妇女孕期磷肥暴露与早产发生风险的关联

张远; 李佳佳; 林是琦; 武继磊; 裴丽君

doi:10.16462/j.cnki.zhjbkz.2021.10.018

妇女孕期磷肥暴露与早产发生风险的关联

doi: 10.16462/j.cnki.zhjbkz.2021.10.018

张远^{1, 2},
李佳佳¹,
林是琦¹,
武继磊¹,
裴丽君^1, ,

1.
100871 北京，北京大学人口研究所，北京大学人口健康与发展研究中心
2.
100081 北京，国家卫生健康委科学技术研究所

基金项目:

国家重点研发计划 2018YFC1004303

国家自然科学基金 41871360

河南省卫生健康委员会出生缺陷预防重点实验室开放课题 ZD202002

详细信息

通讯作者:
裴丽君，E-mail: peilj@pku.edu.cn

中图分类号: R181;R714
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- 被引次数: 0
出版历程
- 收稿日期: 2020-10-24
- 修回日期: 2021-01-28
- 网络出版日期: 2021-11-17
- 刊出日期: 2021-10-10

Association between maternal exposure to phosphate fertilizers during pregnancy and the risk of preterm birth

ZHANG Yuan^{1, 2},
LI Jia-jia¹,
LIN Shi-qi¹,
WU Ji-lei¹,
PEI Li-jun^{1
, ,}

1.
Institute of Population Research, Peking University, Center for Population Health and Development, Peking University, Beijing 100871, China
2.
National Research Institute for Health and Family Planning, Beijing 100081, China

Funds:

National Key Research and Development Program of China 2018YFC1004303

National Natural Science Foundation of China 41871360

Open Project of Key Laboratory of Birth Defect Prevention of National Health Commission, Henan ZD202002

More Information

Corresponding author: PEI Li-jun, E-mail: peilj@pku.edu.cn

摘要

摘要: 目的了解农村化肥施用量与早产发生风险的关系，为提高出生人口素质提供参考。方法利用山西省平定县2007年10月1日至2012年9月30日的出生人口监测数据，随访获得155例早产新生儿，从同时期出生、无任何体表缺陷、孕周≥37周、正常出生体重(2 500~4 000 g)的新生儿中，随机选择204例作为对照组。采用分层多因素Logistic回归分析模型和结构方程模型分析方法，探索早产发生风险与母亲孕期化肥暴露之间的关联及多种暴露因素对早产风险的贡献。结果分层多因素Logistic回归分析模型结果显示，调整混杂因素后，暴露于村级化肥施用量≥100 t的妇女早产发生风险大于村级化肥施用量＜50 t的妇女(aOR=2.51, 95% CI：1.23~5.12)；妇女家庭施用磷肥是早产发生的危险因素(aOR=2.54, 95% CI：1.23~5.22)；结构方程模型检验发现，村级化肥施用量是对妇女早产发生风险贡献较大的环境因素。结论妇女孕期暴露于化肥，特别是磷肥与早产发生风险存在关联，建议农村妇女孕期尽量避免暴露于化肥施用环境。
- 早产 /
- 化肥 /
- 磷肥 /
- 孕期 /
- 妇女 /
- 关联
Abstract: Objective To explore the association between consumption of chemical fertilizers and the risk of preterm birth, to provide references for improvement of birth outcomes. Methods Using the birth population monitoring data from October 1, 2007 to September 30, 2012 in Pingding County, Shanxi Province, 155 cases of preterm birth were followed up, and 204 newborns with normal birth weight (2 500~4 000 g) born at the same time without any surface defects and gestational age ≥37 weeks were randomly selected as the control group. Stratified multivariate Logistic regression model and structural equation model were used to investigate the associations between the risk of preterm birth and maternal exposure to chemical fertilizers during pregnancy. Results The results of the stratified multivariate Logistic regression analysis model showed that after adjusting for confounding factors, women exposed to village-level fertilizer application ≥100 t had a higher risk of preterm birth than women who had village-level fertilizer application < 50 t (aOR=2.51, 95% CI: 1.23-5.12). Household consumption of phosphorus fertilizer was a risk factor for premature birth (aOR=2.54, 95% CI: 1.23-5.22). The findings of structural equation model indicated that maternal exposure to phosphate fertilizer during pregnancy may be an important environmental factor for the risk of premature birth. Conclusions Women's exposure to chemical fertilizers during pregnancy, especially phosphate fertilizers, is associated with the risk of preterm birth, so it is recommended that rural women should try to avoid exposure to chemical fertilizers during pregnancy.
- Preterm birth /
- Chemical fertilizer /
- Phosphate /
- Pregnancy /
- Women /
- Association

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图 1 早产结构方程模型结果路径图

Figure 1. Path map of preterm birth structural equation model

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表 1 山西省平定县早产新生儿组和健康新生儿组的人口学分布特征和暴露因素[n(%)]

