宫内铅、镉及拟除虫菊酯类杀虫剂暴露对婴幼儿生长发育的影响
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摘要
[研究背景]
环境化学污染对儿童健康的影响正日益引起人们的重视。胎儿期是各种器官形成和发育的特殊时期,对各种环境毒物的吸收、代谢、排泄途径均与成人不同,相同的暴露水平可能对成人不产生影响,但可导致胎儿严重的发育障碍,对其一生的健康产生深远的影响。正是基于这样的背景,本课题组选择江苏省射阳县作为研究现场,以2009年6月中旬至2010年1月中旬至该县妇产科医院分娩且同意参与研究的1149对孕产妇-新生儿为研究对象,开展了宫内环境化学污染物暴露对儿童生长发育影响的前瞻性队列研究。本课题是该项研究的一部分,主要关注宫内铅、镉等重金属及拟除虫菊酯类杀虫剂暴露对新生儿及一岁幼儿生长发育的可能影响。
[研究目的]
1、评估研究地区铅、镉及拟除虫菊酯类杀虫剂宫内暴露的水平及特征；
2、了解研究地区新生儿及幼儿发育的一般状况；
3、探讨研究地区宫内铅、镉及拟除虫菊酯类杀虫剂暴露是否会对新生儿及幼儿生长发育产生不良影响,为提高当地出生人口素质提供科学依据。
[研究内容和方法]
1、研究地区铅、镉及拟除虫菊酯类杀虫剂宫内暴露水平及特征的评估：主要通过对产妇进行问卷调查及检测新生儿脐带血中铅、镉元素水平与孕妇尿液中三种拟除虫菊酯类杀虫剂代谢产物水平来进行；
2、新生儿生长发育状况评估：分娩时测量其出生体重、身长、头围,并记录新生儿性别、孕周、分娩方式等基本信息及APGAR评分、有无出生缺陷；3、一岁幼儿生长发育状况的随访：待研究幼儿发育至一岁时,跟踪随访其体格及神经智力发育状况。体格测量指标有：体重、身高、头围、胸围；神经智力发育状况评估采用“0-6岁发育筛查测验”,对幼儿的运动能力、社会适应及智力进行综合评估,并计算发育商及智力指数；
4、资料录入和统计分析：使用EPIDATA 3.1软件进行资料录入,采用SPSS 17.0软件进行统计分析。主要运用t检验、协方差分析、多因素线性回归及非参数检验等统计分析方法。
[主要研究结果]本次研究共有1149对母亲-新生儿进入研究队列。本次研究共随访到1岁幼儿620名。
1、本研究中1149名孕产妇主要为受教育程度较低(中学及以下87.4%)、从事体力劳动或无业(88.1%)、居住在乡村或城乡结合部(65.0%)、家庭年经济收入水平较低(5万元以下者83.4%)的人群；
2、本研究1158名新生儿中出生缺陷发生率为6.0‰；低体重儿发生率为0.9%；早产儿发生率为0.4%,均低于我国同期平均水平；
3、本研究中新生儿及幼儿体格发育水平接近我国同期儿童发育水平。但幼儿神经智力发育水平与同期城市幼儿相比较低,发育商异常者达7.1%,智力指数异常者达3.4%；
4、宫内铅、镉暴露对新生儿及幼儿发育的影响：以脐血铅、镉元素水平分组,发现高镉组与低镉组间新生儿及幼儿体格发育水平有统计学差异,高镉组新生儿出生体重、身长及幼儿身高均显著低于低镉组；多元线性回归分析结果亦发现脐血镉与新生儿身高、体重及幼儿身高呈负相关；脐血铅与新生儿及幼儿发育指标间未发现统计学关联；
5、孕妇尿中三种拟除虫菊酯类杀虫剂代谢产物均具有较高的检出率及水平。高达94.1%的孕妇尿中同时检出了三种拟除虫菊酯类杀虫剂代谢产物；代谢产物3-PBA、cis-DCCA及trans-DCCA在本研究孕妇中的检出率分别为98.8%、95.3%及98.3%；其中位数水平分别为：1.01μg/L,0.44μg/L,1.17μg/L; 1.55μg/g Cre.,0.69μg/g Cre.,1.86μg/g Cre(肌酐校正)；对影响孕妇尿中拟除虫菊酯类杀虫剂代谢产物水平的单因素分析提示,孕妇尿中拟除虫菊酯代谢产物水平可能会受到文化程度、职业及室内杀虫剂使用情况的影响；
6、孕妇尿中拟除虫菊酯代谢产物水平呈现季节变化趋势,夏秋季孕妇尿中代谢物水平显著高于冬季孕妇尿中代谢物水平；
7、孕妇尿中拟除虫菊酯类代谢产物水平与新生儿体格发育指标、幼儿体格发育指标间未发现统计学关联；
8、以孕妇尿中拟除虫菊酯类杀虫剂代谢物水平分组,统计分析发现：不同拟除虫菊酯暴露水平孕妇所产幼儿发育商及智力指数之间有统计学差异,随着暴露水平的增高,幼儿发育商及智力指数出现降低的趋势；以上结果提示：宫内拟除虫菊酯类杀虫剂代谢产物暴露可能会对幼儿神经智力发育产生不良影响。
[结论]
1、研究地区孕妇宫内镉暴露会对新生儿及幼儿体格发育产生不良影响；
2、研究对象孕妇尿中具有较高的拟除虫菊酯类杀虫剂代谢产物检出率及水平；
3、研究地区孕妇宫内拟除虫菊酯类杀虫剂暴露可能会对幼儿神经智力发育产生不良影响。
[Backgrounds]
There is growing concern about the potential health effects of exposure to various environmental chemicals during pregnancy and infancy. Evidence suggests that fetuses and children are more sensitive than adults to the toxicity of many environmental chemical pollutants because of their higher cell proliferation rates, lower immunologic competence, and decreased ability to detoxify carcinogens and to repair DNA damage. We are conducting a prospective cohort study among pregnant women and newborns to examine the effects of prenatal exposure to these common toxicants on infant growth and early neurodevelopment. The study recruited 1149 mother- baby pairs delivered in the Hospital for Gynecology and Obstetrics of Sheyang County, Jiangsu Province from June 2009 to January 2010. As a part of research project, this paper is principally concerned with effects of heavy metals such as lead and cadmium, and pyrethroid pesticides.
