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Urakura AK, Gajula R, Kankanala GR, Kotha R, Mendu SB, Harsha N. Effect of Neonatal Intensive Care Unit (NICU) Humidity on Neonates: A Systematic Review. Cureus 2024; 16:e58524. [PMID: 38765381 PMCID: PMC11101598 DOI: 10.7759/cureus.58524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
This study explores the role of room humidity levels in the neonate intensive care unit (NICU) and how they impact their growth and development in this fragile stage. The study considers seven relevant studies that have explored this factor in different settings. Humidity's role in developing neonatal conditions, such as respiratory distress and fungal infections, is also elaborated on. For the literature review, the study utilized PubMed, Embase, and Scopus databases to guarantee comprehensive findings on the role of NICU room humidity on neonates. By examining these studies' evidence, the research highlights the paramount need to ensure that the room has adequate moisture, as exposure to less desirable humidity levels increases mortality and the severity of morbidity rates among neonates. The fact that the majority of NICUs lack humidity control, which is required, stimulated us to conduct this review.
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Affiliation(s)
| | - Ravi Gajula
- Pediatrics, Government Medical College Siddipet, Siddipet, IND
| | | | - Rakesh Kotha
- Neonatology, Osmania Medical College, Hyderabad, IND
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Bai S, Zhang J, Cui L, Du S, Lin S, Liang Y, Liu Y, Wang Z. The joint effect of cumulative doses for outdoor air pollutants exposure in early life on asthma and wheezing among young children. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 273:116097. [PMID: 38367605 DOI: 10.1016/j.ecoenv.2024.116097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Constrained by no proper way to assess cumulative exposure, the joint effect of air pollution cumulative exposure doses on childhood asthma and wheezing (AW) was not understood. OBJECTIVE To assess the association between cumulative exposure to multiple air pollutants in early life and childhood AW. METHODS We designed a nested case-control study based on the birth cohort in Jinan City. Children with AW followed up within 2 years after birth were treated as cases, and non-cases in this cohort were treated as the control source population, and the propensity score matching method was used to match each case to 5 controls. We calculated the individual cumulative outdoor exposure doses for each period using an inverse distance weighted model, alongside the complex Simpson's formula, accounting for outdoor time and respiratory volume. The Least absolute shrinkage and selection operator (Lasso) regression was performed to screen for covariates. To analyze the joint effects of pollutants, we employed the weighted quantile sum (WQS) regression model in conjunction with conditional logistic regression. RESULTS 84 cases and 420 controls were included in this study. The odds ratio (OR) with 95% confidence interval (CI) of the impact of cumulative exposure (mg/m3) after birth on childhood AW was 1.78 (1.15-2.74) for SO2, 1.69 (1.11-2.57) for NO2, and 1.65 (1.09-2.52) for PM2.5, respectively. Furthermore, with each 25th percentile increase in the WQS index, the overall risk of cumulative doses for six pollutants exposure after birth on AW increased by an adjusted OR of 1.10 (1.03, 1.18), and SO2, PM2.5, and NO2 contributed the most to the WQS index. However, no statistically significant association was found between cumulative exposure to all pollutants before birth and childhood AW. CONCLUSIONS There was a joint effect of the cumulative exposure dose of outdoor air pollutants after birth on AW in children aged 0-2 years. And traffic-related pollutants (SO2, PM2.5, and NO2) make a greater contribution to the joint effect.
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Affiliation(s)
- Shuoxin Bai
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China; Qilu Hospital of Shandong University, Jinan, Shandong, 250012, PR China
| | - Jiatao Zhang
- Department of Occupational and Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China
| | - Liangliang Cui
- Jinan Municipal Center for Disease Control and Prevention, Jinan, Shandong, PR China; Jinan Mental Health Center, Jinan, Shandong, P.R. China
| | - Shuang Du
- Department of Occupational and Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China; Department of Environmental Health, Fudan University, Shanghai, PR China
| | - Shaoqian Lin
- Jinan Municipal Center for Disease Control and Prevention, Jinan, Shandong, PR China
| | - Yuxiu Liang
- Department of Occupational and Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China
| | - Yi Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China.
| | - Zhiping Wang
- Department of Occupational and Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China.
