<20岁年龄组和≥35岁年龄组发病率较高，且组间没有差异(P>0.05)，其次为20～25岁年龄组(IRR=0.816，95%CI：0.701-0.949，P=0.008)、25～30岁(IRR=0.761，95%CI：0.655-0.883，P<0.001)及30～35岁年龄组(IRR=0.731，95%CI：0.623-0.858，P<0.001)。
2.孕早期空气污染物PM_(10)的暴露对出生缺陷有不良影响。海口市多污染物logistic回归调整模型结果显示，在控制了一般因素和另外两种污染物的影响后，妊娠第2月(OR=1.039，95%CI：1.016-1.063，P=0.001)与第3月(OR=1.066，95%CI：1.043-1.090，P<0.001)空气中PM_(10)的暴露对出生缺陷的总发生率有不良影响。三亚市多污染物logistic回归调整模型结果显示，妊娠第3月(OR=1.025，95%CI：1.006-1.044，P=0.009)空气中PM_(10)的暴露对出生缺陷总发生率有不良影响。海口市空气污染物暴露与先天性心脏病和唇腭裂的关系研究显示，海口市孕早期空气中PM_(10)的暴露为先天性心脏病的影响因素(OR=1.103，95%CI：1.023-1.190，P=0.011)。而所研究的三种污染物孕早期对婴儿唇腭裂发生的影响无统计学意义。
3.海口市大气主要污染物PM_(10)和SO_2浓度水平对早产发生率有不利影响，全污染物模型拟合分析结果显示，PM_(10)污染物滞后当天对新生儿日早产数影响的相对危险度为1.016(95%CI：1.003-1.030，P<0.05)；SO_2污染物累积6天对新生儿日早产数影响的相对危险度为1.141(95%CI：1.039-1.242，P<0.05)；大气主要污染物PM_(10)对低出生体重发生率有不利影响，PM_(10)污染物滞后1天对新生儿日低出生体重数影响的相对危险度为1.024(95%CI：1.011-1.038，P<0.05)；累积6天对新生儿日低出生体重数影响的相对危险度为1.064(95%CI：1.042-1.087，P<0.05)。
结论：孕早期空气污染物PM_(10)的暴露是出生缺陷和先天性心脏病的危险因素；大气主要污染物SO_2和PM_(10)的浓度水平与早产率发生有关，PM_(10)浓度水平与新生儿低出生体重率发生有关；一级预防是控制和减少妊娠不良结局最具成本效益的预防措施，要考虑探讨医疗保健部门与环境监控与保护部门联动的预防机制，努力发挥一级预防的效力。
Objective: To explore the relationship between the air pollutants exposure withadverse pregnancy outcomes such as birth defects, premature birth and low birth weight; toprovide scientific basis for proper intervention strategies to adverse pregnancy outcomes.
Methods:1. The prevalence and the rank of birth defects, the urban-rural differencesand sex differences in the prevalence of birth defects were analyzed on the base of birthdefects monitoring data of Hainan province during2000～2010. The methods ofPoisson-regression and Linear Chi-Square tests were used respectively to compare thedifferences in the prevalence of birth defects between male and female infants, urban andrural areas and the tendency of birth defects prevalence in Hainan province during the past11years according to the data from the monitoring program of birth defects in Hainanprovince. T-test and logistic regression was used to analyze the association between airpollutant exposure and birth defects.
2. Generalized Additive Model extended Poisson regression model were used toanalyze the relationship between air pollutant exposure and premature and low birth weightduring2009to2011.
Results:1. The prevalence of birth defects in Hainan area from2000~2011was99.13/10000, which was lower than the prevalence of our country. The prevalence of birthdefects in urban area was lower than that of rural area (IRR=0.765,95%CI:0.715-0.819,P<0.001); the prevalence of birth defect of male infants was lower than that of femaleinfants (IRR=1.092,95%CI:1.021-1.169, P=0.010); our study showed the birth defectswere associated with maternal age: women less than20years old and the age group greaterthan35had more higher prevalence, there were no difference between the twogroup(P>0.05), following by age group of20～25(IRR=0.816,95%CI:0.701-0.949, P=0.008), age group of25～30(IRR=0.761,95%CI:0.655-0.883, P<0.001) and age groupof30～35(IRR=0.731,95%CI:0.623-0.858, P<0.001)；
2. Peri-gestational exposure to air pollutants of PM_(10)was associated with birth defects.The multiple logistic regression analysis showed that the effect of PM_(10)on the secondmonth (OR=1.039,95%CI:1.016-1.063, P=0.001) and third month (OR=1.066,95%CI:1.043-1.090, P<0.001) of pregnancy was statistically significant associated with birthdefects according to the data from Haikou city. The multiple logistic regression analysisshowed that the effect of PM_(10)on the third month (OR=1.025,95%CI:1.006-1.044,P=0.009) of pregnancy was statistically significant associated with birth defects accordingto the data from Sanya city. The multiple logistic regression analysis showed that the effectof PM_(10)on first trimester was statistically significant with congenital heart diseases(OR=1.103,95%CI:1.023-1.190, P=0.011) according to the data from Haikou city and theeffect of studied air pollutants on the cleft lips had no statistical significance.
3. Exposure to PM_(10)and SO_2was a risk factor of preterm delivery in Haikou city. Theresults of model fitting with all pollutants showed that on the same day, exposure to PM_(10)was significantly associated with increased risk of preterm delivery (RR=1.016,95%CI:1.003-1.030, P<0.05) and on the cumulative6days, exposure to SO_2was significantlyassociated with increased risk of preterm delivery (RR=1.141,95%CI:1.039-1.242,P<0.05). Exposure to PM_(10)was a risk factor of low birth weight. The results of modelfitting with all pollutants showed that on the first day, exposure to PM_(10)was significantlyassociated with increased risk of low birth weight (RR=1.024,95%CI:1.011-1.038,P<0.05) and on the cumulative6days, was significantly associated with increased risk oflow birth weight (RR=1.064,95%CI:1.042-1.087, P<0.05).
Conclusions: Exposure to PM_(10)during the early stages of pregnancy was a risk factorof birth defects and congenital heart disease. Exposure to SO_2and PM_(10)was associated withpreterm delivery. And exposure to PM_(10)during the pregnancy was a risk factor of low birthweight. Primary prevention should be strengthened in order to control and reduce theprevalence of birth defects and adverse pregnancy outcomes, and it is necessary to explorea linkage mechanism between departments of medical health care and environmentalprotection so as to bring out the full effectiveness of primary prevention.
引文
[1] Simkhovich B Z, Kleinman M T, Kloner R A. Air pollution and cardiovascular injuryepidemiology, toxicology, and mechanism. J Am Coll Cardiol,2008,52(9):719-726.
[2] Cardenas M, Vallejo M, Romano-Riquer P, et al. Personal exposure to PM2.5airpollution and heart rate variability in subjects with positive or negative head-up tilt test.Environ Res,2008,108(1):1-6.
[3]Viegi G, Maio S, Pistelli F, et al. Epidemiology of chronic obstructive pulmonarydisease: health effects of air pollution. Respirology,2006,11(5):523-532.
[4]Stieb D M, Szyszkowicz M, Rowe B H, et al. Air pollution and emergency departmentvisits for cardiac and respiratory conditions: a multi-city time-series analysis. EnvironHealth,2009,8(25).
[5]Chen H, Goldberg M S, Villeneuve P J. A systematic review of the relation betweenlong-term exposure to ambient air pollution and chronic diseases. Rev Environ Health,2008,23(4):243-297.
[6]Middleton N, Yiallouros P, Kleanthous S, et al. A10-year time-series analysis ofrespiratory and cardiovascular morbidity in Nicosia, Cyprus: the effect of short-termchanges in air pollution and dust storms. Environ Health,2008,7(39).
[7]Chang H H, Fuentes M, Frey H C. Tie series analysis of personal exposure to ambientair pollution and mortality using an exposure simulator. J Expo Sci Environ Epidemiol,2012,22(5):483-488.
[8]黄晓亮,戴灵真,卢萍,等.广州市2004-2008年大气污染对城区居民每日死亡率影响的时间序列分析.中华流行病学杂志,2012,33(2):210-214.