[Objectives]
1、To evaluate the levels and characteristic of lead, cadmium in umbilical cord blood and pyrethroid pesticides in maternal urine;
2、To acquire the profile of physical and mental development of local neonates and 1 year old infants;
3、To investigate the impact of prenatal lead, cadmium and pyrethroid exposure on physical and mental development of neonates and 1 year old infants and provide clues to improve local child health care.
[Methods]
1. Personal interview:A 30-min questionnaire was administered by a trained interviewer after delivery. The questionnaire elicited demographic information, occupational history, residential history, medication information, history of active and passive smoking, alcohol use and pesticide use during pregnancy. Socioeconomic information related to income and education was also collected.
2. Biologic sample collection and analysis:Maternal spot urin and umbilical cord blood were collected. We assessed exposure to heavy metals by the cord blood lead and cadmium measurements, and exposure to pyrethroid pesticides by the three urinary metabolites of pyrethroid measurements (3-PBA, cis-DCCA and trans-DCCA).
3. Measures relevant to birth outcomes and physical development:Birth weight, birth length, and head circumference were measured immediately after parturition. Information included date of delivery; gestational age at birth, infant sex, APGAR score and malformations were also recorded.
4. Follow-up study:After the newborns reached 12 months of age, they were invited to participate in the survey; their weight, height, head circumference and breast circumference were measured as indicators of physical development. Mental development in infancy and early childhood were evaluated using the DST scale.
5. Statistical analysis:Epidata 3.1 software was used for the import of data, and SPSS 17.0 software was applied for Statistical analysis. Measures of lead, cadmium and pyrethroid were In-transformed to normalize the distribution and stabilize the variance. The Student's t-test was used to compare the maternal and cord blood chemical levels in different groups. We used multiple linear regression to analyze the association between lead, cadmium, pyrethroid level and birth outcomes or child development, adjusting for potential confounders.
[Results]
A total of 1,149 pregnant women who gave birth at local maternity hospital took part in this investigation and 620 one year old infants in followed-up study.
