(34.228.41.66) 您好!臺灣時間:2018/12/12 20:00
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

我願授權國圖
本論文永久網址: 
line
研究生:劉家琳
研究生(外文):Chia-Lin Liu
論文名稱:一、母親懷孕期間室外粒狀空氣污染物對子宮內成長遲滯兒之影響二、室外空氣污染與嬰兒猝死症之探討-族群病例對照研究
論文名稱(外文):1.The Effect of Maternal Exposure to Outdoor Particulate Air Pollution during Pregnancy on Small for Gestational Age 2.The Relation between Outdoor Air Pollution and Sudden Infant Death Syndrome – A Population-Based Case-Control Study
指導教授:陳保中陳保中引用關係
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:2004
畢業學年度:92
語文別:英文
論文頁數:52
中文關鍵詞:呼吸道疾病死亡嬰兒猝死症一氧化碳懸浮微粒子宮內生長遲滯兒環境空氣污染物
外文關鍵詞:small for gestational agerespiratory deathssudden infant death syndromeleadparticulate matterair pollutantsenvironmentalcarbon monoxide
相關次數:
  • 被引用被引用:2
  • 點閱點閱:969
  • 評分評分:系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
一、母親懷孕期間室外粒狀空氣污染物對子宮內成長遲滯兒之影響
空氣污染已知會對人體生殖健康造成不良的影響,但唯有少數之研究探討懸浮微粒及其成分與子宮內成長遲滯兒之相關性。因此本研究的目的在探討母親在懷孕過程中所暴露到的氣動直徑小於10微米(PM10)之懸浮微粒與鉛是否會增加子宮內成長遲滯兒的發生。
本研究族群包括在1996-2002年出生的322,513名新生兒,其母親皆居住於與環保署55座一般空氣品質監測站相同之鄉鎮市區內。由環保署空氣品質監測站之資料庫監測獲得懷孕母親在懷孕期間之室外空氣污染物暴露情形,包含白天(7:00 - 19:00) 12小時的氣動直徑小於10微米(PM10)之懸浮微粒、一氧化碳(CO)、二氧化氮(NO2)、二氧化硫(SO2)、臭氧(O3)以及每個月鉛暴露在三個孕程之平均值。出生結果以及其他潛在危險因子的資料來自於內政部之出生登記資料庫。利用generalized additive model估計子宮內成長遲滯兒之勝算比及95%信賴區間,同時考量各項潛在干擾因子與氣狀空氣污染物之控制。
在本研究中,我們發現懷孕母親在懷孕期間三個孕程之PM10暴露和於第三個孕程之鉛暴露與子宮內成長遲滯兒有明顯的暴露效應關係存在。本研究結果指出PM10與其成分中鉛的濃度上升可能會增加子宮內成長遲滯兒之危險性。但其他未測量的危險因子仍不能排除。我們必須在收集更詳細的個人暴露資料、有效控制各項潛在的干擾因子以及瞭解懸浮微粒之成分以及不同的粒徑大小可能引起的生物機轉與累積效應後,針對母親懷孕期間之空氣污染暴露和異常出生結果作進一步之探討。
二、室外空氣污染與嬰兒猝死症之探討–族群病例對照研究
空氣污染長期以來已知會對人體健康造成不良影響。多數的研究指出空氣污染物的暴露會導致成年人與兒童的死亡率上升,唯有少數之研究探討其對嬰兒死亡率的影響。因此本研究的目的在於探討嬰兒於後新生兒期所暴露到的空氣污染物與嬰兒猝死症及呼吸道死亡之相關性。
我們選取了於1997年至2002年死亡的個案,利用族群病例對照研究法,以1比20的匹配方式選取了與死亡個案同性別且同年同月同日生但於個案發生死亡事件時仍然為存活者為對照組。由行政院環保署55個空氣品質監測站的監測資料評估個案死亡前1天至14天之暴露值,包括24小時的一氧化碳(CO)、二氧化氮(NO2)、二氧化硫(SO2)、臭氧(O3)以及氣動直徑小於10微米(PM10)之平均暴露濃度。利用conditional logistic regression 估計各種污染物與嬰兒猝死症及呼吸道疾病死亡之勝算比及95% 信賴區間,同時考量各項潛在干擾因子的控制。
在本研究中,共有398名與121名分別死於嬰兒猝死症與呼吸道疾病之個案。在單一污染與與多重污染物的模式中,我們可以發現在死亡前1天至前14天,每增加100ppb之一氧化碳暴露與嬰兒猝死症達到統計上的顯著相關。然而,我們並未發現空氣污染物會對呼吸道疾病死亡造成急性的不良影響。
本研究指出一氧化碳濃度的上升,可能會增加嬰兒猝死症的急性危險性。在未來的研究中我們必須進一步探討空氣污染物的長期慢性暴露對嬰兒死亡的影響,並且瞭解其可能引起的生物機轉。
Part I The Effect of Maternal Exposure to Outdoor Particulate
Air Pollution during Pregnancy on Small for Gestational Age
It has long been known that air pollution can affect human reproductive health, however, only a few studies indicated the relationship between small for gestational age (SGA, birth weight below the 10th percentile, by sex and gestational week) and ambient particulate matter and chemical compositions in particulate. Therefore, we attempt to investigate the impact of maternal exposure to PM10 and lead during pregnancy on SGA.