[9]王德征,顾清,江国虹,等.天津市空气污染物对脑卒中死亡影响的时间序列分析.中华劳动卫生职业病杂志,2012,30(12):902-907.
[10]常桂秋,潘小川,谢学琴,等.北京市大气污染与城区居民死亡率的时间序列分析.中华预防医学杂志,2012,46(2):139-142.
[11]Balakrishnan K, Ganguli B, Ghosh S, et al. Part1. Short-term effects of air pollutionon mortality: results from a time-series analysis in Chennai, India. Res Rep Health EffInst,2011,Mar(157):7-44.
[12]Lopez-Villarrubia E, Ballester F, Iniguez C, et al. Air pollution and mortality in theCanary Islands: a time-series analysis. Environ Health,2010,9(8):1-11.
[13]Cesaroni G, Badaloni C, Gariazzo C, et al. Long-term exposure to urban air pollutionand mortality in a cohort of more than a million adults in Rome. Environ HealthPerspect,2013,121(3):324-331.
[14]Hackley B, Feinstein A, Dixon J. Air pollution: impact on maternal and perinatal health.J Midwifery Womens Health,2007,52(5):435-443.
[15]朱军.国内外出生缺陷的监测进展.实用妇产科杂志,2008(1):3-4.
[16]梅盛平,张红.出生缺陷相关因素的研究进展.湖北职业技术学院学报,2011,14(4):107-109.
[17]吴颖臻,傅咏南,方茹,等.当前我国生殖健康与出生缺陷的现状分析与思考.中国优生优育,2013,19(1):45-49.
[18]中华人民共和国卫生部.中国出生缺陷防治报告2012.北京:中华人民共和国卫生部,2012.
[19]蔡晶,杨菁.导致出生缺陷的环境因素研究进展.国际妇产科学杂志,2012(5):483-486.
[20]Ritz B, Yu F, Fruin S, et al. Ambient air pollution and risk of birth defects in SouthernCalifornia. Am J Epidemiol,2002,155(1):17-25.
[21]Patel S S, Burns T L, Botto L D, et al. Analysis of selected maternal exposures and non‐syndromic atrioventricular septal defects in the National Birth Defects PreventionStudy,1997–2005. American Journal of Medical Genetics Part A,2012,158(10):2447-2455.
[22]Dadvand P, Rankin J, Rushton S, et al. Ambient air pollution and congenital heartdisease: a register-based study. Environ Res,2011,111(3):435-441.
[23]Dolk H, Armstrong B, Lachowycz K, et al. Ambient air pollution and risk of congenitalanomalies in England,1991-1999. Occup Environ Med,2010,67(4):223-227.
[24]Hansen C A, Barnett A G, Jalaludin B B, et al. Ambient air pollution and birth defectsin brisbane, australia. PLoS One,2009,4(4):e5408.
[25]Hwang B F, Jaakkola J J. Ozone and other air pollutants and the risk of oral clefts.Environ Health Perspect,2008,116(10):1411-1415.
[26]Marshall E G, Harris G, Wartenberg D. Oral cleft defects and maternal exposure toambient air pollutants in New Jersey. Birth Defects Res A Clin Mol Teratol,2010,88(4):205-215.
[27]Rankin J, Chadwick T, Natarajan M, et al. Maternal exposure to ambient air pollutantsand risk of congenital anomalies. Environ Res,2009,109(2):181-187.
[28]Dadvand P, Rankin J, Rushton S, et al. Association between maternal exposure toambient air pollution and congenital heart disease: A register-based spatiotemporalanalysis. Am J Epidemiol,2011,173(2):171-182.
[29]徐志红,徐爱群,曾蔚越.早产的定义和分类.实用妇产科杂志,2005,21(11):643-644.
[30]Goldenberg R L, Culhane J F, Iams J D, et al. Epidemiology and causes of pretermbirth. Lancet,2008,371(9606):75-84.
[31]汪雪琴,李金涛,汪林峰.空气污染物暴露与早产的相关性调查.中国现代医生,2012(14):19-21.
[32]中华人民共和国卫生部妇幼保健与社区卫生司.全国妇幼卫生监测及年报通讯.北京:卫生部,2008.
[33]孙蓉,侯晓静.早产相关因素研究进展.中国公共卫生,2012(4):560-561.
[34]张晓铭,张美仙,侯冬青,等.出生体重对儿童期和成年期高血压影响的队列研究.中国循证儿科杂志,2011,6(3):199-204.
[35]Ritz B. Air pollution and congenital anomalies. Occup Environ Med,2010,67(4):221-222.
[36] Pereira G,Nassar N,Cook A, et al. Traffic emissions are associated with reduced fetalgrowth in areas of Perth, Western Australia: an application of the AusRoads dispersionmodel. Aust N Z J Public Health,2011,35(5):451-458.
[37]Woodruff T J, Carlson A, Schwartz J M, et al. Proceedings of the Summit onEnvironmental Challenges to Reproductive Health and Fertility: executive summary.Fertil Steril,2008,89(Suppl2):e1-e20.
[38]Shah P S, Balkhair T. Air pollution and birth outcomes: a systematic review. EnvironInt,2011,37(2):498-516.
[39]陈晓,陈亚琼,侯海燕,等.天津地区空气污染与围生儿死亡和出生缺陷的关系.国际妇产科学杂志,2012,39(3):308-310.
[40]郑金艳,惠武莉，兰晓霞，等.围妊娠期暴露于空气污染物SO2、NO2与出生缺陷的相关性研究.国际妇产科学杂志,2013,40(1):71-73.
[41]Wang X, Ding H, Ryan L, et al. Association between air pollution and low birth weight:a community-based study. Environ Health Perspect,1997,105(5):514-520.
[42]赵庆国,李兵.户外空气中可吸入颗粒物对出生体重的影响.中国妇幼健康研究,2008,19(1):4-6.
[43]李庆业,刘筱娴.出生缺陷的研究进展.国外医学(社会医学分册),2001,18(2):64-67.
[44]赵秀艳,游昭华,史习舜.出生缺陷的研究进展.海峡预防医学杂志,2006,12(2):23-26.
[45]Tan K H, Tan T Y, Tan J, et al. Birth defects in Singapore:1994-2000. Singapore MedJ,2005,46(10):545-552.
[46]王秀梅.盐城市2008-2010年出生缺陷监测结果分析.江苏卫生保健(学术版),2011,13(5):40-41.
[47]国家环境保护部.关于发布国家环境质量标准<环境空气质量标准>的公告.http://www.gov.cn/zwgk/2012-03/02/content_2081359.htm,2012-02-29/2013-05-18.
[48]Marcazzan G M, Vaccaro S, Valli G, et al. Characterisation of PM10and PM2.5particulate matter in the ambient air of Milan (Italy). Atmospheric Environment,2001,35(27):4639-4650.
[49]Barnett A G, Williams G M, Schwartz J, et al. The effects of air pollution onhospitalizations for cardiovascular disease in elderly people in Australian and NewZealand cities. Environ Health Perspect,2006,114(7):1018-1023.
[50]Barnett A G, Williams G M, Schwartz J, et al. Air pollution and child respiratoryhealth: a case-crossover study in Australia and New Zealand. Am J Respir Crit CareMed,2005,171(11):1272-1278.
[51]Mathews T J, MacDorman M F. Infant mortality statistics from the2005period linkedbirth/infant death data set. Natl Vital Stat Rep,2008,57(2):1-32.
[52]Ritz B, Wilhelm M. Ambient air pollution and adverse birth outcomes: methodologicissues in an emerging field. Basic Clin Pharmacol Toxicol,2008,102(2):182-190.
[53]Slama R, Darrow L, Parker J, et al. Meeting report: atmospheric pollution and humanreproduction. Environ Health Perspect,2008,116(6):791-798.
[54]Stillerman K P, Mattison D R, Giudice L C, et al. Environmental exposures andadverse pregnancy outcomes: a review of the science. Reprod Sci,2008,15(7):631-650.
[55]Gilboa S M, Mendola P, Olshan A F, et al. Comparison of residential geocodingmethods in population-based study of air quality and birth defects. EnvironmentalResearch,2006,101(2):256-262.
[56]Gilboa S M, Mendola P, Olshan A F, et al. Relation between ambient air quality andselected birth defects, seven county study, Texas,1997-2000. Am J Epidemiol,2005,162(3):238-252.