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Zhang J, Tao Y, Wang Y, Ji X, Wu Y, Zhang F, Wang Z. Independent and interaction effects of prenatal exposure to high AQI and extreme Humidex on the risk of preterm birth: A large sample population study in northern China. Reprod Toxicol 2024; 124:108544. [PMID: 38246475 DOI: 10.1016/j.reprotox.2024.108544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/29/2023] [Accepted: 01/17/2024] [Indexed: 01/23/2024]
Abstract
The combined effects of air pollution and extreme temperature on PTB remain unclear. To evaluate the independent effect and interaction effect of prenatal extreme exposure to air quality index (AQI) and Humidex, on PTB. Based on the National Health Care Data Platform of Shandong University, women who gave birth in 2019-2020 were selected for the study. First, the independent effects of AQI and Humidex on PTB were assessed by logistic regression model. Subsequently, the interaction effects of AQI and Humidex on PTB were estimated separately by calculation of the relative excess risk of interaction (RERI). A total of 34365 pregnant women were included and 1975 subjects were diagnosed with PTB. We observed a significant increase in the odds of PTB associated with maternal high AQI exposure, with an OR of 1.70 (95% CI: 1.59, 1.81). Similarly, extreme exposure to Humidex also demonstrated an elevated PTB odds, with a low Humidex OR of 2.48 (95% CI: 2.23, 2.76) and a high Humidex OR of 1.48 (95% CI: 1.31, 1.67). Finally, we observed an interaction between high AQI and extreme Humidex during the 1st trimester. Interaction effects were noted between high AQI and low Humidex throughout the entire trimester and the 2nd trimester. This study suggests that prenatal exposure to high AQI and extreme Humidex could increase the odds of PTB, with effects exhibiting the sensitivity window and a cumulative trend. Additionally, there is an interaction between AQI and Humidex.
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Affiliation(s)
- Jiatao Zhang
- Department of Occupational and Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China
| | - Yu Tao
- Department of Occupational and Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China
| | - Yongchao Wang
- Institute for Medical Dataology, Shandong University, Shandong, PR China
| | - Xiaokang Ji
- Institute for Medical Dataology, Shandong University, Shandong, PR China
| | - Yanling Wu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China
| | - Fengmei Zhang
- Department of Occupational and Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China.
| | - Zhiping Wang
- Department of Occupational and Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China; Institute for Medical Dataology, Shandong University, Shandong, PR China.
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Li X, Jing MA, Cheng Y, Feng L, Wang S, Dong G. The relationship between extreme ambient temperature and small for gestational age: A cohort study of 1,436,480 singleton term births in China. ENVIRONMENTAL RESEARCH 2023:116412. [PMID: 37315757 DOI: 10.1016/j.envres.2023.116412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/29/2023] [Accepted: 06/11/2023] [Indexed: 06/16/2023]
Abstract
Studies have shown that exposure to extreme ambient temperature can contribute to adverse pregnancy outcomes, however, results across studies have been inconsistent. We aimed to evaluate the relationships between trimester-specific extreme temperature exposures and fetal growth restriction indicated by small for gestational age (SGA) in term pregnancies, and to assess whether and to what extent this relationship varies between different geographic regions. We linked 1,436,480 singleton term newborns (2014-2016) in Hubei Province, China, with a sub-district-level temperature exposures estimated by a generalized additive spatio-temporal model. Mixed-effects logistic regression models were employed to estimate the effects of extreme cold (temperature ≤5th percentile) and heat exposures (temperature >95th percentile) on term SGA in three different geographic regions, while adjusting for the effects of maternal age, infant sex, the frequency of health checks, parity, educational level, season of birth, area-level income, and PM2.5 exposure. We also stratified our analyses by infant sex, maternal age, urban‒rural type, income categories and PM2.5 exposure for robustness analyses. We found that both cold (OR:1.32, 95% CI: 1.25-1.39) and heat (OR:1.17, 95% CI: 1.13-1.22) exposures during the third trimester significantly increased the risk of SGA in the East region. Only extreme heat exposure (OR:1.29, 95% CI: 1.21-1.37) during the third trimester was significantly related to SGA in the Middle region. Our findings suggest that extreme ambient temperature exposure during pregnancy can lead to fetal growth restriction. Governments and public health institutions should pay more attention to environmental stresses during gestation, especially in the late stage of the pregnancy.
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Affiliation(s)
- Xiang Li
- Beijing Key Laboratory for Remote Sensing of Environment and Digital Cities, Faculty of Geographical Science, Beijing Normal University, 19 Xinjiekouwai Street, Beijing. 100875, China.
| | - M A Jing
- Beijing Key Laboratory for Remote Sensing of Environment and Digital Cities, Faculty of Geographical Science, Beijing Normal University, 19 Xinjiekouwai Street, Beijing. 100875, China.
| | - Yang Cheng
- Beijing Key Laboratory for Remote Sensing of Environment and Digital Cities, Faculty of Geographical Science, Beijing Normal University, 19 Xinjiekouwai Street, Beijing. 100875, China
| | - Ling Feng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Road, Wuhan, 430030, China
| | - Shaoshuai Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Road, Wuhan, 430030, China
| | - Guanpeng Dong
- Key Research Institute of Yellow River Civilization and Sustainable Development, Henan University, 85, Minglun Street, Kaifeng, 475001, China; Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Henan University, 85, Minglun Street, Kaifeng, 475001, China.
