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Sun HZ, Tang H, Fang J, Dai H, Zhao H, Xu S, Xiang Q, Tian Y, Jiao Y, Luo T, Huang M, Shu J, Zang L, Liu H, Guo Y, Xu W, Bai X. A Chinese longitudinal maternity cohort study (2013-2021) on intrahepatic cholestasis phenotypes: Risk associations from environmental exposure to adverse pregnancy outcomes. JOURNAL OF HAZARDOUS MATERIALS 2024; 463:132915. [PMID: 37951168 DOI: 10.1016/j.jhazmat.2023.132915] [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: 08/17/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/13/2023]
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is an idiopathic disease that occurs during mid-to-late pregnancy and is associated with various adverse pregnancy outcomes, including intrauterine fetal demise. However, since the underlying cause of ICP remains unclear, there is an ongoing debate on the phenotyping criteria used in the diagnostic process. Here, we identified single- and multi-symptomatic ICP (ICP-S and ICP-M) in 104,221 Chinese females from the ZEBRA maternity cohort, with the objective of exploring the risk implications of the two phenotypes on pregnancy outcomes and from environmental exposures. We employed multivariate binary logistic regression to estimate confounder-adjusted odds ratios and found that ICP-M was more strongly associated with preterm birth and low birth weight compared to ICP-S. Throughout pregnancy, incremental exposure to PM2.5, O3, and greenness could alter ICP risks by 17.3%, 12.5%, and -2.3%, respectively, with more substantial associations observed with ICP-M than with ICP-S. The major scientific advancements lie in the elucidation of synergistic risk interactions between pollutants and the protective antagonistic effects of greenness, as well as highlighting the risk impact of preconceptional environmental exposures. Our study, conducted in the context of the "three-child policy" in China, provides epidemiological evidence for policy-making to safeguard maternal and neonatal health.
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Affiliation(s)
- Haitong Zhe Sun
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117609, Republic of Singapore; Centre for Sustainable Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117609, Republic of Singapore; Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, UK; Department of Earth Sciences, University of Cambridge, Cambridge CB2 3EQ, UK.
| | - Haiyang Tang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China
| | - Jing Fang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China; Lanxi People's Hospital, Jinhua, Zhejiang 321102, PR China
| | - Haizhen Dai
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China
| | - Huan Zhao
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China; Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang 322000, PR China
| | - Siyuan Xu
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China
| | - Qingyi Xiang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China
| | - Yijia Tian
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China
| | - Yurong Jiao
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China
| | - Ting Luo
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China
| | - Meishuang Huang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China
| | - Jia Shu
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China
| | - Lu Zang
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, PR China
| | - Hengyi Liu
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, School of Public Health, Peking University Health Science Centre, Beijing 100191, PR China
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Wei Xu
- Maternal and Child Health Division, Health Commission of Zhejiang Province, Hangzhou, Zhejiang 310006, PR China
| | - Xiaoxia Bai
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China; Traditional Chinese Medicine for Reproductive Health Key Laboratory of Zhejiang Province, Hangzhou, Zhejiang 310006, PR China; Zhejiang Provincial Clinical Research Centre for Obstetrics and Gynecology, Hangzhou, Zhejiang 310006, PR China; Key Laboratory of Women's Reproductive Health, Hangzhou, Zhejiang 310006, PR China.