[57]Strickland M J, Klein M, Correa A, et al. Ambient air pollution and cardiovascularmalformations in Atlanta, Georgia,1986-2003. Am J Epidemiol,2009,169(8):1004-1014.
[58]Vrijheid M, Martinez D, Manzanares S, et al. Ambient air pollution and risk ofcongenital anomalies: a systematic review and meta-analysis. Environ Health Perspect,2011,119(5):598-606.
[59]Kim O J, Ha E H, Kim B M, et al. PM10and pregnancy outcomes: a hospital-basedcohort study of pregnant women in Seoul. J Occup Environ Med,2007,49(12):1394-1402.
[60]郑金艳.围孕期空气污染的暴露与出生缺陷的相关性研究:[硕士学位论文].河北医科大学图书馆,2010.
[61]Brender J D, Zhan F B, Suarez L, et al. Linking environmental hazards and birthdefects data. International Journal of Occupational and Environmental Health,2006,12(2):126-133.
[62]冯小微,朴军,肖平,等.本溪市出生缺陷儿与大气污染及其它环境因素关系的研究.中华儿童保健杂志,1997,5(4):276-279.
[63]林玲,赵妮,张蕴晖,等.空气污染对人群生殖健康的影响.国外医学(卫生学分册),2006,33(6):348-352.
[64]李玲,万丽娟,李向云.出生缺陷相关危险因素研究进展.见:中华医学会新生儿筛查20周年纪念论坛论文集,西安,2009.
[65]国务院妇女儿童工作委员会.中国提高出生人口素质减少出生缺陷和残疾行动计划(2002～2010年).中国妇幼保健,2002(11):4-7.
[66]杜玉开,丁辉.生殖健康概论.第1版.北京:人民卫生出版社,2012,115-120.
[67]Hellerstedt W L, Pirie P L, Lando H A, et al. Differences in preconceptional andprenatal behaviors in women with intended and unintended pregnancies. Am J PublicHealth,1998,88(4):663-666.
[68]Green-Raleigh K, Lawrence J M, Chen H, et al. Pregnancy planning status and healthbehaviors among nonpregnant women in a California managed health care organization.Perspect Sex Reprod Health,2005,37(4):179-183.
[69] Morin P, De Wals P, St-Cyr-Tribble D, et al. Pregnancy planning: a determinant offolic acid supplements use for the primary prevention of neural tube defects. Can JPublic Health,2002,93(4):259-263.
[70]郑晓瑛,宋新明,李成福,等.计划与非计划怀孕围孕期环境危险因素暴露差异的分析中华流行病学杂志,2008,29(3):216-219.
[71]宫蕊,王志萍,赵仲堂.神经管缺陷一级预防措施研究与实施现状.中华流行病学杂志,2008,29(11):1144-1148.
[72]Busby A, Abramsky L, Dolk H, et al. Preventing neural tube defects in Europe:population based study. BMJ,2005,330(7491):574-575.
[73]周英凤,吕军,白鸽,等.孕前保健服务的内涵及现状分析.中国卫生资源,2010,13(4):162-165.
[74]夏建红,于佳,赵庆国,等.户外空气质量与出生缺陷的生态学研究及干预.中国优生与遗传杂志.2009,17(3):102-104.
[75]Bonzini M, Carugno M, Grillo P, et al. Impact of ambient air pollution on birthoutcomes: systematic review of the current evidences. Med Lav,2010,101(5):341-363.
[76]Jiang L L, Zhang Y H, Song G X, et al. A time series analysis of outdoor air pollutionand preterm birth in Shanghai, China. Biomed Environ Sci,2007,20(5):426-431.
[77]赵庆国,梁志江,李兵,等.某市空气污染对早产急性影响的Poisson广义可加模型分析.环境与健康杂志,2010(06):488-492.
[78]Schwartz J, Dockery D W, Neas L M. Is daily mortality associated specifically withfine particles?. J Air Waste Manag Assoc,1996,46(10):927-939.
[79]Wood S N, Augustin N H. GAMs with integrated model selection using penalizedregression splines and applications to environmental modelling. Ecological Modelling,2002,157(2):157-177.
[80]陈峰.医用多元统计分析方法.第2版.北京:中国统计出版社,2007.
[81]Peng R D, Dominici F, Louis T A. Model choice in time series studies of air pollutionand mortality. Journal of the Royal Statistical Society: Series A (Statistics in Society),2006,169(2):179-203.
[82]Hastie T, Tibshirani R. Generalized additive models. Chapman\&Hall/CRC,1990,28.
[83]Goldberg M S, Bailar Rd J C, Burnett R T, et al. Identifying subgroups of the generalpopulation that may be susceptible to short-term increases in particulate air pollution: atime-series study in Montreal, Quebec. Research Report (Health Effects Institute),2000(97):7-113.
[84]Schwartz J, Spix C, Touloumi G, et al. Methodological issues in studies of air pollutionand daily counts of deaths or hospital admissions. Journal of Epidemiology andCommunity Health,1996,50(Suppl1):S3-S11.
[85] Wong C, Ma S, Hedley A J, et al. Effect of air pollution on daily mortality in HongKong. Environmental Health Perspectives,2001,109(4):335-340.
[86]Goldberg M S, Burnett R T, Bailar Rd J C, et al. The association between dailymortality and ambient air particle pollution in Montreal, Quebec.2. Cause-specificmortality. Environmental Research,2001,86(1):26-36.
[87]王艳,张宜升,李欣鹏.济南城区空气污染对呼吸道疾病门诊量的影响.中国环境科学,2008,28(6):571-576.
[88]赵庆国.妊娠期空气污染物暴露对早产与低出生体重的健康效应研究:[博士学位论文]武汉:华中科技大学图书馆,2010.
[89]徐丽珍,薛小平,张燕萍,等.太原市孕期空气污染暴露对早产的影响.环境与健康杂志,2008(4):298-301.
[90]张美云,金银龙.空气污染对早产和低出生体重影响的流行病学研究现况.环境与健康杂志,2008(3):270-273.
[91] Ritz B, Wilhelm M, Hoggatt K J, et al. Ambient air pollution and preterm birth in theenvironment and pregnancy outcomes study at the University of California, LosAngeles. Am J Epidemiol,2007,166(9):1045-1052.
[92] Bell M L, Ebisu K, Belanger K. Ambient air pollution and low birth weight inConnecticut and Massachusetts. Environ Health Perspect,2007,115(7):1118-1124.
[93]王斌,高会旺.中国沿海城市空气污染指数的分布特征.生态环境,2008(2):542-548.
[1]熊惠玲,马艳.出生缺陷的病因学研究进展.新疆医科大学学报,2006,29(8):765-766.
[2]杜玉开,丁辉.生殖健康概论.第1版.北京:人民卫生出版社,2012.115-120.
[3]杨敏娟,潘小川.北京市大气污染与居民心脑血管疾病死亡的时间序列分析.环境与健康杂志,2008,4(25):294-297.
[4] Watanabe N, Oonuki Y. Inhalation of diesel exhaust affects spermato-genesis ingrowing male rats. Environ Health Perspect,1999,107(7):539-544.
[5] Yoshida S, Sagai M, Oshio S, et al. Exposure to diesel exhaust affects the malereproductive system of mice. Int J Androl,1999,22(5):307-315.
[6] Tsukue N, Toda N, Tsubone H, et al. Diesel exhaust (DE) affects there gulation oftesticular function in male Fischer344rats. J Toxicol Environ Health A,2001,63(2):115-126.
[7] Singh J. Nitrogen dioxide exposure alters neonatal development. Neurotoxicology,1988,9(3):545-549.
[8] Astrup P, Olsen H M, Trolle D, et al. Effect of moderate carbon monoxide exposure onfetal development. The Lancet,1972,300(7789):1220-1222.
[9] Bailey L T J, Johnston M C, Billet J. Effects of carbon monoxide and hypoxia on cleftlip in A/J mice. Cleft Palate Craniofac J,1995,32(1):14-19.
[10]Singh J, Scott L H. Threshold for carbon monoxide induced Fetotoxi City. Teratology,1984,30(2):253-257.
