Long-term effects of pregnancy exposure to natural disasters on physical health: a review
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摘要: 健康和疾病的发育起源理论强调成年期疾病的发生与生命早期经历不利因素有关。本研究通过文献回顾,研究妊娠期及其不同阶段暴露于地震、洪水、饥荒、热带气旋、飓风和冰暴等灾难事件对婴幼儿、儿童、青少年及成年之后的生理健康的影响,结果表明,妊娠期灾难事件暴露对从新生儿到成年后的生理健康均会产生不良影响,且不同时期的暴露对人口生理健康的影响侧重略有不同。目前中国关于妊娠期灾难事件暴露对生理健康长期影响的研究相对较少,有必要建立暴露人群的长期监测队列。另外,在研究内容方面,还需要进一步探索妊娠期不同阶段的灾难事件暴露对生理健康的影响,为有效采取合理的干预措施和防治方案提供科学依据。Abstract: Based on the theory of developmental origins of health and disease (DOhaD), adult diseases are related to adverse factors experienced in early life. In this study, we reviewed relevant literatures and studied the effects of pregnancy exposure to disasters such as earthquakes, floods, famines, hurricanes, tropical cyclone, and ice storms on physical health of infants, children, adolescents, and adults. Published researches demonstrated that exposure to catastrophic events during fetus period could exert adverse effects on physical health from newborn to adulthood, and the exposure at different periods could have different effects on physical health. At present, there are a few studies on the long - term effects of fetal exposure to catastrophic events on physical health in China, and it is necessary to establish a long - term monitoring cohort of exposed people. In addition, further study is needed to explore the impact of catastrophic exposure at different stages of fetal period on physiological health in order to provide evidences for developing effective intervention programs.
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Key words:
- gestation period /
- natural disaster /
- physical health /
- long-term effect
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表 1 妊娠期暴露于自然灾难对生理健康的影响研究
灾难类型 作者 时间及地点 研究设计 研究对象 样本量 研究结果 地震 张燕(2010)[7] 1996,中国丽江县 横断面 3~6岁儿童 2236 与较低的预期寿命和较慢的儿童身高、体重增长有关 陈欠欠(2016)[9] 1976,中国唐山 横断面 成年人 996 对成年后血尿酸水平和高尿酸血症发生率增高有影响 Ji(2017)[10] 1976,中国唐山 队列 成年人 1072 与成年期尿酸浓度增高有关 洪水 Kroska(2017)[4] 2008,美国爱荷华州 队列 30个月幼儿 103 与幼儿30个月时的体重指数(BMI)呈显著正相关 Rosales-Rueda(2018)[8] 1997 — 1998,厄瓜多尔 队列 6岁儿童 7989 影响儿童生长发育 饥荒 李远碧(2014)[11] 1959 — 1961,中国安徽 队列 成年人 3793 影响代谢性炎症状态及代谢综合征,尤其女性空腹血糖 赵艳(2013)[12] 1959 — 1961,中国安徽 队列 成年人 668 增加高甘油三酯血症风险 Wang(2012)[13] 1959 — 1961,中国广东 队列 成年人 12065 影响成年后高血压患病风险 Liu(2017)[14] 1959 — 1961,中国重庆 队列 成年人 1224 使成年后患高血压的可能性增加 Xin(2019)[15] 1959 — 1961,中国 队列 成年人 4843 与成年期血脂异常风险增加有关 Chen(2016)[16] 1959 — 1961,中国重庆 队列 成年人 10935 与成年期脂肪肝疾病风险增加有关 Shi(2013)[17] 1959 — 1961,中国江苏 队列 成年人 2007 与成年期贫血风险增加有关 Wang(2017)[18] 1959 — 1961,中国 队列 中老年人 2752 与成年期血脂异常有关,尤其是女性 Wang(2017)[19] 1959 — 1961,中国 队列 成年人 6445 与成年期代谢综合征有关,女性暴露者患病率显著升高 Hult(2010)[20] 1967 — 1970,尼日利亚 队列 成年人 1339 与成年后高血压和葡萄糖耐量受损的风险显著增加有关 Li(2010)[21] 1959 — 1961,中国 队列 成年人 7874 与成年期高血糖和2型糖尿病风险有关 Chen(2014)[23] 1959 — 1961,中国 队列 成年人 1415 对成年后心血管疾病有影响,对女性影响更大 Wang(2010)[24] 1959 — 1961,中国重庆 队列 成年人 17023 与成年期超重和肥胖风险以及更矮的身高有关 Liu(2017)[25] 1959 — 1961,中国青岛 队列 成年人 8185 对成年期肥胖有影响 气旋
飓风
冰暴Parayiwa(2018)[2] (热带气旋)2008 — 2012,
澳大利亚昆士兰时间序列 成年人 311389 与早产可能性增加和低出生体重比例升高有关 Currie(2013)[3] (飓风)1996 — 2008,美国
德克萨斯时间序列 新生儿 4237494 增加新生儿异常的风险 Dancause(2012)[5] (冰暴)1998,加拿大魁北克 队列 5.5岁儿童 111 使5.5岁儿童的肥胖风险增加 Dancause(2013)[6] (冰暴)1998,加拿大魁北克 队列 青少年 32 与青春期(13岁左右)胰岛素分泌显著正相关 表 2 不同时期暴露于自然灾难对生理健康的影响研究
灾难类型 作者 时间及地点 研究设计 研究对象 样本量 研究结果 妊娠早期 地震 Torche(2011)[26] 2005,智利 横断面 新生儿 500983 导致低出生体重比例增加 Torche(2012)[27] 2005,智利 横断面 新生儿 13989 导致早产的可能性增加 洪水 Hilmert(2016)[28] 2009,美国北达科他州 横断面 新生儿 169 使胎儿生长速度降低,存在新生儿低体重的风险 Dancause(2016)[38] 2008,美国爱荷华州 队列 2.5~4岁儿童 106 导致儿童在2.5~4岁之间的体重指数(BMI)增加 饥荒 Roseboom(2003)[31] 1944 — 1945,荷兰 队列 成年人 912 导致成年后健康状况更差 Roseboom(2006)[32] 1944 — 1945,荷兰 队列 成年人 2414 成年后冠心病、动脉粥样硬化、凝血紊乱和肥胖患病率增加,妇女乳腺癌风险更高 气旋、飓风、冰暴 Xiong(2008)[29] (飓风)2005,美国新奥尔良
和巴吞鲁日队列 新生儿 301 影响出生结局,新生儿低体重与早产可能性增加 妊娠中期 地震 Chang(2002)[33] 1999,中国台湾 横断面 新生儿 171 与低出生体重有关 Wang(2017)[40] 1976,中国唐山 横断面 成年人 1196 与成年期不良健康结局相关 饥荒 Roseboom(2006)[32] 1944 — 1945,荷兰 队列 成年人 2414 患微量白蛋白尿和阻塞性呼吸道疾病较多 妊娠晚期 地震 Wang(2017)[34] 1976,中国唐山 横断面 成年人 180 与成年期疾病风险增加有关 钱嵘(2010)[35] 2008,中国汶川 横断面 胎儿 120 与胎儿心率、脐带血流阻力等增高有关 洪水 Rosales-Rueda(2018)[8] 1997 — 1998,厄瓜多尔 自然实验 6岁儿童 7989 使低出生体重的概率增加 Simcock(2016)[36] 2011,澳大利亚昆士兰 队列 2~16个月婴幼儿 351 与运动发育情况有关 Simcock(2018)[37] 2011,澳大利亚昆士兰 队列 2.5~4岁儿童 587 导致儿童粗大运动技能变差 饥荒 Roseboom(2001)[41] 1944 — 1945,荷兰 队列 成年人 2254 增加50岁之前的死亡率 气旋、飓风、冰暴 Liu(2016)[38] (冰暴)1998,加拿大魁北克 队列 5~15岁儿童 178 与较高体重指数水平和中心性肥胖有关 Turcotte(2014)[39] (冰暴)1998,加拿大魁北克 队列 青少年 68 增加11~12岁女孩的哮喘风险 -
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