Table 1. Demographic distribution characteristics and exposure factors of premature delivery case group and healthy control group in Pingding County, Shanxi Province [n(%)]

变量	早产新生儿组(n=155)	健康新生儿组(n=204)	χ²值	P值
妇女年龄(岁)			9.974	0.007
＜25	48(30.97)	83(40.69)
25~＜30	33(21.29)	57(27.94)
≥30	74(47.74)	64(31.37)
妇女职业^a			4.210	0.240
企事业	7(4.61)	7(3.48)
商业和服务业	20(13.16)	43(21.39)
农业和工业	56(36.84)	65(32.34)
家务或待业	69(45.39)	86(42.79)
妇女教育程度^b			12.842	0.002
小学及以下	34(22.08)	18(8.87)
初中	93(60.39)	150(73.89)
高中及以上	27(17.53)	35(17.24)
产次(次)^c			9.385	0.009
1	67(43.23)	103(50.74)
2	58(37.42)	83(40.89)
≥3	30(19.35)	17(8.37)
家庭年人均收入(元)^d			8.852	0.031
＜2 300	23(14.84)	38(18.72)
2 300~＜5 000	55(35.48)	52(25.62)
5 000~＜8 000	53(34.19)	60(29.56)
≥8 000	24(15.48)	53(26.11)
孕前BMI(kg/m²)^e			3.184	0.204
＜18.5	8(5.16)	10(4.93)
18.5~＜24.0	86(55.48)	131(64.53)
≥24.0	61(39.35)	62(30.54)
孕期感染性疾病^f			0.885	0.347
无	141(91.56)	192(94.12)
有	13(8.44)	12(5.88)
注：^a早产新生儿组和健康新生儿组各有3例缺失；^b早产新生儿组和健康新生儿组各有1例缺失；^c、d、e健康新生儿组皆有1例缺失；^f早产新生儿组有1例缺失。

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表 2 山西省平定县早产新生儿组和健康新生儿组家庭及村级层面农业环境暴露因素[n(%)]

Table 2. Agricultural exposure factors at family and village level of premature delivery case group and healthy control groupin Pingding County, Shanxi Province [n(%)]

变量	早产新生儿组(n=155)	健康新生儿组(n=204)	χ²值	P值
家庭层面
家庭耕地			4.611	0.100
无耕地	67(43.23)	107(52.45)
两亩及以内	35(22.58)	30(14.71)
两亩以上	53(34.19)	67(32.84)
家庭磷肥施用			8.334	0.004
无	122(78.71)	183(89.71)
有	33(21.29)	21(10.29)
家庭氮肥施用			0.460	0.498
无	138(89.03)	186(91.18)
有	17(10.97)	18(8.82)
家庭复合肥施用			0.691	0.406
无	107(69.03)	149(73.04)
有	48(30.97)	55(26.96)
村级层面
村用电量(万度)			0.753	0.386
＜100	122(78.71)	168(82.35)
≥100	33(21.29)	36(17.65)
村级化肥施用量(t)			9.685	0.008
＜50	71(45.81)	125(61.27)
50~＜100	44(28.39)	48(23.53)
≥100	40(25.81)	31(15.20)
村级经济总收入(万元)			3.480	0.323
＜2 500	45(29.03)	67(32.84)
2 500~＜5 000	24(15.48)	43(21.08)
5 000~＜10 000	39(25.16)	44(21.57)
≥10 000	47(30.32)	50(24.51)
村级粮食总产量(t)			6.660	0.036
＜150	29(18.71)	56(27.45)
150~＜500	69(44.52)	96(47.06)
≥500	57(36.77)	52(25.49)

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表 3 早产发生风险与妇女农业环境暴露因素关联的分层多因素Logistic回归分析模型结果

Table 3. The results of stratified multivariate Logistic regression analysis model between the risk of preterm birth and agricultural environmental exposure factors

变量	cOR(95% CI)值^a	aOR(95% CI)值^b
村级化肥施用量(t)
＜50	1.00	1.00
50~＜100	1.61(0.98~2.67)	1.30(0.67~2.53)
≥100	2.27(1.31~3.95)	2.51(1.23~5.12)
家庭磷肥施用
无	1.00	1.00
有	2.34(1.30~4.24)	2.54(1.23~5.22)
注：^a cOR即crude odds ratio, 粗比值比；^b aOR即adjusted odds ratio, 调整比值比。

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表 4 早产危险因素效应分析

Table 4. Effect analysis of risk factors for preterm birth

影响因素	因子载荷系数	总效应	效应排序
村级化肥施用量	0.275	0.263	1
妇女年龄	0.813	0.237	2
家庭磷肥施用	0.247	0.236	3
村级粮食总产量	0.227	0.217	4
产次	0.691	0.201	5
妇女教育程度	0.299	0.087	6
家庭年人均收入	0.274	0.080	7

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