[11]Singh J, Aggison L, Moore-Cheatum L. Teratogenicity and developmental toxicity ofcarbon monoxide in protein-deficient mice. Teratology,1993,48(2):149-159.
[12]Somers C M, Mc Carry B E, Malek F, et al. Reduction of particulate air pollutionlowers the risk of heritable mutations in mice. Science,2004,304(5673):1008-1010.
[13]Samet J M, DeMarini D M, Malling H V. Do airborne particles induce heritablemutations?. Science,2004,304(5673):971-972.
[14]Perera F P, Rauh V, Whyatt R M, et al. Molecular evidence of an interaction betweenprenatal environmental exposures on birth outcomes in a multiethnic population.Environ Health Perspect,2004,112(5):626-630.
[15]Somers C M, Yauk C L, White P A, et al. Air pollution induces heritable DNAmutations. Proc Natl Acad USA,2002,99(15):904-907.
[16]秦保平,解辉,韩静.天津市空气污染物PM10/TSP比例研究.城市环境与城市生态,2002,15(6):20-21.
[17]王伟人,孙长学.出生缺陷相关危险因素.中国优生与遗传杂志,2005,13(9):1-6.
[18]Wihelm M, Ritz B. Local variations in CO and particulate air pollution and birthoutcomes in Los Angeles County, California. Environ Health Perspect,2005,113(9):1212-1221.
[19]Sagiv S K, Mendola P, Loomis D, et al. A time series analysis of air pollution andpreterm birth in Pennsylvania,1997-2001. Environ Health Perspect,2005,113(5):602-606.
[20]Srám R J, Binková B, Dejmek J, et al. Ambient air pollution and pregnancy outcomes:a review of the literature. Environ Health Perspect,2005,113(4):375-382.
[21]黄醒华.早产的防治.中华围产医学杂志,2003,6(6):363-365.
[22]Ponce N A, Hoggatt K J, Wilhelm M, et al. Preterm Birth: The Interaction ofTraffic-related Air Pollution with Economic Hardship in Los Angeles Neighborhoods.Am J Epidemiol,2005,162(2):140-148.
[23]龚建华.早产危险因素的研究进展.国外医学:妇幼保健分册,1990,1:11.
[24]Chien P F, Khan K S, Ogston S, et al. The diagnostic accuracy of cervico-vaginal fetalfibronectin in predicting preterm delivery: an overview. British Journal of Obstetricsand Gynaecology,1997,104(4):436-444.
[25]Poloniecki J D, Atkinson R W, Poncede Leon A, Anderson H R. Daily time series forcardiovascular hospital admissions and previous day's air pollution in London, UK.Occup Environ Med.1997,54(8):535-540.
[26]Maynard R L, Cameron K M, Fielder R. Setting air quality standards for carcinogens:an alter native to mathematical quantitative risk assessment-discission paper. Hum anExp Toxicol,1995,14(2):175-186.
[27]Stieb D M, Szyszkowicz M, Rowe B H, et al. Air pollution and emergency departmentvisits for cardiac and respiratory conditions: a multi-city time-series analysis. EnvironHealth,2009,8:25.
[28]Wordley J, Walter S, Ayres J G. Short term variations in hospital admissions andmortality and particulate air pollution. Occup Environ Med,1997,54(2):108-116.
[29]Kline J, Stein Z, usser M. Conception to birth: epidemiology of prenatal development.New York: Oxford University Press,1989;191-207.
[30]Ritz B, Yu F, Chapa G, et al. Effect of air pollution on preterm birth among childrenborn in Southern California between1989and1993. Epidemiol.2000,11(5):502-511.
[31]Sagiv SK, Mendola P, Loomis D, et al. A time-series analysis of air pollution andpreterm birth in Pennsylvania,1997-2001. Environ Health Perspect,2005,113(5):602-606.
[32]Leem J H, Kaplan B M, Shim Y K, et al. Exposures to air pollutants during pregnancyand preterm delivery. Environ Health Perspect,2006,114(6):905-910.
[33]Liu S, Krewski D, Shi Y, et al. Association between gaseous ambient air pollutants andadverse pregnancy outcomes in Vancouver, Canada. Environ Health Perspect,2003,111(14):1773-1778.
[34]Hansen C, Neller A, Williams G, et al. Maternal exposure to low levels of ambient airpollution and preterm birth in Brisbane, Australia. BJOG,2006,113(8):935-941..
[35]Xu X, Ding H, Wang X. Acute effects of total suspended particles and sulfur dioxideson preterm delivery: a community-based cohort study. Arch Environ Health,1995,50(6):407-415.
[36]Jiang L, Zhang Y, Song G, et al. A time series analysis of outdoor air pollution andpreterm birth in Shanghai, China. Biomed Environ Sci,2007,20(5):426-431.
[37]朱娟,梁志江,温济英,等.某市空气污染对早产影响的病例对照研究.环境与健康杂志,2011,28(2):132-135.
[38]汪雪琴,李金涛,汪林峰.空气污染物暴露与早产的相关性调查.中国现代医生,2012,50(14):19-21.
[39]张燕萍,张志琴,武永春,等.太原市空气污染对早产的急性影响.环境与健康杂志,2008,25(3):196-197.
[40]Mumbare S S, Maindarkar G, Darade R, et al.Matenal risk factors associated with termlow birth weight neonates: A matched-pair case control study. Indian Pediatrics,2012,49(1):25-28.
[41]张扬,王爱英,郑戈.低出生体重儿及其影响因素.河南预防医学杂志,1994,5(6):344-345.
[42]Duvekot J J, Cheriex E C, Pieters F A A, et al. Severely impaired fetal growth ispreceded by maternal hemodynamic maladaptation in very early pregnancy. ActaObstet Gynecol Scand,1995,74(9):693-697.
[43]Khong T Y, Wolf F, Robertson W B, et al. Inadequate maternal vascular response toplacentation in pregnancies complicate‐d eclabmy psiap reand bysmall‐for‐gestationalageinfants. BJOG,1986,93(10):1049-1059.
[44]Bobak M. Outdoor air pollution, low birth weight, and prematurity. Environ HealthPerspect,2000,108(2):173-176.
[45]Longo L D. The biological effects of carbon monoxide on the pregnant woman, fetus,and newborn infant. Am J Obstet Gynecol,1977,129(1):69-103.
[46]Lin C M, Li C Y, Yang G Y, et al. Association between maternal exposureto elevatedambient sulfer dioxide during pregnancy and term low birth weight. Environ Res,2004,96(1):41-50.
[47]Perera F P, Jedrychowski W, Rauh V, et al. Molecular epidemiologic research on theeffects of environmental pollutants on the fetus. Environ Health Perspect,1999,107(Suppl3):451-460.
[48]Perera F P, Hemminki K, Gryzbowska E, et al. Molecular and genetic damage inhumans from environmental pollution in Poland. Nature,1992,360:256-258.
[49]Perera FP, Whyatt R M, Jedrychowski W, et al. Recent developments in molecularepidemiology: a study of the effects of environmental polycyclic aromatichydrocarbons on birth outcomes in Poland. Am J Epidemiol,1998,147(3):309-314.
[50]Hansen C A, Barnett A G, Jalaludin B B, et a1. Ambient air pollution and birth defectsin Brisbane Australia. PLoS ONE,2009,4(4): e5408.
[51]Morales-Suárez-Varela M M, Bille C, Christensen K, et al. Smoking habits, nicotineuse, and congenital malformations. Obstet Gynecol,2006,107(1):51-57.
[52]Wu J, Hou H, Ritz B, et al. Exposure to polycyclic aromatichydrocarbons and missedabortion in early pregnancy in a Chinese population. Sci Total Environ,2010,408(11):2312-2318.
[53]卫生部妇幼保健与社区卫生司.全国妇幼卫生监测及年报通讯. http://www.mch-scn. org/Article_Show. asp?ArticleI=429,2011-03-01/2011-08-24.
[54]郑林媚,洪新如,孙庆华.空气污染对胎儿生长发育的影响及作用机制.中国优生与遗传杂志,2011:19(3):1-3.
[55]Gilboa S M, Mendoh P, Olshan A F, et a1. Relation between ambient air quality andselected birth defects, seven county study, texas,1997-2000. Am J Epidemiol,2005,162(3):238-252.