The study population consisted of 322,513 singleton live births born to mothers who resided in one of the 55 towns with air monitoring stations in Taiwan between 1996 and 2002. Daytime (7 AM to 7 PM) exposure to particulate matter <=10�n μm (PM10), carbon monoxide (CO), sulfur dioxide (SO2), nitrogen dioxide (NO2) and ozone (O3), and monthly exposure to lead during each trimester were estimated. Perinatal information and potential risk factors were obtained from the birth certificate database which was responsible by the Ministry of Interior. Generalized additive model (GAM) was used to assess the association between particulate air pollutants and SGA taking into account potential confounders and gaseous air pollutants.
We found significant association between maternal PM10 exposure and SGA in single- and multi-pollutant models during each trimester and exhibited exposure-response relationship. Maternal lead exposure the highest (>=75th) concentration was also associated with SGA during the first and second trimester of pregnancy. In single- and multi-pollutant models, it shows apparent significant association between maternal lead exposure-response during the third trimester of pregnancy.
In conclusion, increased exposure to PM10 and lead in particulate, respectively, during pregnancy, contribute to the small but significant risk in SGA for pregnant women. But the effect of other unmeasured risk factors cannot be excluded. Further studies with more detailed information on personal exposures and effect modifiers are needed to investigate the cumulative exposure effect and biologic mechanisms of air pollution, such as particle size and components on adverse birth outcomes.
PartII The Relation between Outdoor Air Pollution and Sudden Infant Death Syndrome – A Population-Based Case-Control Study
Most available evidence relating air pollution and mortality was obtained from studies of adults and children. Only a few studies evaluated the association between infant mortality and air pollution. To examine the potential acute effects of air pollution on sudden infant death syndrome (SIDS) and respiratory deaths in postneonatal period for infants in Taiwan, we conducted a population-based case-control study from 1997 to 2002. For each case of infant death, we randomly selected 20 matched controls from all infants of the same gender who were born on the same day and were alive when the case died. Twenty-four hour measurements of air pollutants and meteorological factors of each case and control for 1- to 14-day lags were constructed from one of the 55 air monitoring stations. We used conditional logistic regression to estimate the effects of air pollutants on SIDS and respiratory deaths, controlling for potential confounders.
There were 398 SIDS and 121 respiratory deaths for infants. Either in single- or multi-pollutant model, we found that 100 ppb increment in carbon monoxide (CO) with 1- to 14-day lags was associated with a significant increase in SIDS. We didn’t find a significant relationship between air pollution and respiratory death on 1- to 14-day lags.
Short-term CO exposure was associated with a significant increase in SIDS of the postneonatal period. In the future, we should investigate chronic effects for long-term air pollution exposure period between the birth and death on infant mortality and examine the potential biologic mechanism.
PartI
Chinese Abstract ii
English Abstract iii
Contents v
List of Tables vi
List of Figures vii
Introduction 1
Material and Methods 2
Study population 2
Exposure assessment 3
Statistical analysis 3
Results 6
Basic characteristics of birth cohort 6
Description of air pollution 6
Small for gestational age 7
Discussion 14
References 19
Appendix A. The summary of literatures about air pollution and preterm delivery 24
Appendix B. The summary of literatures about air pollution and low birth weight 27
Appendix C. The summary of literatures about air pollution and small for gestational age 30
Appendix D. The summary of literatures about air pollution and adverse outcomes in Taiwan 31
Appendix E. Certificate of Birth 32
PartII
Chinese Abstract i
English Abstract ii
Contents iii
List of Tables iv
List of Figures v
Introduction 1
Material and methods 2
Study population 2
Exposure assessment 3
Statistical analysis 3
Results 5
Basic characteristics of study population 5
Description of air pollution 5
Single-pollutant model 5
Multi-pollutant model 6
Discussion 11
References 15
Appendix A. The summary of literatures about air pollution and infant mortality 18
Appendix B. Certificate of Death 20
PartI
1.Dockery DW, Schwartz J, Spengler JD. Air pollution and daily mortality: associations with particles and acid aerosols. Environ Res 1992; 59: 362-373.