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Su YF, Li C, Xu JJ, Zhou FY, Li T, Liu C, Wu YT, Huang HF. Associations between short-term and long-term exposure to particulate matter and preterm birth. CHEMOSPHERE 2023; 313:137431. [PMID: 36455656 DOI: 10.1016/j.chemosphere.2022.137431] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
Despite the longstanding evidence on the effect of air pollutants on preterm birth (PTB), few studies have focused on its subtypes, including spontaneous preterm birth (sPTB) and medically indicated preterm birth (miPTB). Most studies evaluated only the short-term or long-term effects of particulate matter (PM) on PTB. Thus, we designed this study, based on a cohort of 179,385 women, to evaluate both short- and long-term effects of PM with diameters ≤2.5 μm and ≤10 μm (PM2.5 and PM10) on PTB, sPTB and miPTB in Shanghai. Generalized additive models (GAMs) were applied to evaluate short-term effects. Lagged effects were identified using different lag structures. Exposure-response correlation curves were plotted using GAMs after adjustment for confounders. ORs and 95% CIs were calculated using logistic regression to estimate the long-term effect after adjustment for confounders. There was 5.67%, 3.70% and 1.98% daily incidence of PTB, sPTB, and miPTB on average. Every 10 μg/m3 increase in PM2.5 and PM10 was positively associated with PTB and sPTB at lag 2 day. The exposure-response curves (lag 2 day) indicated a rapid increase in sPTB for PM2.5 and a linear increase for PM10, in PTB for PM2.5 and PM10 at concentrations over 100 μg/m3. Regarding long-term exposure, positive associations were found between 10 μg/m3 increases in PM2.5 and PM10 in 3rd trimester and greater odds of sPTB (aOR: 1.042, 95% CI: 1.018-1.065, and 1.018, 95% CI:1.002-1.034), and during the 3 months before conception and miPTB (aOR: 1.023, 95% CI: 1.003-1.042, and 1.017, 95% CI: 1.000-1.036). Acute exposure to PM2.5 and PM10 at lag 2 day and chronic exposure in 3rd trimester was significantly associated with sPTB, while miPTB was related to chronic exposure during the 3 months before pregnancy. These findings indicate that susceptibility windows of PM exposure can be influenced by different underlying etiologies of PTB.
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Affiliation(s)
- Yun-Fei Su
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Cheng Li
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China.
| | - Jing-Jing Xu
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China.
| | - Fang-Yue Zhou
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Tao Li
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Cong Liu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China.
| | - Yan-Ting Wu
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China.
| | - He-Feng Huang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China; Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences, China.
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Zhou FY, Li C, Qin KZ, Luo C, Huang HF, Wu YT. Delivery and neonatal outcomes of pregnant women during the Shanghai lockdown: A retrospective analysis. Front Pediatr 2023; 11:992908. [PMID: 36816385 PMCID: PMC9932883 DOI: 10.3389/fped.2023.992908] [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: 07/13/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Shanghai witnessed an unprecedented outbreak of COVID-19 and experienced a strict lockdown from March 28, 2022 to May 31, 2022. Most studies to date are on the first lockdown after the outbreak in December 2019. This study aimed to examine the impact of lockdown on delivery and neonatal outcomes among uninfected pregnant women in the new phase of the COVID-19 outbreak. METHODS A retrospective analysis was conducted in the Obstetrics and Gynecology Hospital of Fudan University. Pregnant women without COVID-19 who delivered from March 28, 2022 to May 31, 2022 (lockdown group) and the same period in 2021 (non-lockdown group) were recruited for this study. Logistic regression models and 1 : 1 propensity score matching (PSM) were used to assess the effect of lockdown on delivery outcomes. RESULTS A total of 2,962 patients were included in this study, 1,339 of whom were from the lockdown group. Compared with the non-lockdown group, pregnant women giving birth during lockdown had an increased risk of term prelabor rupture of membranes (TPROM) (aOR = 1.253, 95% CI: 1.026-1.530), and decreased risks of postpartum hemorrhage (PPH) (aOR = 0.362, 95% CI: 0.216-0.606) and fetal malformation (aOR = 0.309, 95% CI: 0.164-0.582). The risk of large for gestational age (LGA) (aOR = 0.802, 95% CI: 0.648-0.992) and rate of admission to the neonatal intensive care unit (NICU) (aOR = 0.722, 95% CI: 0.589-0.885) also significantly declined. After 1 : 1 PSM, the impact of lockdown on the risk of TPROM (aOR = 1.501, 95% CI: 1.083-2.080), PPH (aOR = 0.371, 95% CI: 0.211-0.654), fetal malformation (aOR = 0.332, 95% CI: 0.161-0.684), LGA (aOR = 0.749, 95% CI: 0.594-0.945) and rate of admission to the NICU (aOR = 0.700, 95% CI: 0.564-0.869) all remained. There were no other delivery or neonatal outcomes affected by the lockdown after the COVID-19 outbreak. CONCLUSION This study indicated a significant increase in the risk of term PROM, significant decreases in the risk of PPH, fetal malformation and LGA, and a marked decline in the rate of admission to the NICU during Shanghai Lockdown.
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Affiliation(s)
- Fang-Yue Zhou
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China.,International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Cheng Li
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Kai-Zhou Qin
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Chuan Luo
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - He-Feng Huang
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China.,International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences (No. 2019RU056), Shanghai, China
| | - Yan-Ting Wu
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
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