[56]Ritz B, Yu F, Fruin S, et al. Ambient air pollution and risk of birth defects in southernCalifornia. Am J Epidemiol,2002,155(1):17-25.
[57]Strickland M J, Klein M, Correa A, et al. Ambient Air Pollution and CardiovascularMalformations in Atlanta, Georgia,1986-2003. Am J Epidemiol,2009,169(8):1004-1014.
[58]van Beynum I M, Mooij C, Kapusta L, et al. Common894G> T single nucleotidepolymorphism in the gene coding for endothelial nitric oxide synthase (eNOS) and riskof congenital heart defects. Clin Chem Lab Med,2008,46(10):1369-1375.
[59]Smrcka V, Leznarova D. et al. Environmental pollution and the occurrence ofcongenital defects in a15-year period in a south Moravian district. Acta Chir Plast,1998,40(4):112-114.
[60]Leem J H, Kaplan B M, Shim Y K, et a.l Exposures to air pollutants during pregnancyand preterm delivery. Environ Health Perspect,2006,114(6):905.
[61]郑金艳,惠武利,兰晓霞,等.围妊娠期暴露于空气污染物SO2、NO2与出生缺陷的相关性研究.国际妇产科学杂志,2013(1):71-74.
[62]Rogers J F, Dunlop A L. Air pollution and very low birth weight infants: A targetpopulation?. Pediatrics,2006,118(1):156-164.
[63]Lee B E, Ha E.H, Park H.S, et al. Exposure to air pollution during different gestationalphase contributes to risk of low birth weight. Human Reproduction,2003,18(3):638-643.
[64]Dugandzic R, Dodds L, Stieb D, et al. The association between low level exposures toambient air pollution and term low birth weight: a retrospective cohort study. EnvironHealth,2006,5:3.
[65]Gouveia N, Bremner S A, Novaes H M D. Association between ambient air pollutionand birth weight in Sao Paulo, Brazil. J Epidemiol Community Health,2004,58(1):11-17.
[66]Choi H, Jedryehowski W, Spengler J, et al. International studies ofprenatal exposure topolyeyelie aromatic hydrocarbons and fetalgrowth. Environ Health Perspect,2006,114(11):1744-1750.
[67]Le H Q, Batterman S A, Wirth J J, et al. Air pollutant exposure and pretermand term small-for-gestational-age births in Detroit, Michigan: long-term trends andassociations. Environ Int.2012,44:7-17.
[68] Bell M L, Ebisu K, Belanger K. Ambient air pollution and low birthweight in Connecticut andMassachusetts. Environ Health Perspect,2007,115(7):1118-1124.
[69] Medeiros A, Gouveia N. Relationship between low birthweight and airpollution in the city of SaoPaulo, Brazil. Rev Saude Publica,2005,39(6):965-972.
[70] Brauer M, Lencar C, Tamburic L, et al. Acohort study of traffic related air pollution impacts onbirth outcomes. Environ Health Perspect,2008,116(5):680-686.
[71]Liu S, Krewski D, Shi Y, et al. Association between maternal exposure to ambient air pollutantsduring pregnancy and fetal growth restriction. J Expo Sci Environ Epidemiol,2007,17(5):426-432.
[72] Steinvil A, Kordova-Biezuner L, Shapira I, et al. Short term exposure to air pollution andinflammation sensitive biomarkers. Environ Res,2008,106(1):51-61.
[2] Cardenas M, Vallejo M, Romano-Riquer P, et al. Personal exposure to PM2.5airpollution and heart rate variability in subjects with positive or negative head-up tilt test.Environ Res,2008,108(1):1-6.
[3]Viegi G, Maio S, Pistelli F, et al. Epidemiology of chronic obstructive pulmonarydisease: health effects of air pollution. Respirology,2006,11(5):523-532.
[4]Stieb D M, Szyszkowicz M, Rowe B H, et al. Air pollution and emergency departmentvisits for cardiac and respiratory conditions: a multi-city time-series analysis. EnvironHealth,2009,8(25).
[5]Chen H, Goldberg M S, Villeneuve P J. A systematic review of the relation betweenlong-term exposure to ambient air pollution and chronic diseases. Rev Environ Health,2008,23(4):243-297.
[6]Middleton N, Yiallouros P, Kleanthous S, et al. A10-year time-series analysis ofrespiratory and cardiovascular morbidity in Nicosia, Cyprus: the effect of short-termchanges in air pollution and dust storms. Environ Health,2008,7(39).
[7]Chang H H, Fuentes M, Frey H C. Tie series analysis of personal exposure to ambientair pollution and mortality using an exposure simulator. J Expo Sci Environ Epidemiol,2012,22(5):483-488.
[8]黄晓亮,戴灵真,卢萍,等.广州市2004-2008年大气污染对城区居民每日死亡率影响的时间序列分析.中华流行病学杂志,2012,33(2):210-214.
[9]王德征,顾清,江国虹,等.天津市空气污染物对脑卒中死亡影响的时间序列分析.中华劳动卫生职业病杂志,2012,30(12):902-907.
[10]常桂秋,潘小川,谢学琴,等.北京市大气污染与城区居民死亡率的时间序列分析.中华预防医学杂志,2012,46(2):139-142.
[11]Balakrishnan K, Ganguli B, Ghosh S, et al. Part1. Short-term effects of air pollutionon mortality: results from a time-series analysis in Chennai, India. Res Rep Health EffInst,2011,Mar(157):7-44.
[12]Lopez-Villarrubia E, Ballester F, Iniguez C, et al. Air pollution and mortality in theCanary Islands: a time-series analysis. Environ Health,2010,9(8):1-11.
[13]Cesaroni G, Badaloni C, Gariazzo C, et al. Long-term exposure to urban air pollutionand mortality in a cohort of more than a million adults in Rome. Environ HealthPerspect,2013,121(3):324-331.
[14]Hackley B, Feinstein A, Dixon J. Air pollution: impact on maternal and perinatal health.J Midwifery Womens Health,2007,52(5):435-443.
[15]朱军.国内外出生缺陷的监测进展.实用妇产科杂志,2008(1):3-4.
[16]梅盛平,张红.出生缺陷相关因素的研究进展.湖北职业技术学院学报,2011,14(4):107-109.
[17]吴颖臻,傅咏南,方茹,等.当前我国生殖健康与出生缺陷的现状分析与思考.中国优生优育,2013,19(1):45-49.
[18]中华人民共和国卫生部.中国出生缺陷防治报告2012.北京:中华人民共和国卫生部,2012.
[19]蔡晶,杨菁.导致出生缺陷的环境因素研究进展.国际妇产科学杂志,2012(5):483-486.
[20]Ritz B, Yu F, Fruin S, et al. Ambient air pollution and risk of birth defects in SouthernCalifornia. Am J Epidemiol,2002,155(1):17-25.
[21]Patel S S, Burns T L, Botto L D, et al. Analysis of selected maternal exposures and non‐syndromic atrioventricular septal defects in the National Birth Defects PreventionStudy,1997–2005. American Journal of Medical Genetics Part A,2012,158(10):2447-2455.
[22]Dadvand P, Rankin J, Rushton S, et al. Ambient air pollution and congenital heartdisease: a register-based study. Environ Res,2011,111(3):435-441.
[23]Dolk H, Armstrong B, Lachowycz K, et al. Ambient air pollution and risk of congenitalanomalies in England,1991-1999. Occup Environ Med,2010,67(4):223-227.
[24]Hansen C A, Barnett A G, Jalaludin B B, et al. Ambient air pollution and birth defectsin brisbane, australia. PLoS One,2009,4(4):e5408.
[25]Hwang B F, Jaakkola J J. Ozone and other air pollutants and the risk of oral clefts.Environ Health Perspect,2008,116(10):1411-1415.
[26]Marshall E G, Harris G, Wartenberg D. Oral cleft defects and maternal exposure toambient air pollutants in New Jersey. Birth Defects Res A Clin Mol Teratol,2010,88(4):205-215.
[27]Rankin J, Chadwick T, Natarajan M, et al. Maternal exposure to ambient air pollutantsand risk of congenital anomalies. Environ Res,2009,109(2):181-187.