1、Of the 1,149 pregnant women,77.0% were under 25 years old; 87.4% of their educational level were no more than middle school; 65.0% of them lived in countryside or rural area and 57.3% participated in physical labor before or during pregnancy; 83.4% of them family annual income was below 50,000 yuan; Close to half (45.5%) of women self-reported that they or their household member had applied commercially available indoor insecticides during pregnancy;
2、The prevalence of birth defects in our study was 6.0 per 1000 births, low-weight was 0.9% and premature infants was 0.4%; Which were all below the national average level; physical development level of newborns and one year infants were normal, whereas,7.1% and 3.4% of them had low scores in developmental quotient and mental index respectively;
3、Significantly negative correlations were found between cord blood cadmiuneexposure and physical development of neonates and infants; Generally, elevated cord blood cadmium levels were significantly associated with decreased birth weight and reduced length, but not with head circumference and breast circumference; Whereas, no sifnificant correlations were found between cord blood lead level and fetus development and later infant development. The results aboved were verified by multiple linear regression analysis;
5、Three pyrethroid metabolites were detected synchronously in spot urin samples from 94.1% of mothers with median unadjusted (μg/L) and creatinine-adjusted (μg/g Cre.) were 1.01 and 1.55 for 3-PBA,0.44 and 0.69 for cis-DCCA,1.17 and 1.86 for trans-DCCA respectively. The median values of urinary metabolites in our study were about 4 to 10 times higher as those of general population from the developed countries. Single factor variance analysis showed that pyrethroid metabolites level in maternal urine samples may be affected by educational level, career and the usage condition of indoor pesticide;
6、Interestingly, we found there was a temporal season variation tendency in different months. Especially the levels of urinary metabolites in summer were significant higher than those in winter;
7、Covariance analysis showed with the increasing of urine pyrethroid metabolites level, the infant's performance score of DST scale decreased,which suggested that prenatal pyrethroid exposure may associated with poor mental development of infant.
[Conclusions]
Our research suggested that:
1、There was a significant association between elevated cord blood cadmium with reduced physical growth of newborns and one year old infants;
2、There were high detectable rate and levels of pyrethroid metabolites in pregnant women's urine sample in this population;
3、Exposure to elevated levels of pyrethroid pesticides was associated with reduced infant's mental development in this population.