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Bai S, Cui L, Du S, Zhao X, Lin S, Yang X, Zhang J, Liang Y, Wang Z. A life course approach to asthma and wheezing among young children caused by ozone: A prospective birth cohort in northern China. ENVIRONMENTAL RESEARCH 2023; 226:115687. [PMID: 36925033 DOI: 10.1016/j.envres.2023.115687] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/22/2023] [Accepted: 03/12/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Given differences in vulnerability of children in early life, a life course approach to asthma and wheezing (AW) in young children caused by ozone (O3) is not fully understood. METHODS We conducted a birth cohort in Jinan, China from 2018 to 2021 to elucidate the onset model of childhood AW due to O3 exposure. An inverse distance weighted model was used for individual exposure assessment. The time-dependent Cox proportional-hazard model and logistic model were used to investigate the effects of O3 exposure on AW. Principal component analysis, interaction analysis, and distributed lag model were used to analyze the life course approach. RESULTS The cumulative incidence rate for AW among 6501 children aged 2 was 1.4%. A high level of O3 was related to AW (HR: 2.10, 95% CI: 1.31, 3.37). Only O3 exposure after birth was associated with AW, with an OR of 1.82 (1.08, 3.12), after adjusting for the effect before birth. Furthermore, adjusting for other air pollutants, the HR for the individual effect of high O3 exposure on AW was 2.44 (1.53, 3.89). Interestingly, P values for interactions for O3 and the principal components of other pollutants, as well as the characteristic variable of open windows were less than 0.1. Moreover, an increase in the IQR of O3 exposure at the 31st to 37th weeks before birth and the 1st to 105th weeks after birth was associated with an increase in the HRs for AW. CONCLUSIONS High-level of O3 exposure after birth could lead to AW among young children. Importantly, the AW onset model may include the risk factors accumulation and the sensitive period model. Specifically, there are two sensitive windows in early life, and the correlated insults between the high level of O3 and other pollutants as well as open windows in the asthma-inducing effect.
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Affiliation(s)
- Shuoxin Bai
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China
| | - Liangliang Cui
- Jinan Municipal Center for Disease Control and Prevention, Jinan, Shandong, PR China
| | - Shuang Du
- Department of Occupational and Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China
| | - Xiaodong Zhao
- Jinan Municipal Center for Disease Control and Prevention, Jinan, Shandong, PR China
| | - Shaoqian Lin
- Jinan Municipal Center for Disease Control and Prevention, Jinan, Shandong, PR China
| | - Xiwei Yang
- Department of Occupational and Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China
| | - Jiatao Zhang
- Department of Occupational and Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China
| | - Yuxiu Liang
- Department of Occupational and Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China
| | - Zhiping Wang
- Department of Occupational and Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China.
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Liang Y, Zhang J, Bai S, Du S, Yang X, Wang Z. Short-term and long-term effects of cesarean section on asthma and wheezing: A cohort study and meta-analysis. Respir Med 2023:107300. [PMID: 37257787 DOI: 10.1016/j.rmed.2023.107300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/21/2023] [Accepted: 05/27/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To describe the short-term and long-term effects of cesarean section on childhood asthma and wheezing. METHOD Firstly, in the cohort study, 6640 infants were included in the cohort baseline from January 2018 to December 2019, in which 6501 children completed the follow-up study for respiratory diseases at age 2 years. The effect of cesarean section on asthma and wheezing was estimated by the logistic regression model. Secondly, we conducted a meta-analysis of studies with outcomes of childhood asthma and wheezing under 2 years of age and over 2 years of age, respectively, to investigate the short-term and long-term effects of cesarean section on asthma and wheezing. RESULTS In our cohort study, the cumulative incidence of asthma and wheezing was 1.3% (84/6501). 45.5% of children (2961/6501) were born by cesarean section. The adjusted odds ratio for the effect of cesarean section on asthma and wheezing in children under 2 years of age was 1.14 (95%CI 0.73-1.78). Combining previous studies (outcomes of asthma and wheezing under 2 years of age) with our results for a meta-analysis, the odds ratio was 1.15 (95%CI 1.05-1.25, I2 = 46.82%). Meanwhile, cesarean section had a long-term effect on asthma and wheezing in the child population over 2 years of age (OR = 1.17, 95%CI 1.11-1.24, P < 0.001, I2 = 79.38%). CONCLUSION Cesarean section had a short-term effect on asthma and wheezing before the age of 2, in addition, the long-term effect of cesarean section on asthma and wheezing persisted in the child population (under 18).