[28]Dadvand P, Rankin J, Rushton S, et al. Association between maternal exposure toambient air pollution and congenital heart disease: A register-based spatiotemporalanalysis. Am J Epidemiol,2011,173(2):171-182.
[29]徐志红,徐爱群,曾蔚越.早产的定义和分类.实用妇产科杂志,2005,21(11):643-644.
[30]Goldenberg R L, Culhane J F, Iams J D, et al. Epidemiology and causes of pretermbirth. Lancet,2008,371(9606):75-84.
[31]汪雪琴,李金涛,汪林峰.空气污染物暴露与早产的相关性调查.中国现代医生,2012(14):19-21.
[32]中华人民共和国卫生部妇幼保健与社区卫生司.全国妇幼卫生监测及年报通讯.北京:卫生部,2008.
[33]孙蓉,侯晓静.早产相关因素研究进展.中国公共卫生,2012(4):560-561.
[34]张晓铭,张美仙,侯冬青,等.出生体重对儿童期和成年期高血压影响的队列研究.中国循证儿科杂志,2011,6(3):199-204.
[35]Ritz B. Air pollution and congenital anomalies. Occup Environ Med,2010,67(4):221-222.
[36] Pereira G,Nassar N,Cook A, et al. Traffic emissions are associated with reduced fetalgrowth in areas of Perth, Western Australia: an application of the AusRoads dispersionmodel. Aust N Z J Public Health,2011,35(5):451-458.
[37]Woodruff T J, Carlson A, Schwartz J M, et al. Proceedings of the Summit onEnvironmental Challenges to Reproductive Health and Fertility: executive summary.Fertil Steril,2008,89(Suppl2):e1-e20.
[38]Shah P S, Balkhair T. Air pollution and birth outcomes: a systematic review. EnvironInt,2011,37(2):498-516.
[39]陈晓,陈亚琼,侯海燕,等.天津地区空气污染与围生儿死亡和出生缺陷的关系.国际妇产科学杂志,2012,39(3):308-310.
[40]郑金艳,惠武莉，兰晓霞，等.围妊娠期暴露于空气污染物SO2、NO2与出生缺陷的相关性研究.国际妇产科学杂志,2013,40(1):71-73.
[41]Wang X, Ding H, Ryan L, et al. Association between air pollution and low birth weight:a community-based study. Environ Health Perspect,1997,105(5):514-520.
[42]赵庆国,李兵.户外空气中可吸入颗粒物对出生体重的影响.中国妇幼健康研究,2008,19(1):4-6.
[43]李庆业,刘筱娴.出生缺陷的研究进展.国外医学(社会医学分册),2001,18(2):64-67.
[44]赵秀艳,游昭华,史习舜.出生缺陷的研究进展.海峡预防医学杂志,2006,12(2):23-26.
[45]Tan K H, Tan T Y, Tan J, et al. Birth defects in Singapore:1994-2000. Singapore MedJ,2005,46(10):545-552.
[46]王秀梅.盐城市2008-2010年出生缺陷监测结果分析.江苏卫生保健(学术版),2011,13(5):40-41.
[47]国家环境保护部.关于发布国家环境质量标准<环境空气质量标准>的公告.http://www.gov.cn/zwgk/2012-03/02/content_2081359.htm,2012-02-29/2013-05-18.
[48]Marcazzan G M, Vaccaro S, Valli G, et al. Characterisation of PM10and PM2.5particulate matter in the ambient air of Milan (Italy). Atmospheric Environment,2001,35(27):4639-4650.
[49]Barnett A G, Williams G M, Schwartz J, et al. The effects of air pollution onhospitalizations for cardiovascular disease in elderly people in Australian and NewZealand cities. Environ Health Perspect,2006,114(7):1018-1023.
[50]Barnett A G, Williams G M, Schwartz J, et al. Air pollution and child respiratoryhealth: a case-crossover study in Australia and New Zealand. Am J Respir Crit CareMed,2005,171(11):1272-1278.
[51]Mathews T J, MacDorman M F. Infant mortality statistics from the2005period linkedbirth/infant death data set. Natl Vital Stat Rep,2008,57(2):1-32.
[52]Ritz B, Wilhelm M. Ambient air pollution and adverse birth outcomes: methodologicissues in an emerging field. Basic Clin Pharmacol Toxicol,2008,102(2):182-190.
[53]Slama R, Darrow L, Parker J, et al. Meeting report: atmospheric pollution and humanreproduction. Environ Health Perspect,2008,116(6):791-798.
[54]Stillerman K P, Mattison D R, Giudice L C, et al. Environmental exposures andadverse pregnancy outcomes: a review of the science. Reprod Sci,2008,15(7):631-650.
[55]Gilboa S M, Mendola P, Olshan A F, et al. Comparison of residential geocodingmethods in population-based study of air quality and birth defects. EnvironmentalResearch,2006,101(2):256-262.
[56]Gilboa S M, Mendola P, Olshan A F, et al. Relation between ambient air quality andselected birth defects, seven county study, Texas,1997-2000. Am J Epidemiol,2005,162(3):238-252.
[57]Strickland M J, Klein M, Correa A, et al. Ambient air pollution and cardiovascularmalformations in Atlanta, Georgia,1986-2003. Am J Epidemiol,2009,169(8):1004-1014.
[58]Vrijheid M, Martinez D, Manzanares S, et al. Ambient air pollution and risk ofcongenital anomalies: a systematic review and meta-analysis. Environ Health Perspect,2011,119(5):598-606.
[59]Kim O J, Ha E H, Kim B M, et al. PM10and pregnancy outcomes: a hospital-basedcohort study of pregnant women in Seoul. J Occup Environ Med,2007,49(12):1394-1402.
[60]郑金艳.围孕期空气污染的暴露与出生缺陷的相关性研究:[硕士学位论文].河北医科大学图书馆,2010.
[61]Brender J D, Zhan F B, Suarez L, et al. Linking environmental hazards and birthdefects data. International Journal of Occupational and Environmental Health,2006,12(2):126-133.
[62]冯小微,朴军,肖平,等.本溪市出生缺陷儿与大气污染及其它环境因素关系的研究.中华儿童保健杂志,1997,5(4):276-279.
[63]林玲,赵妮,张蕴晖,等.空气污染对人群生殖健康的影响.国外医学(卫生学分册),2006,33(6):348-352.
[64]李玲,万丽娟,李向云.出生缺陷相关危险因素研究进展.见:中华医学会新生儿筛查20周年纪念论坛论文集,西安,2009.
[65]国务院妇女儿童工作委员会.中国提高出生人口素质减少出生缺陷和残疾行动计划(2002～2010年).中国妇幼保健,2002(11):4-7.
[66]杜玉开,丁辉.生殖健康概论.第1版.北京:人民卫生出版社,2012,115-120.
[67]Hellerstedt W L, Pirie P L, Lando H A, et al. Differences in preconceptional andprenatal behaviors in women with intended and unintended pregnancies. Am J PublicHealth,1998,88(4):663-666.
[68]Green-Raleigh K, Lawrence J M, Chen H, et al. Pregnancy planning status and healthbehaviors among nonpregnant women in a California managed health care organization.Perspect Sex Reprod Health,2005,37(4):179-183.
[69] Morin P, De Wals P, St-Cyr-Tribble D, et al. Pregnancy planning: a determinant offolic acid supplements use for the primary prevention of neural tube defects. Can JPublic Health,2002,93(4):259-263.
[70]郑晓瑛,宋新明,李成福,等.计划与非计划怀孕围孕期环境危险因素暴露差异的分析中华流行病学杂志,2008,29(3):216-219.
[71]宫蕊,王志萍,赵仲堂.神经管缺陷一级预防措施研究与实施现状.中华流行病学杂志,2008,29(11):1144-1148.
[72]Busby A, Abramsky L, Dolk H, et al. Preventing neural tube defects in Europe:population based study. BMJ,2005,330(7491):574-575.
[73]周英凤,吕军,白鸽,等.孕前保健服务的内涵及现状分析.中国卫生资源,2010,13(4):162-165.
[74]夏建红,于佳,赵庆国,等.户外空气质量与出生缺陷的生态学研究及干预.中国优生与遗传杂志.2009,17(3):102-104.
