胎兒全氟碳化物暴露與兒童成長及發展

In-utero Exposure to Perfluorinated Compounds on Child Growth and Development

陳美惠(Mei-Huei Chen)

指導教授 ： 陳保中

共同指導教授 ： 謝武勳(Wu-Shiun Hsieh)

國立臺灣大學/公共衛生學院/職業醫學與工業衛生研究所/博士(2013年)

https://doi.org/10.6342/NTU.2013.02814

摘要

背景及目的: 全氟碳化合物是環境中廣泛存在的持續性有機汙染物。動物研究顯示胎兒時期全氟碳化合物的暴露可能導致不良的出生結果、生長和神經行為發展。但這些健康效應在有限的人類研究結果尚不清楚。本研究的目的為探討產前全氟碳化合物的暴露對嬰幼兒成長與發展的影響。
方法:本研究對象為2004年4月至2005年1月參與台灣出生長期追蹤研究之486對母嬰配對。我們在產前以結構式的問卷訪視母親、生產時收集臍帶血，並於病歷擷取出生結果之記錄。當孩童兩歲時，由專業人員使用嬰幼兒綜合發展測驗評估其發展，孩童的生長資料則依據兒童健康手冊之記錄收集至7歲半。臍帶血中的全氟碳化合物濃度是使用超高效液相層析串聯質譜法分析，定量極限在4種高偵測率的物質分別為: 全氟辛酸, 1.58 ng/mL; 全氟辛烷磺酸,0.22 ng/mL; 全氟壬酸,0.84 ng/mL; 全氟癸酸,3.1 ng/mL。
結果: 研究的第一部分發現，臍帶血中全氟辛烷磺酸的濃度和新生兒妊娠週數、出生體重、頭圍、早產及體重低於妊娠週數呈負相關。當新生兒依據其全氟辛烷磺酸暴露濃度分為四組時，也可觀察到顯著的劑量效應。但研究結果沒有發現出生結果與其它全氟碳化合物暴露之相關性。第二部分的研究發現，臍帶血中全氟辛烷磺酸的濃度和兒童2歲的發展商數有明顯的負相關，包括發展商數總分、粗動作、細動作和自理能力都有影響，尤其對粗動作發展呈現顯著的劑量效應。第三部分的研究顯示胎兒時期全氟辛烷磺酸的暴露，與出生體重和身高有負向相關，但影響效應會隨著年齡增長而下降。當幼兒成長大於6個月時，產前全氟辛烷磺酸的暴露對身高的影響，呈現正向趨勢。
結論: 我們的研究指出產前全氟辛烷磺酸的暴露和胎兒生長有負向相關，包括縮短妊娠週數和降低出生體重。胎兒時期有較高全氟辛烷磺酸暴露的孩童，成長至兩歲時粗動作的發展則表現較差。而產前全氟辛烷磺酸暴露對新生兒體重和身高的負面影響，會隨著年齡增長而消失。

關鍵字

出生體重 ； 兒童生長 ； 神經行為發展 ； 全氟碳化合物 ； 全氟辛酸 ； 全氟辛烷磺酸

並列摘要

Background and Objectives: Perfluorinated compounds (PFCs) are persistent organic pollutants and wildly distributed in the environment. Previous animal studies have shown that in-utero PFCs exposure have adverse impacts on birth outcomes, growth and neurodevelopment. However, these health effects in humans are still unclear. The aim of the study was to explore the impact of prenatal exposure to PFCs on child growth and development.
Methods: The study population was 486 mother-infant pairs who gave births in Taiwan between April 2004 and January 2005 from Taiwan Birth Panel Study. We interviewed them by a structured questionnaire before delivery, collected umbilical cord blood at birth and extracted birth outcomes from medical records. The children were followed by using the Developmental Inventory for Infants and Toddlers (CDIIT) at two years of age. Growth data were collected from records in Child Healthcare Handbooks until 7.5 years of age. PFCs in umbilical cord blood were analyzed by ultra-high-performance liquid chromatography/tandem mass spectrometry. The limits of quantitation for four commonly detectable PFCs, namely perfluorooctanoic acid (PFOA), perfluorooctyl sulfonate (PFOS), perfluorononanoic acid (PFNA), and perfluoroundecanoic acid (PFUA) were 1.58, 0.22, 0.84, and 3.1 ng/mL, respectively.
Results: The first part had shown that PFOS levels in cord blood plasma are negatively associated with gestational age, birth weight, head circumference, preterm birth, and small for gestational age. A dose-response relation was observed while classifying the PFOS levels into quartiles. However, we did not find a convincing association between birth outcomes and prenatal exposure to PFOA, PFNA or PFUA. The second part had shown that PFOS levels in cord blood plasma were adversely associated with developmental quotients (DQs) of the whole test, gross-motor, fine-motor, and self-help domains of the CDIIT at two years of age. The impact was most apparent for the gross-motor subdomain, and demonstrated a dose-dependent relationship. The third part had shown that higher prenatal PFOS exposure was associated with lower body weight and length at birth, the effect diminished as children grow up.
Conclusions: Our study had shown that prenatal PFOS exposures are associated with adverse fetal growth, including shortened gestational age and lower birth weight. Those children with higher prenatal PFOS exposure had poorer performance on their gross motor developments at 2 years of age. The adverse effect of in utero PFOS exposure on weight decreased as children grow up.

並列關鍵字

birth weight ； child growth ； neurodevelopment ； perfluorinated compounds ； perfluorooctanoic acid ； perfluorooctyl sulfonate ； preterm birth

參考文獻

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