Abstract
BackgroundThe associations between maternal exposure to ambient PM2.5 during pregnancy and the risk of premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM) are controversial. And no relevant study has been conducted in Asia. This study aimed to determine the association between maternal exposure to ambient PM2.5 during pregnancy and the risk of (P)PROM.MethodsA cohort study including all singleton births in a hospital located in Central China from January 2015 through December 2017 was conducted. Multivariable logistic regression models, stratified analysis, generalized additive model, and two-piece-wise linear regression were conducted to evaluate how exposure to ambient PM2.5 during pregnancy is associated with the risks of PROM and PPROM.ResultsA total of 4364 participants were included in the final analysis, where 11.71 and 2.34% of births were complicated by PROM and PPROM, respectively. The level of PM2.5 exhibited a degree of seasonal variation, and its median concentrations were 63.7, 59.3, 55.8, and 61.8 μg/m3 for the first trimester, second trimester, third trimester, and the whole duration of pregnancy, respectively. After adjustment for potential confounders, PROM was positively associated with PM2.5 exposure (per 10 μg/m3) [Odds Ratio (OR) = 1.14, 95% Confidence Interval (CI), 1.02–1.26 for the first trimester; OR = 1.09, 95% CI, 1.00–1.18 for the second trimester; OR = 1.13, 95% CI, 1.03–1.24 for the third trimester; OR = 1.35, 95% CI, 1.12–1.63 for the whole pregnancy]. PPROM had positive relationship with PM2.5 exposure (per 10 μg/m3) (OR = 1.17, 95% CI, 0.94–1.45 for first trimester; OR = 1.11, 95% CI, 0.92–1.33 for second trimester; OR = 1.19, 95% CI, 0.99–1.44 for third trimester; OR = 1.53, 95% CI, 1.03–2.27 for the whole pregnancy) Positive trends between the acute exposure window (mean concentration of PM2.5 in the last week and day of pregnancy) and risks of PROM and PPROM were also observed.ConclusionsExposure to ambient PM2.5 during pregnancy was associated with the risk of PROM and PPROM.
Highlights
The membranes surrounding the amniotic cavity normally rupture at the beginning of labor or during labor
Pereira et al found that exposure to airborne particulate matter with an aerodynamic diameter of 0.25 μm or less (PM2.5) during the second trimester of pregnancy had an effect on premature rupture of membranes (PROM) risk in Western Australia [11]
During the study period, 11.7% (511) and 2.3% (102) of births were complicated by PROM and premature rupture of membranes (PPROM), Fig. 2 Temporal trend of PM2.5 level and quarterly incidence rates of PROM and PPROM from January 2014 to December 2017
Summary
The membranes surrounding the amniotic cavity normally rupture at the beginning of labor or during labor. PROM, especially PPROM, has been linked with a number of adverse outcomes, including preterm birth, chorioamnionitis, endomyometritis, pelvic abscess, bacteremia, postpartum hemorrhage [2, 3], umbilical cord prolapses, umbilical cord compression, retained placenta, fetal distress [4, 5], and early onset neonatal infection [6]. These outcomes are often associated with increased maternal complications, neonatal mortality [7,8,9], and even adverse long-term outcomes [10]. This study aimed to determine the association between maternal exposure to ambient PM2.5 during pregnancy and the risk of (P)PROM
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