[75]Bonzini M, Carugno M, Grillo P, et al. Impact of ambient air pollution on birthoutcomes: systematic review of the current evidences. Med Lav,2010,101(5):341-363.
[76]Jiang L L, Zhang Y H, Song G X, et al. A time series analysis of outdoor air pollutionand preterm birth in Shanghai, China. Biomed Environ Sci,2007,20(5):426-431.
[77]赵庆国,梁志江,李兵,等.某市空气污染对早产急性影响的Poisson广义可加模型分析.环境与健康杂志,2010(06):488-492.
[78]Schwartz J, Dockery D W, Neas L M. Is daily mortality associated specifically withfine particles?. J Air Waste Manag Assoc,1996,46(10):927-939.
[79]Wood S N, Augustin N H. GAMs with integrated model selection using penalizedregression splines and applications to environmental modelling. Ecological Modelling,2002,157(2):157-177.
[80]陈峰.医用多元统计分析方法.第2版.北京:中国统计出版社,2007.
[81]Peng R D, Dominici F, Louis T A. Model choice in time series studies of air pollutionand mortality. Journal of the Royal Statistical Society: Series A (Statistics in Society),2006,169(2):179-203.
[82]Hastie T, Tibshirani R. Generalized additive models. Chapman\&Hall/CRC,1990,28.
[83]Goldberg M S, Bailar Rd J C, Burnett R T, et al. Identifying subgroups of the generalpopulation that may be susceptible to short-term increases in particulate air pollution: atime-series study in Montreal, Quebec. Research Report (Health Effects Institute),2000(97):7-113.
[84]Schwartz J, Spix C, Touloumi G, et al. Methodological issues in studies of air pollutionand daily counts of deaths or hospital admissions. Journal of Epidemiology andCommunity Health,1996,50(Suppl1):S3-S11.
[85] Wong C, Ma S, Hedley A J, et al. Effect of air pollution on daily mortality in HongKong. Environmental Health Perspectives,2001,109(4):335-340.
[86]Goldberg M S, Burnett R T, Bailar Rd J C, et al. The association between dailymortality and ambient air particle pollution in Montreal, Quebec.2. Cause-specificmortality. Environmental Research,2001,86(1):26-36.
[87]王艳,张宜升,李欣鹏.济南城区空气污染对呼吸道疾病门诊量的影响.中国环境科学,2008,28(6):571-576.
[88]赵庆国.妊娠期空气污染物暴露对早产与低出生体重的健康效应研究:[博士学位论文]武汉:华中科技大学图书馆,2010.
[89]徐丽珍,薛小平,张燕萍,等.太原市孕期空气污染暴露对早产的影响.环境与健康杂志,2008(4):298-301.
[90]张美云,金银龙.空气污染对早产和低出生体重影响的流行病学研究现况.环境与健康杂志,2008(3):270-273.
[91] Ritz B, Wilhelm M, Hoggatt K J, et al. Ambient air pollution and preterm birth in theenvironment and pregnancy outcomes study at the University of California, LosAngeles. Am J Epidemiol,2007,166(9):1045-1052.
[92] Bell M L, Ebisu K, Belanger K. Ambient air pollution and low birth weight inConnecticut and Massachusetts. Environ Health Perspect,2007,115(7):1118-1124.
[93]王斌,高会旺.中国沿海城市空气污染指数的分布特征.生态环境,2008(2):542-548.
[1]熊惠玲,马艳.出生缺陷的病因学研究进展.新疆医科大学学报,2006,29(8):765-766.
[2]杜玉开,丁辉.生殖健康概论.第1版.北京:人民卫生出版社,2012.115-120.
[3]杨敏娟,潘小川.北京市大气污染与居民心脑血管疾病死亡的时间序列分析.环境与健康杂志,2008,4(25):294-297.
[4] Watanabe N, Oonuki Y. Inhalation of diesel exhaust affects spermato-genesis ingrowing male rats. Environ Health Perspect,1999,107(7):539-544.
[5] Yoshida S, Sagai M, Oshio S, et al. Exposure to diesel exhaust affects the malereproductive system of mice. Int J Androl,1999,22(5):307-315.
[6] Tsukue N, Toda N, Tsubone H, et al. Diesel exhaust (DE) affects there gulation oftesticular function in male Fischer344rats. J Toxicol Environ Health A,2001,63(2):115-126.
[7] Singh J. Nitrogen dioxide exposure alters neonatal development. Neurotoxicology,1988,9(3):545-549.
[8] Astrup P, Olsen H M, Trolle D, et al. Effect of moderate carbon monoxide exposure onfetal development. The Lancet,1972,300(7789):1220-1222.
[9] Bailey L T J, Johnston M C, Billet J. Effects of carbon monoxide and hypoxia on cleftlip in A/J mice. Cleft Palate Craniofac J,1995,32(1):14-19.
[10]Singh J, Scott L H. Threshold for carbon monoxide induced Fetotoxi City. Teratology,1984,30(2):253-257.
[11]Singh J, Aggison L, Moore-Cheatum L. Teratogenicity and developmental toxicity ofcarbon monoxide in protein-deficient mice. Teratology,1993,48(2):149-159.
[12]Somers C M, Mc Carry B E, Malek F, et al. Reduction of particulate air pollutionlowers the risk of heritable mutations in mice. Science,2004,304(5673):1008-1010.
[13]Samet J M, DeMarini D M, Malling H V. Do airborne particles induce heritablemutations?. Science,2004,304(5673):971-972.
[14]Perera F P, Rauh V, Whyatt R M, et al. Molecular evidence of an interaction betweenprenatal environmental exposures on birth outcomes in a multiethnic population.Environ Health Perspect,2004,112(5):626-630.
[15]Somers C M, Yauk C L, White P A, et al. Air pollution induces heritable DNAmutations. Proc Natl Acad USA,2002,99(15):904-907.
[16]秦保平,解辉,韩静.天津市空气污染物PM10/TSP比例研究.城市环境与城市生态,2002,15(6):20-21.
[17]王伟人,孙长学.出生缺陷相关危险因素.中国优生与遗传杂志,2005,13(9):1-6.
[18]Wihelm M, Ritz B. Local variations in CO and particulate air pollution and birthoutcomes in Los Angeles County, California. Environ Health Perspect,2005,113(9):1212-1221.
[19]Sagiv S K, Mendola P, Loomis D, et al. A time series analysis of air pollution andpreterm birth in Pennsylvania,1997-2001. Environ Health Perspect,2005,113(5):602-606.
[20]Srám R J, Binková B, Dejmek J, et al. Ambient air pollution and pregnancy outcomes:a review of the literature. Environ Health Perspect,2005,113(4):375-382.
[21]黄醒华.早产的防治.中华围产医学杂志,2003,6(6):363-365.
[22]Ponce N A, Hoggatt K J, Wilhelm M, et al. Preterm Birth: The Interaction ofTraffic-related Air Pollution with Economic Hardship in Los Angeles Neighborhoods.Am J Epidemiol,2005,162(2):140-148.
[23]龚建华.早产危险因素的研究进展.国外医学:妇幼保健分册,1990,1:11.
[24]Chien P F, Khan K S, Ogston S, et al. The diagnostic accuracy of cervico-vaginal fetalfibronectin in predicting preterm delivery: an overview. British Journal of Obstetricsand Gynaecology,1997,104(4):436-444.
[25]Poloniecki J D, Atkinson R W, Poncede Leon A, Anderson H R. Daily time series forcardiovascular hospital admissions and previous day's air pollution in London, UK.Occup Environ Med.1997,54(8):535-540.
[26]Maynard R L, Cameron K M, Fielder R. Setting air quality standards for carcinogens:an alter native to mathematical quantitative risk assessment-discission paper. Hum anExp Toxicol,1995,14(2):175-186.
[27]Stieb D M, Szyszkowicz M, Rowe B H, et al. Air pollution and emergency departmentvisits for cardiac and respiratory conditions: a multi-city time-series analysis. EnvironHealth,2009,8:25.
[28]Wordley J, Walter S, Ayres J G. Short term variations in hospital admissions andmortality and particulate air pollution. Occup Environ Med,1997,54(2):108-116.
[29]Kline J, Stein Z, usser M. Conception to birth: epidemiology of prenatal development.New York: Oxford University Press,1989;191-207.
