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研究生:李律瑋
研究生(外文):Lu-Wei Lee
論文名稱:母親懷孕期間空氣污染暴露和異常出生結果之關係
論文名稱(外文):The Relationship between Maternal Exposure to Air Pollution during Pregnancy and Adverse Birth Outcomes
指導教授:陳保中陳保中引用關係
指導教授(外文):Pau-Chung Chen
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:職業醫學與工業衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文出版年:2001
畢業學年度:89
語文別:英文
論文頁數:50
中文關鍵詞:空氣污染出生結果早產低出生體重
外文關鍵詞:air pollutionbirth outcomepreterm deliverylow birth weight
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空氣污染長期以來已知會影響人體健康,同時也會導致新生兒死亡及後新生兒期死亡的增加。就個別污染物而言,曾有研究探討懸浮微粒和二氧化硫對新生兒和後新生兒期死亡率之影響,此外另有研究指出二氧化硫和總懸浮微粒會增加低出生體重之發生率。在預測嬰兒死亡率、兒童死亡率方面,早產(preterm delivery, 懷孕週數< 37週 )和低出生體重 (low birth weight,出生體重<2500公克)都是重要的指標。
本研究主要的目的為探討母親懷孕過程中所暴露的室外空氣污染是否會增加異常出生結果。本研究共包含1995-97年間出生的34,881名新生兒,其母親皆居住於環保署空氣品質監測站之半徑700公尺內。由空氣品質監測站之監測資料獲得母親懷孕期間之室外空氣污染物暴露情形,包含白天 (7:00-19:00) 和全天24小時的二氧化硫、氣動直徑小於10微米之懸浮微粒、一氧化碳、氮氧化物、臭氧在總懷孕過程、懷孕開始後的第一個月及前兩個月、各個孕程、出生前的兩個月及一個月的平均。並以Multiple logistic regression 估計早產和低出生體重的勝算比及95%信賴區間 (95% confidence interval, 95%CI)。
在本研究中,出生前一個月的全天二氧化硫暴露和白天臭氧暴露都和早產有暴露效應關係存在。出生前一個月全天二氧化硫暴露之早產勝算比為1.26 (95% CI=1.05- 1.53),白天臭氧之早產勝算比則為1.21 (95% CI=1.01-1.45)。出生前兩個月的白天一氧化碳暴露在中暴露量和極高暴露量對早產的勝算比則有明顯較低的現象。母親在出生前的一個月二氧化硫之全天暴露和整個懷孕過程中白天的臭氧暴露和未校正出生週數的低出生體重有暴露效應關係。整個懷孕過程的白天臭氧暴露在高暴露亮和及高暴露量對低出生體重的勝算比為1.20 (95% CI=1.01-1.43)和1.29 (95% CI=1.04- 1.61)。校正出生週數後,整個懷孕過程的白天臭氧暴露在中暴露量和高暴露量對低出生體重之勝算比仍有1.29 (95% CI=1.06-1.56)和1.29 (95%CI=1.06-1.57)。
本研究結果指出二氧化硫及臭氧的濃度上升可能會增加早產及低出生體重的危險性,但其他未測量的危險因子仍不能排除其影響。母親懷孕期間之空氣污染暴露和異常出生結果之關係還需進一步的探究。

Increased level of specific pollutant has been found to be responsible for the increased neonatal and postneonatal mortality. Since both preterm delivery (PTD) and low birth weight (LBW) are significant predictors of infant mortality and childhood mortality.
We attempted to investigate whether maternal exposure to air pollution during pregnancy associated with these adverse birth outcomes in Taiwan. The study population consisted of 34,481 infants born to mothers who resided within a radius of 700 m to the air monitoring stations (n=50) in 1995-97. Daytime and daily maternal exposures to sulfur dioxide (SO2), particulate matter≦10 μm (PM10), carbon monoxide (CO), nitrogen oxides (NOx), and ozone (O3) in the first month and initial two months of pregnancy, the last month and last two months of pregnancy, during each trimester and gestation period were estimated as well. Multiple logistic regression was used to estimate odds ratios (ORs) and their 95% confidence intervals (CIs) for PTD and LBW.
The results showed significant exposure-response relationships between PTD and maternal daily SO2 exposure in the last month of pregnancy or daytime O3 exposure in the 1st month of pregnancy. The adjusted odds ratios at extra high exposure level were 1.26 (CI=1.05-1.53) and 1.21 (CI=1.01-1.45) respectively. A decreased risk of PTD was observed for maternal daytime exposure to middle and extra high level of CO. Maternal daily SO2 exposure in the last month of pregnancy and daytime O3 exposure during whole gestation period also had an exposure-response relationship with LBW. The adjusted odds ratios of maternal O3 exposure high and extra high levels during whole gestation were 1.20 (CI=1.01-1.43) and 1.29 (CI=1.04-1.61), respectively. The gestational age adjusted risk of LBW remained significant for daytime O3 exposure during whole gestation. The adjusted Odds ratios in middle and high level were 1.29 (CI=1.06-1.56) and 1.29 (CI=1.06-1.57).
In conclusion, this study suggested that the increased exposure to SO2 and O3 might contribute to the excess risk of PTD and LBW. But the associations with other unmeasured risk factors deserve further exploration.

Chinese Abstract
English Abstract
Contents
List of Tables
List of Figures
1. Introduction
2. Material and Methods
2.1. Subjects and outcomes
2.2. Exposure assessment
2.3. Statistical analysis
3. Results
3.1. Basic characteristics of birth cohort
3.2. Description of air pollution
3.3. Seasonal and regional effect
3.4. One-pollutant model
3.5. Period multi-pollutant model
3.6. Multi-pollutant model
4. Discussion
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