2.Katsouyanni K, Touloumi G, Spix C, Schwartz J, Balducci F, Medina S, Rossi G, Wojtyniak B, Sunyer J, Bacharova L, Schouten JP, Ponka A, Anderson HR. Short-term effects of ambient sulphur dioxide and particulate matter on mortality in 12 European cities: results from time series data from the APHEA project. Br Med J 1997; 314:1658-1663.
3.Conceição GMS, Miraglia SGEK, Kishi HS, Saldiva PHN, Singer JM. Air pollution and child mortality: a time-series study in São Paulo, Brazil. Environ Health Perspect 2001; 109(suppl 3):347-350.
4.Bobak M, Leon DA. The effect of air pollution on infant mortality appears specific for respiratory causes in the postneonatal period. Epidemiology 1999; 10:666-670.
5.Woodruff TJ, Grillo J, Schoendorf KC. The relationship between selected causes of postneonatal infant mortality and particulate air pollution in the United States. Environ Health Perspect 1997; 105:608-612.
6.Loomis D, Castillejos M, Gold DR, McDonnell W, Borja-Aburto VH. Air pollution and infant mortality in Mexico City. Epidemiology 1999; 10:118-123.
7.Berkowitz GS, Papiernik E. Epidemiology of preterm birth. Epidemiol Rev 1993; 15:414-443.
8.Kramer MS. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ 1987; 65:663-737.
9.Xu X, Ding H, Wang X. Acute effects of total suspended particles and sulfur dioxides on preterm delivery: a community-based cohort study. Arch Environ Health 1995; 50:407-415.
10.Wang X, Ding H, Ryan L, Xu X. Association between air pollution and low birth weight: a community-based study. Environ Health Perspect 1997; 105:514-520.
11.Bobak M. Outdoor air pollution, low birth weight, and prematurity. Environ Health Perspect 2000; 108:173-176.
12.Ritz B, Yu F, Chapa G, Fruin S. Effect of air pollution on preterm birth among children born in Southern California between 1989 and 1993. Epidemiology 2000; 11:502-511
13.Ha EH, Hong YC, Lee BE, Woo BH, Schwartz J, Christiani DC. Is air pollution a risk factor for low birth weight in Seoul? Epidemiology 2001; 12:643-648.
14.Lee BE, Ha EH, Park HS, Kim YJ, Hong YC, Kim H, Lee JT. Exposure to air pollution during different gestational phases contributes to risks of low birth weight. Hum Reprod 2003; 18:638-643.
15.Gouveia N, Bremner SA, Novaes HMD. Association between ambient air pollution and birth weight in São Paulo, Brazil. J Epidemiol Community Health 2004; 58:11-17.
16.McMichael AJ, Vimpani GV, Robertson EF, Baghurst PA, Clark PD. The Port Pirie cohort study: maternal lead and pregnancy. J Epidemiol Community Health 1986; 40:18-25.
17.Odland JØ, Nieboer E, Romanova N, Thomassen Y, Lund E. Blood lead and cadmium and birth weight among sub-arctic and arctic populations of Norway and Russia. Acta Obstet Gynecol Scand 1999; 78:852-860.
18.Dejmek J, Selevan SG, Beneš I, Solanský I, Šrám RJ. Fetal growth and maternal exposure to particulate matter during pregnancy. Environ Health Perspect 1999; 107:475-480.
19.Dejmek J, Solanskỳ I, Beneš I, Leniček, Šrám RJ. The impact of polycyclic aromatic hydrocarbons and fine particles on pregnancy outcome. Environ Health Perspect 2000; 108:1159-1164.
20.Ministry of Interior, R.O.C. The Children Welfare Act. 1993.
21.Arbuckle TE, Wilkins R, Sherman GJ. Birth weight percentiles by gestational age in Canada. Obstet Gynecol 1993; 81:39-48.
22.Chiao MC. 1998. Birth weight for gestational age model in Taiwan [Master thesis]. Taipei, Taiwan: National Taiwan University College of Public Health.
23.Environmental Protection Administration, R.O.C. Air quality monitoring report of 2002 annual report in Taiwan. 2002.