[30]Ritz B, Yu F, Chapa G, et al. Effect of air pollution on preterm birth among childrenborn in Southern California between1989and1993. Epidemiol.2000,11(5):502-511.
[31]Sagiv SK, Mendola P, Loomis D, et al. A time-series analysis of air pollution andpreterm birth in Pennsylvania,1997-2001. Environ Health Perspect,2005,113(5):602-606.
[32]Leem J H, Kaplan B M, Shim Y K, et al. Exposures to air pollutants during pregnancyand preterm delivery. Environ Health Perspect,2006,114(6):905-910.
[33]Liu S, Krewski D, Shi Y, et al. Association between gaseous ambient air pollutants andadverse pregnancy outcomes in Vancouver, Canada. Environ Health Perspect,2003,111(14):1773-1778.
[34]Hansen C, Neller A, Williams G, et al. Maternal exposure to low levels of ambient airpollution and preterm birth in Brisbane, Australia. BJOG,2006,113(8):935-941..
[35]Xu X, Ding H, Wang X. Acute effects of total suspended particles and sulfur dioxideson preterm delivery: a community-based cohort study. Arch Environ Health,1995,50(6):407-415.
[36]Jiang L, Zhang Y, Song G, et al. A time series analysis of outdoor air pollution andpreterm birth in Shanghai, China. Biomed Environ Sci,2007,20(5):426-431.
[37]朱娟,梁志江,温济英,等.某市空气污染对早产影响的病例对照研究.环境与健康杂志,2011,28(2):132-135.
[38]汪雪琴,李金涛,汪林峰.空气污染物暴露与早产的相关性调查.中国现代医生,2012,50(14):19-21.
[39]张燕萍,张志琴,武永春,等.太原市空气污染对早产的急性影响.环境与健康杂志,2008,25(3):196-197.
[40]Mumbare S S, Maindarkar G, Darade R, et al.Matenal risk factors associated with termlow birth weight neonates: A matched-pair case control study. Indian Pediatrics,2012,49(1):25-28.
[41]张扬,王爱英,郑戈.低出生体重儿及其影响因素.河南预防医学杂志,1994,5(6):344-345.
[42]Duvekot J J, Cheriex E C, Pieters F A A, et al. Severely impaired fetal growth ispreceded by maternal hemodynamic maladaptation in very early pregnancy. ActaObstet Gynecol Scand,1995,74(9):693-697.
[43]Khong T Y, Wolf F, Robertson W B, et al. Inadequate maternal vascular response toplacentation in pregnancies complicate‐d eclabmy psiap reand bysmall‐for‐gestationalageinfants. BJOG,1986,93(10):1049-1059.
[44]Bobak M. Outdoor air pollution, low birth weight, and prematurity. Environ HealthPerspect,2000,108(2):173-176.
[45]Longo L D. The biological effects of carbon monoxide on the pregnant woman, fetus,and newborn infant. Am J Obstet Gynecol,1977,129(1):69-103.
[46]Lin C M, Li C Y, Yang G Y, et al. Association between maternal exposureto elevatedambient sulfer dioxide during pregnancy and term low birth weight. Environ Res,2004,96(1):41-50.
[47]Perera F P, Jedrychowski W, Rauh V, et al. Molecular epidemiologic research on theeffects of environmental pollutants on the fetus. Environ Health Perspect,1999,107(Suppl3):451-460.
[48]Perera F P, Hemminki K, Gryzbowska E, et al. Molecular and genetic damage inhumans from environmental pollution in Poland. Nature,1992,360:256-258.
[49]Perera FP, Whyatt R M, Jedrychowski W, et al. Recent developments in molecularepidemiology: a study of the effects of environmental polycyclic aromatichydrocarbons on birth outcomes in Poland. Am J Epidemiol,1998,147(3):309-314.
[50]Hansen C A, Barnett A G, Jalaludin B B, et a1. Ambient air pollution and birth defectsin Brisbane Australia. PLoS ONE,2009,4(4): e5408.
[51]Morales-Suárez-Varela M M, Bille C, Christensen K, et al. Smoking habits, nicotineuse, and congenital malformations. Obstet Gynecol,2006,107(1):51-57.
[52]Wu J, Hou H, Ritz B, et al. Exposure to polycyclic aromatichydrocarbons and missedabortion in early pregnancy in a Chinese population. Sci Total Environ,2010,408(11):2312-2318.
[53]卫生部妇幼保健与社区卫生司.全国妇幼卫生监测及年报通讯. http://www.mch-scn. org/Article_Show. asp?ArticleI=429,2011-03-01/2011-08-24.
[54]郑林媚,洪新如,孙庆华.空气污染对胎儿生长发育的影响及作用机制.中国优生与遗传杂志,2011:19(3):1-3.
[55]Gilboa S M, Mendoh P, Olshan A F, et a1. Relation between ambient air quality andselected birth defects, seven county study, texas,1997-2000. Am J Epidemiol,2005,162(3):238-252.
[56]Ritz B, Yu F, Fruin S, et al. Ambient air pollution and risk of birth defects in southernCalifornia. Am J Epidemiol,2002,155(1):17-25.
[57]Strickland M J, Klein M, Correa A, et al. Ambient Air Pollution and CardiovascularMalformations in Atlanta, Georgia,1986-2003. Am J Epidemiol,2009,169(8):1004-1014.
[58]van Beynum I M, Mooij C, Kapusta L, et al. Common894G> T single nucleotidepolymorphism in the gene coding for endothelial nitric oxide synthase (eNOS) and riskof congenital heart defects. Clin Chem Lab Med,2008,46(10):1369-1375.
[59]Smrcka V, Leznarova D. et al. Environmental pollution and the occurrence ofcongenital defects in a15-year period in a south Moravian district. Acta Chir Plast,1998,40(4):112-114.
[60]Leem J H, Kaplan B M, Shim Y K, et a.l Exposures to air pollutants during pregnancyand preterm delivery. Environ Health Perspect,2006,114(6):905.
[61]郑金艳,惠武利,兰晓霞,等.围妊娠期暴露于空气污染物SO2、NO2与出生缺陷的相关性研究.国际妇产科学杂志,2013(1):71-74.
[62]Rogers J F, Dunlop A L. Air pollution and very low birth weight infants: A targetpopulation?. Pediatrics,2006,118(1):156-164.
[63]Lee B E, Ha E.H, Park H.S, et al. Exposure to air pollution during different gestationalphase contributes to risk of low birth weight. Human Reproduction,2003,18(3):638-643.
[64]Dugandzic R, Dodds L, Stieb D, et al. The association between low level exposures toambient air pollution and term low birth weight: a retrospective cohort study. EnvironHealth,2006,5:3.
[65]Gouveia N, Bremner S A, Novaes H M D. Association between ambient air pollutionand birth weight in Sao Paulo, Brazil. J Epidemiol Community Health,2004,58(1):11-17.
[66]Choi H, Jedryehowski W, Spengler J, et al. International studies ofprenatal exposure topolyeyelie aromatic hydrocarbons and fetalgrowth. Environ Health Perspect,2006,114(11):1744-1750.
[67]Le H Q, Batterman S A, Wirth J J, et al. Air pollutant exposure and pretermand term small-for-gestational-age births in Detroit, Michigan: long-term trends andassociations. Environ Int.2012,44:7-17.
[68] Bell M L, Ebisu K, Belanger K. Ambient air pollution and low birthweight in Connecticut andMassachusetts. Environ Health Perspect,2007,115(7):1118-1124.
[69] Medeiros A, Gouveia N. Relationship between low birthweight and airpollution in the city of SaoPaulo, Brazil. Rev Saude Publica,2005,39(6):965-972.
[70] Brauer M, Lencar C, Tamburic L, et al. Acohort study of traffic related air pollution impacts onbirth outcomes. Environ Health Perspect,2008,116(5):680-686.
[71]Liu S, Krewski D, Shi Y, et al. Association between maternal exposure to ambient air pollutantsduring pregnancy and fetal growth restriction. J Expo Sci Environ Epidemiol,2007,17(5):426-432.
[72] Steinvil A, Kordova-Biezuner L, Shapira I, et al. Short term exposure to air pollution andinflammation sensitive biomarkers. Environ Res,2008,106(1):51-61.