环境化学污染对儿童健康的影响正日益引起人们的重视。胎儿期是各种器官形成和发育的特殊时期,对各种环境毒物的吸收、代谢、排泄途径均与成人不同,相同的暴露水平可能对成人不产生影响,但可导致胎儿严重的发育障碍,对其一生的健康产生深远的影响。正是基于这样的背景,本课题组选择江苏省射阳县作为研究现场,以2009年6月中旬至2010年1月中旬至该县妇产科医院分娩且同意参与研究的1149对孕产妇-新生儿为研究对象,开展了宫内环境化学污染物暴露对儿童生长发育影响的前瞻性队列研究。本课题是该项研究的一部分,主要关注宫内铅、镉等重金属及拟除虫菊酯类杀虫剂暴露对新生儿及一岁幼儿生长发育的可能影响。
[研究目的]
1、评估研究地区铅、镉及拟除虫菊酯类杀虫剂宫内暴露的水平及特征；
2、了解研究地区新生儿及幼儿发育的一般状况；
3、探讨研究地区宫内铅、镉及拟除虫菊酯类杀虫剂暴露是否会对新生儿及幼儿生长发育产生不良影响,为提高当地出生人口素质提供科学依据。
[研究内容和方法]
1、研究地区铅、镉及拟除虫菊酯类杀虫剂宫内暴露水平及特征的评估：主要通过对产妇进行问卷调查及检测新生儿脐带血中铅、镉元素水平与孕妇尿液中三种拟除虫菊酯类杀虫剂代谢产物水平来进行；
2、新生儿生长发育状况评估：分娩时测量其出生体重、身长、头围,并记录新生儿性别、孕周、分娩方式等基本信息及APGAR评分、有无出生缺陷；3、一岁幼儿生长发育状况的随访：待研究幼儿发育至一岁时,跟踪随访其体格及神经智力发育状况。体格测量指标有：体重、身高、头围、胸围；神经智力发育状况评估采用“0-6岁发育筛查测验”,对幼儿的运动能力、社会适应及智力进行综合评估,并计算发育商及智力指数；
4、资料录入和统计分析：使用EPIDATA 3.1软件进行资料录入,采用SPSS 17.0软件进行统计分析。主要运用t检验、协方差分析、多因素线性回归及非参数检验等统计分析方法。
[主要研究结果]本次研究共有1149对母亲-新生儿进入研究队列。本次研究共随访到1岁幼儿620名。
1、本研究中1149名孕产妇主要为受教育程度较低(中学及以下87.4%)、从事体力劳动或无业(88.1%)、居住在乡村或城乡结合部(65.0%)、家庭年经济收入水平较低(5万元以下者83.4%)的人群；
2、本研究1158名新生儿中出生缺陷发生率为6.0‰；低体重儿发生率为0.9%；早产儿发生率为0.4%,均低于我国同期平均水平；
3、本研究中新生儿及幼儿体格发育水平接近我国同期儿童发育水平。但幼儿神经智力发育水平与同期城市幼儿相比较低,发育商异常者达7.1%,智力指数异常者达3.4%；
4、宫内铅、镉暴露对新生儿及幼儿发育的影响：以脐血铅、镉元素水平分组,发现高镉组与低镉组间新生儿及幼儿体格发育水平有统计学差异,高镉组新生儿出生体重、身长及幼儿身高均显著低于低镉组；多元线性回归分析结果亦发现脐血镉与新生儿身高、体重及幼儿身高呈负相关；脐血铅与新生儿及幼儿发育指标间未发现统计学关联；
5、孕妇尿中三种拟除虫菊酯类杀虫剂代谢产物均具有较高的检出率及水平。高达94.1%的孕妇尿中同时检出了三种拟除虫菊酯类杀虫剂代谢产物；代谢产物3-PBA、cis-DCCA及trans-DCCA在本研究孕妇中的检出率分别为98.8%、95.3%及98.3%；其中位数水平分别为：1.01μg/L,0.44μg/L,1.17μg/L; 1.55μg/g Cre.,0.69μg/g Cre.,1.86μg/g Cre(肌酐校正)；对影响孕妇尿中拟除虫菊酯类杀虫剂代谢产物水平的单因素分析提示,孕妇尿中拟除虫菊酯代谢产物水平可能会受到文化程度、职业及室内杀虫剂使用情况的影响；
6、孕妇尿中拟除虫菊酯代谢产物水平呈现季节变化趋势,夏秋季孕妇尿中代谢物水平显著高于冬季孕妇尿中代谢物水平；
7、孕妇尿中拟除虫菊酯类代谢产物水平与新生儿体格发育指标、幼儿体格发育指标间未发现统计学关联；
8、以孕妇尿中拟除虫菊酯类杀虫剂代谢物水平分组,统计分析发现：不同拟除虫菊酯暴露水平孕妇所产幼儿发育商及智力指数之间有统计学差异,随着暴露水平的增高,幼儿发育商及智力指数出现降低的趋势；以上结果提示：宫内拟除虫菊酯类杀虫剂代谢产物暴露可能会对幼儿神经智力发育产生不良影响。
[结论]
1、研究地区孕妇宫内镉暴露会对新生儿及幼儿体格发育产生不良影响；
2、研究对象孕妇尿中具有较高的拟除虫菊酯类杀虫剂代谢产物检出率及水平；
3、研究地区孕妇宫内拟除虫菊酯类杀虫剂暴露可能会对幼儿神经智力发育产生不良影响。
[Backgrounds]
There is growing concern about the potential health effects of exposure to various environmental chemicals during pregnancy and infancy. Evidence suggests that fetuses and children are more sensitive than adults to the toxicity of many environmental chemical pollutants because of their higher cell proliferation rates, lower immunologic competence, and decreased ability to detoxify carcinogens and to repair DNA damage. We are conducting a prospective cohort study among pregnant women and newborns to examine the effects of prenatal exposure to these common toxicants on infant growth and early neurodevelopment. The study recruited 1149 mother- baby pairs delivered in the Hospital for Gynecology and Obstetrics of Sheyang County, Jiangsu Province from June 2009 to January 2010. As a part of research project, this paper is principally concerned with effects of heavy metals such as lead and cadmium, and pyrethroid pesticides.