24.Taiwan Air analysis methods. Taiwan NIEA. Available: http://www.niea.gov.tw/analysis/method/ListMethod.asp?methodtype=AIR
25.Hastie TJ, Tibshirani RJ. Generalized Additive Models. London, United Kingdom: Chapman & Hall; 1990.
26.Taiwan Air Quality Monitoring Net Quality Assurance. Taiwan EPA. Available: http://www.epa.gov.tw/monitoring/qalab/index.htm
27.Yang CY, Tseng YT, Chang CC. Effects of air pollution on birth weight among children bon between 1995 and 1997 in Kaohsiung, Taiwan. J Toxicol Environ Health (Part A) 2003; 66:807-816.
28.Liu S, Krewski D, Shi Y, Chen Y, Burnett RT. Association between gaseous ambient air pollutants and adverse pregnancy outcomes in Vancouver, Canada. Environ Health Perspect 2003; 111:1773-1778.
29.Styne DM. Fetal growth. Clin Perinatol 1998; 25:917-938.
30.Challis JRG. Mechanism of parturition and preterm labor. Obstet Gynecol Surv 2000; 55:650-660.
31.Andrews KW, Savitz DA, Hertz-Picciotto I. Prenatal lead exposure in relation to gestational age and birth weight: a review of epidemiologic studies. Am J Ind Med 1994; 26:13-32.
32.Irgens A, Krüger K, Skorve AH, Irgens LM. Reproductive outcome in offspring of parents occupationally exposed to lead in Norway. Am J Ind Med 1998; 34:431-437.
33.Lin S, Hwang SA, Marshall EG, Marion D. Dose paternal occupational lead exposure increase the risks of low birth weight or pregmaturity. Am J Epidemiol 1998; 148:173-181.
34.Factor-Litvak P, Wasserman G, Kline JK, Graziano J. The Yugoslavia prospective study of environmental lead exposure. Environ Health Perspect 1999; 107:9-15.
35.Osman K, Åkesson A, Berglund M, Bremme K, Schütz A, Ask K, Vahter M. Toxic and essential elements in placentas of Swedish women. Clin Biochem 2000; 33:131-138.
36.Liou SH, Wu TN, Chiang HC, Yang T, Yang GY, Wu YQ, Lai JS, Ho ST, Guo YL, Ko KN, Chang PY. Three-year survey of blood lead levels in 8828 Taiwanese adults. Int Arch Occup Environ Health. 1995; 68:80-87.
37.Hwang YH, Ko Y, Chiang CD, Hsu SP, Lee YH, Yu CH, Chiou CH, Wang JD, Chuang HY. Transition of cord blood lead level, 1985-2002, in Taipei area and its determinants after the cease of leaded gasoline use. Environ Res (In press).
38.Yen LL, Pan LY. Smoking prevalence and behaviors of adults in Taiwan: A national survey, 1999. Chin J Public Health (Taipei) 2000; 19:423-436.
39.Chen L, Lee JS, Cheng KS. Correlation model for indoor and outdoor air pollution. J Chin Inst Environ Eng 1999; 9:73-79.
40.Report on the internal migration survey in Taiwan area. Taipei, Taiwan: Directorate-General of Budget Accounting and Statistic, the Executive Yuan, Taiwan, 1994.
PartII
1.Dockery DW, Pope AC, Xu X, Spengler JD, Ware JH, Fay ME, Ferris BG, Speizer FE. An association between air pollution and mortality in six U.S. cities. N Engl J Med 1993; 329:1753-1759.
2.Schwartz J. Air pollution and daily mortality: a review and meta-analysis. Environ Res 1994; 64:36-52.
3.Katsouyanni K, Touloumi G, Spix C, Schwartz J, Balducci F, Medina S, Rossi G, Wojtyniak B, Sunyer J, Bacharova L, Schouten JP, Ponka A, Anderson HR. Short-term effects of ambient sulphur dioxide and particulate matter on mortality in 12 European cities: results from time series data from the APHEA project. Br Med J 1997; 314:1658-1663.
4.Saldiva PHN, Pope CA III, Schwartz J, Dockery DW, Lichtenfels AJ, Salge JM, Barone J, Bohm GM. Air pollution and mortality in elderly people: a time-series analysis in Sao Paolo, Brazil. Arch Environ Health 1995; 50:159-163.
5.Xu X, Gao J, Dockery DW. Air pollution and daily mortality in residential areas of Beijing, China. Arch Environ Health 1994; 49:216-222.