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Affiliation(s)
- Yuxiu Liang
- Department of Occupational and Environmental Health, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong, 250012, PR China
| | - Jiatao Zhang
- Department of Occupational and Environmental Health, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong, 250012, PR China
| | - Shuoxin Bai
- Department of Epidemiology, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong, 250012, PR China
| | - Shang Du
- Department of Occupational and Environmental Health, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong, 250012, PR China
| | - Xiwei Yang
- Department of Occupational and Environmental Health, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong, 250012, PR China.
| | - Zhiping Wang
- Department of Occupational and Environmental Health, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong, 250012, PR China.
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Zhao S, Xu J, Li W, Lu Y, Huang L, Xu H, Shi M, Wang Y, Zhu Q, Xu Q. High-temperature exposure and risk of spontaneous abortion during early pregnancy: a case-control study in Nanjing, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:29807-29813. [PMID: 36418820 DOI: 10.1007/s11356-022-24315-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
As one of the most common complications of early pregnancy, spontaneous abortion is associated with environmental factors, but reports estimating the effect of ambient temperature on spontaneous abortion are still inconclusive. Herein, a case-control study (1002 cases and 2004 controls) in Nanjing, China, from 2017 to 2021 was conducted to evaluate the association between temperature exposure and the risk of spontaneous abortion by using distributed lag nonlinear model (DLNM). As a result, daily mean temperature exposure and early spontaneous abortion showed a nonlinear relationship in 14-day lag periods. Moreover, taking the median temperature (17 °C) as a reference, gradually increased positive effects of high temperature on spontaneous abortion could be found during the 4 days prior to hospitalization, and the highest odds ratio (OR) of 2.07 (95% confidence interval (CI): 1.36, 3.16) at extremely hot temperature (33 °C) was observed at 1 lag day. The results suggested that high-temperature exposure in short times during early pregnancy might increase the risk of SAB. Thus, our findings highlight the potential risk of short-term high-temperature exposure during early pregnancy, and more evidence was given for the effects of climate change on maternal health.
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Affiliation(s)
- Shuangshuang Zhao
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210004, China
| | - Jie Xu
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210004, China
| | - Wen Li
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210004, China
| | - Yingying Lu
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210004, China
| | - Linxiang Huang
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210004, China
| | - Haoyi Xu
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210004, China
| | - Mingxia Shi
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210004, China
| | - Yan Wang
- Department of Prenatal Diagnosis, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu Province, China
| | - Qiaoying Zhu
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210004, China
| | - Qing Xu
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210004, China.
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Bai S, Du S, Liu H, Lin S, Zhao X, Wang Z, Wang Z. The causal and independent effect of ozone exposure during pregnancy on the risk of preterm birth: Evidence from northern China. ENVIRONMENTAL RESEARCH 2022; 214:113879. [PMID: 35835165 DOI: 10.1016/j.envres.2022.113879] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/15/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
The concentration of ozone (O3) in the environment is gradually increasing, but there are limited reports on the exposure to O3 during pregnancy on the risk of adverse birth outcomes. Our study aimed to examine the causal and independent effect of O3 exposure during pregnancy on the risk of preterm birth (PTB) and to identify the critical window. Based on the baseline population of the birth cohort in Jinan, northern China, we obtained the individual exposure for each subject during pregnancy of ambient 8-h moving average O3 through the inverse distance weighting model. The effect of O3 exposure during pregnancy on PTB was evaluated through the time-dependent Cox proportional-hazard models. And we assessed the causal relationship by controlling unknown confounding factors using the instrumental variable (IV) analysis, estimated the independent effect by principal component analysis, and identified the critical window period of exposure through the distributed lag model. Among 6501 subjects, 285 mothers delivered prematurely. The median (IQR) of O3 concentration during pregnancy was 109.51 (23.54) μg/m3. The high level of O3 exposure (>173.64 μg/m³) increased the risk of PTB, with HR of 1.92 (95% CI: 1.38-2.66). Furthermore, the HR (95% CI) of the O3 estimated value calculated by the IV (wind speed) on the risk of PTB was 2.63 (1.41-4.88). In addition, the high level of O3 exposure was associated with the risk of PTB in the 13th-18th gestational weeks. Therefore, the high level of O3 exposure during pregnancy may independently increase the risk of PTB, which may be a causal effect. The 13th to 18th week of gestation is a critical window for preventing this risk.
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Affiliation(s)
- Shuoxin Bai
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China
| | - Shuang Du
- Department of Occupational and Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China
| | - Haiping Liu
- Xianwen Community Health Service Center, Jinan, Shandong, PR China
| | - Shaoqian Lin
- Jinan Municipal Center for Disease Control and Prevention, Jinan, Shandong, PR China
| | - Xiaodong Zhao
- Jinan Municipal Center for Disease Control and Prevention, Jinan, Shandong, PR China
| | - Zhaojun Wang
- Shandong Jinan Ecological Environment Monitoring Center, Jinan, Shandong, PR China
| | - Zhiping Wang
- Department of Occupational and Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China.
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