Correlation between exposure to fine particulate matter and hypertensive disorders of pregnancy in Shanghai, China
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RESEARCH
Open Access
Correlation between exposure to fine particulate matter and hypertensive disorders of pregnancy in Shanghai, China Xiujuan Su, Yan Zhao, Yingying Yang and Jing Hua*
Abstract Background: Association between fine particulate matter (PM2.5) and hypertensive disorders of pregnancy (HDP) is inconsistent and appears to change in each trimester. We aim to investigate the association of exposure to ambient PM2.5 in early pregnancy with HDP. Methods: A retrospective cohort study was performed among 8776 women with singleton pregnancy who attended the antenatal clinic before 20 gestational weeks in a tertiary women’s hospital during 2014–2015. Land use regression models were used to predict individual levels of PM2.5 exposure. Results: The average PM2.5 concentration during the first 20 gestational weeks ranged from 28.6 to 74.8 μg m− 3 [median, 51.4 μg m− 3; interquartile range, 47.3–57.8 μg m− 3]. A total of 440 (5.0%) women was diagnosed with HDP. The restricted cubic spline showed a positive exposure-response relationship between the PM2.5 concentration and risk of HDP. We observed an association between PM2.5 exposure during the first trimester with HDP (RR = 3.89 per 10 μg m− 3, 95% CI: 1.45–10.43), but not during the second trimester (RR = 0.71 per 10 μg m− 3, 95% CI: 0.40–1.27). Compared with their counterparts, nulliparous women who were exposed to high levels of PM2.5 in the index pregnancy had a higher risk of developing HDP [the relative excess risk due to interaction was 0.92 (0.46–1.38)]. Conclusion: Our findings suggest that PM2.5 exposure during the first trimester is associated with the development of HDP. The effect estimate is more obvious for nulliparous women than multiparous women. Keywords: Fine particulate matter (PM2.5), Hypertensive disorders of pregnancy, Hypertension, Parity, Relative excess risk due to interaction
Background Hypertensive disorders of pregnancy (HDP), including gestational hypertension, preeclampsia, and eclampsia, exert substantial adverse effects on both maternal and foetal health [1, 2]. It complicates up to 10% pregnancies [3, 4] and ranks as the second leading causes of maternal mortality in China [5]. Despite the serious consequences, the biological mechanisms underlying HDP remain unclear. * Correspondence: [email protected] Department of Women & Children’s Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Shanghai 200040, China
Fine particulate matter (median aerodynamic diameter ≤ 2.5 μm; PM2.5), has been proposed to be associated with the incidence of hypertension in the general population [6–8]. PM2.5 generally has been associated with increased risks of cardiovascular diseases within hours to days of exposure in susceptible individuals [9]. Due to cardiovascular changes that occur as part of a normal pregnancy, pregnant women might be more vulnerable to the adverse effects of PM2.5, while its association with HDP is inconsistent and appears to change in each trimester [10
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