6.Loomis D, Castillejos M, Gold DR, McDonnell W, Borja-Aburto VH. Air pollution and infant mortality in Mexico City. Epidemiology 1999; 10:118-123.
7.Woodruff TJ, Grillo J, Schoendorf KC. The relationship between selected causes of postneonatal infant mortality and particulate air pollution in the United States. Environ Health Perspect 1997; 105:608-612.
8.Bobak M, Leon DA. Air pollution and infant mortality in the Czech Republic, 1986-88. Lancet 1992; 340:1010-1014.
9.Bobak M, Leon DA. The effect of air pollution on infant mortality appears specific for respiratory causes in the postneonatal period. Epidemiology 1999; 10:666-670.
10.Saldiva PHN, Lichtenfels AJFC, Paiva PSO, Barone IA, Martins MA, Massad E, Pereira JCR, Xavier VP, Singer JM, Böhm GM. Association between air pollution and mortality due to respiratory diseases in children in São Paulo, Brazil: a preliminary report. Environ Res 1994; 65:218-225.
11.Conceição GMS, Miraglia SGEK, Kishi HS, Saldiva PHN, Singer JM. Air pollution and child mortality: a time-series study in São Paulo, Brazil. Environ Health Perspect 2001; 109(suppl 3):347-350.
12.Ha EH, Lee JT, Kim H, Hong YC, Lee BE, Park HS, Christiani DC. Infant susceptibility of mortality to air pollution in Seoul, South Korea. Pediatrics 2003; 111:284-290.
13.Knöbel HH, Chen CJ, Liang KY. Sudden infant death syndrome in relation to weather and optimetrically measured air pollution in Taiwan. Pediatrics 1995; 96:1106-1110.
14.Greenberg MA, Nelson KE, Carnow BW. A study of the relationship between sudden infant death syndrome and environmental factors. Am J Epidemiol 1972; 98:412-422.
15.Douglas AS, Allan TM, Helms PJ. Seasonality and the sudden infant death syndrome during 1987-9 and 1991-3 in Australia and Britain. Br Med J 1996; 312:1381-1383.
16.Schoendorf KC, Kiely JL. Relationship of sudden infant death syndrome to maternal smoking during and after pregnancy. Pediatrics 1992; 90:905-908.
17.Wisborg K, Kesmodel U, Henriksen TB, Olsen SF, Secher NJ. A prospective study of smoking during pregnancy and SIDS. Arch Dis Child 2000; 83:203-206.
18.Hoppenbrouwers T, Calub M, Arakawa K, Hodgman JE. Seasonal relationship of sudden infant death syndrome and environmental pollutants. Am J Epidemiol 1981; 113:623-635.
19.Taiwan Air Quality Monitoring Net Quality Assurance. Taiwan EPA. Available: http://www.epa.gov.tw/monitoring/qalab/index.htm
20.Environmental Protection Administration, R.O.C. Air quality monitoring report of 2002 annual report in Taiwan. 2002.
21.Yen LL, Pan LY. Smoking prevalence and behaviors of adults in Taiwan: A national survey, 1999 [in Chinese]. Chin J Public Health 2000; 19:423-436.
22.Hauk FR. Changing epidemiology. In: Byard RW, Krouse HF. Eds. Sudden infant death syndrome: problems, progress and possibilities. London, England: Arnold 2001: 31-57.
23.Longo LD. The biological effects of carbon monoxide on the pregnant women, fetus, and newborn infant. Am J Obstet Gynecol 1977; 129:69-103.
24.Hutter CD, Blair ME. Carbon monoxide: dose fetal exposure cause sudden infant death syndrome? Med Hypotheses 1996; 46:1-4.
25.Ritz B, Yu F, Fruin S, Chapa G, Shaw GM, Harris JA. Ambient air pollution and risk of birth defects in Southern California. Am J Epidemiol 2002; 155:17-25.
26.Knöbel HH, Yang WS, Ho MS. Urban-rural and regional differences in infant mortality in Taiwan. Soc Sci Med 1994; 24:815-822.
27.Beckwith JB. Defining the sudden infant death syndrome. Arch Pediatr Adolesc Med 2003; 157:286-290.
28.Knöbel HH, Yang WS, Chen CJ. Risk factors of sudden infant death in Chinese babies. Am J Epidemiol 1996; 144:1070-1073.
29.Chen L, Lee JS, Cheng KS. Correlation model for indoor and outdoor air pollution. J Chin Inst Environ Eng 1999; 9:73-79.
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
系統版面圖檔 系統版面圖檔