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標題: | 產前產後,環境空氣污染與母乳哺育 對於兒童氣喘發病率之影響 The Effects of Prenatal and Postnatal Ambient Air Pollutants Exposure and Breastfeeding on the Incidence of Asthma in Children |
作者: | 河野美空 Miku Kono |
指導教授: | 郭育良 Yue-Liang Leon Guo |
關鍵字: | 產前和產後的暴露,環境空氣汙染,母乳哺育,兒童,氣喘, Prenatal and Postnatal Exposure,Ambient Air Pollution,Breastfeeding,Children,Asthma, |
出版年 : | 2023 |
學位: | 碩士 |
摘要: | 背景: 兒童氣喘是兒童最常見的慢性非傳染性疾病(NCD),兒童氣喘發病率的快速變化表明環境因素在氣喘發展中起著關鍵作用。然而,仍然缺乏關於產前和產後空氣污染物暴露與兒童氣喘發病率的證據。此外,另一個早期環境因素—母乳哺育,對空氣污染引起的兒童氣喘發病率的影響也沒有得到充分的探討。
目的: 本研究旨在調查台灣地區(母親)產前和產後環境空氣污染物的暴露量以及母乳哺育及其對兒童8歲前氣喘發病率的相互影響。 方法: 研究族群選自臺灣出生世代研究(TBCS),估計的空氣污染物暴露的估計量與研究對象的居住鄉鎮相關。研究使用的空氣污染物暴露數據NO2和PM2.5是採用混合克利金法/土地利用回歸(LUR)來估計NO2和PM2.5,而空氣監測站的CO以及則是以基於LUR的機器學習為基礎來估計來自空氣監測站的CO。本研究以進行邏輯回歸,分別考觀察產前和產後空氣污染物暴露與母乳哺育對兒童氣喘發病率的關聯,以及觀察母乳哺育在空氣污染物的暴露對母乳哺育對兒童氣喘發病率的修飾作用。 結果: 本研究共有15,973對母嬰被納入分析,其中1,723名嬰兒在8歲前患上氣喘。在整個妊娠期和嬰兒出生後6個月,CO和NO2的暴露與兒童氣喘發病的風險呈正相關。在所有調查時段中,懷孕前三個月的NO2二氧化氮暴露具有最高的兒童氣喘發病風險[校正後的機率(aOR)為每10.42 ppb 四分位距(IQR) 1.40,95%置信區間(CI)為1.27-1.54]。PM2.5的暴露的影響似乎因地理位置而異。在北部地區,PM2.5的暴露與兒童氣喘發病風險有關。然而,在中部和南部地區,PM2.5的暴露的影響與兒童氣喘發病率無關。在母乳哺育和兒童氣喘發病率間無發現顯著相關,而在母乳哺育和空氣污染物暴露的交互作用下,對兒童氣喘發病率亦無顯著相關。 結論:母親產前和產後交通相關空氣污染(TRAP)的CO和NO2暴露與兒童氣喘發病率呈正相關,並且這種關聯從妊娠早期開始。 Background: Asthma is the most common chronic non-communicable disease (NCD) in children, and the fast changes in childhood asthma prevalence suggest environmental factors play a critical role in asthma development. However, there remains insufficient evidence surrounding air pollutants exposure during prenatal and postnatal periods on childhood asthma incidence. In addition, the effect of another early environmental factor, breastfeeding, on childhood asthma incidence induced by air pollution is underexplored. Objectives: This study aimed to investigate the association of ambient air pollutants exposure during prenatal and postnatal, breastfeeding, and their interaction effect on asthma incidence before eight years old in Taiwan. Methods: The study population was selected from Taiwan Birth Cohort Study (TBCS), and the estimated air pollutants exposures were linked to the study participant’s residential township. Estimated air pollutants exposure data used in this study employed the hybrid kriging/land use regression (LUR) for NO2 and PM2.5 and the LUR-based machine learning for CO from the air monitoring stations. Logistic regressions were performed to examine the association between prenatal and postnatal air pollutants exposure and breastfeeding on childhood asthma incidence separately and the modifying effect of breastfeeding on childhood asthma incidence by air pollutants exposure. Results: 15,973 mother-infant pairs were included in the analysis, of which 1,723 infants developed asthma by eight years old. CO and NO2 exposures were positively associated with the risk of childhood asthma incidence during the three trimesters and six months after birth. NO2 exposure during the first trimester had the highest increased risk of childhood asthma incidence among all investigated periods [adjusted odds ratios (aOR) 1.40 per interquartile range (IQR) of 10.42 ppb, 95% confidence interval (CI) 1.27-1.54]. The effects of PM2.5 exposure appeared to be different in geographical locations. In the northern region, PM2.5 exposure was associated with the risk of childhood asthma incidence. However, the effect of PM2.5 exposure was unrelated to the childhood asthma incidence in the central and southern regions. No significant association was found between breastfeeding and childhood asthma incidence or the interaction effect of breastfeeding and air pollutants exposure on childhood asthma incidence. Conclusions: Traffic-related air pollution (TRAP) of CO and NO2 exposure during prenatal and postnatal periods was positively associated with childhood asthma incidence, and the association began from the early trimester period. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/89216 |
DOI: | 10.6342/NTU202302965 |
全文授權: | 同意授權(限校園內公開) |
顯示於系所單位: | 全球衛生學位學程 |
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