[Objectives]
1、To evaluate the levels and characteristic of lead, cadmium in umbilical cord blood and pyrethroid pesticides in maternal urine;
2、To acquire the profile of physical and mental development of local neonates and 1 year old infants;
3、To investigate the impact of prenatal lead, cadmium and pyrethroid exposure on physical and mental development of neonates and 1 year old infants and provide clues to improve local child health care.
[Methods]
1. Personal interview:A 30-min questionnaire was administered by a trained interviewer after delivery. The questionnaire elicited demographic information, occupational history, residential history, medication information, history of active and passive smoking, alcohol use and pesticide use during pregnancy. Socioeconomic information related to income and education was also collected.
2. Biologic sample collection and analysis:Maternal spot urin and umbilical cord blood were collected. We assessed exposure to heavy metals by the cord blood lead and cadmium measurements, and exposure to pyrethroid pesticides by the three urinary metabolites of pyrethroid measurements (3-PBA, cis-DCCA and trans-DCCA).
3. Measures relevant to birth outcomes and physical development:Birth weight, birth length, and head circumference were measured immediately after parturition. Information included date of delivery; gestational age at birth, infant sex, APGAR score and malformations were also recorded.
4. Follow-up study:After the newborns reached 12 months of age, they were invited to participate in the survey; their weight, height, head circumference and breast circumference were measured as indicators of physical development. Mental development in infancy and early childhood were evaluated using the DST scale.
5. Statistical analysis:Epidata 3.1 software was used for the import of data, and SPSS 17.0 software was applied for Statistical analysis. Measures of lead, cadmium and pyrethroid were In-transformed to normalize the distribution and stabilize the variance. The Student's t-test was used to compare the maternal and cord blood chemical levels in different groups. We used multiple linear regression to analyze the association between lead, cadmium, pyrethroid level and birth outcomes or child development, adjusting for potential confounders.
[Results]
A total of 1,149 pregnant women who gave birth at local maternity hospital took part in this investigation and 620 one year old infants in followed-up study.
1、Of the 1,149 pregnant women,77.0% were under 25 years old; 87.4% of their educational level were no more than middle school; 65.0% of them lived in countryside or rural area and 57.3% participated in physical labor before or during pregnancy; 83.4% of them family annual income was below 50,000 yuan; Close to half (45.5%) of women self-reported that they or their household member had applied commercially available indoor insecticides during pregnancy;
2、The prevalence of birth defects in our study was 6.0 per 1000 births, low-weight was 0.9% and premature infants was 0.4%; Which were all below the national average level; physical development level of newborns and one year infants were normal, whereas,7.1% and 3.4% of them had low scores in developmental quotient and mental index respectively;
3、Significantly negative correlations were found between cord blood cadmiuneexposure and physical development of neonates and infants; Generally, elevated cord blood cadmium levels were significantly associated with decreased birth weight and reduced length, but not with head circumference and breast circumference; Whereas, no sifnificant correlations were found between cord blood lead level and fetus development and later infant development. The results aboved were verified by multiple linear regression analysis;
5、Three pyrethroid metabolites were detected synchronously in spot urin samples from 94.1% of mothers with median unadjusted (μg/L) and creatinine-adjusted (μg/g Cre.) were 1.01 and 1.55 for 3-PBA,0.44 and 0.69 for cis-DCCA,1.17 and 1.86 for trans-DCCA respectively. The median values of urinary metabolites in our study were about 4 to 10 times higher as those of general population from the developed countries. Single factor variance analysis showed that pyrethroid metabolites level in maternal urine samples may be affected by educational level, career and the usage condition of indoor pesticide;
6、Interestingly, we found there was a temporal season variation tendency in different months. Especially the levels of urinary metabolites in summer were significant higher than those in winter;
7、Covariance analysis showed with the increasing of urine pyrethroid metabolites level, the infant's performance score of DST scale decreased,which suggested that prenatal pyrethroid exposure may associated with poor mental development of infant.
[Conclusions]
Our research suggested that:
1、There was a significant association between elevated cord blood cadmium with reduced physical growth of newborns and one year old infants;
2、There were high detectable rate and levels of pyrethroid metabolites in pregnant women's urine sample in this population;
3、Exposure to elevated levels of pyrethroid pesticides was associated with reduced infant's mental development in this population.
引文
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2. 张玉洋.国内外对有毒污染物的研究概况[J].黑龙江环境通报,2004,28(2)：6-7.
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