一、水中消毒副產物與孩童早期神經行為發展之相關;二、鄰苯二甲酸酯類與孩童生長發育之相關

一、The relationship between water disinfection by-products and children’s developmental milestones;二、The relationship between phthalates and child growth

林彥汝(Yen-Ju Lin)

指導教授 ： 陳保中

共同指導教授 ： 陳家揚 ； 王根樹(Gan-Shuh Wang)

國立臺灣大學/公共衛生學院/環境衛生研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.01870

摘要

目的：三鹵甲烷為最常見之水中消毒副產物，本研究主要目的在於探討於不同時期(先天及後天)暴露對於孩童發展里程碑之相關。
方法：本研究的研究對象包含798位居住於台北市及高雄市之產後婦女。產後及其小孩六個月大時，利用結構式問卷對母親進行訪談。利用台灣自來水公司定期之檢測資料去推估族群暴露濃度。利用新生兒發展里程碑量表去進行評估其生長發展情形。在調整其他干擾變因後，用Cox 比例風險迴歸去了解在先天及後天的總三鹵甲烷暴露下，是否會影響六個月大的孩童發展里程碑表現。
結果：在線性迴歸模式中，調整潛在干擾因子後發現於出生前及出生後的暴露下，在「會對主要照顧者微笑」、「會自己翻身」、「將物品由一手移到另一手」及「會肚子貼地式爬行」有顯著的負向影響。而在「會對主要照顧者微笑」「將物品由一手移到另一手」及「會肚子貼地式爬行」行為動作方面，呈現劑量反應。
結論：本研究結果顯示在先天及後天暴露下，皆與六個月大的行為動作有負相關。然而在實際濃度調查上的限制，未來仍須較確切的暴露計量設計去減少造成的偏差。

目的：本研究主要目的在於探討後天鄰苯二甲酸酯類暴露對於孩童生長之相關。
方法：本研究的研究對象包含486位產後婦女，收案地點包括北台灣的四間診所和醫院。產後利用結構式問卷對母親進行訪談，並在生產後收集其尿液。小孩之尿液樣本則於兩歲及五歲時收集。以極致效能液相層析/串聯式譜儀（UHPLC-MS/MS）測量尿液中鄰苯二甲酸酯類代謝物之濃度。鄰苯二甲酸酯類代謝物濃度經過ln轉換以符合常態分布。使用線性混合模式(linear mixed model)分析兩歲及五歲尿液中代謝物濃度和生長結果包括身高、體重、頭圍及身體質量指數的關係。
結果：在線性迴歸模式中，調整潛在干擾因子後發現於兩歲暴露下，對於整體孩童族群及女童，MEHP 和兩歲至三歲以及兩歲至六歲間的體重及BMI 有顯著負相關。在男童方面，尿液中MBzP 濃度則是和身高呈現負相關(每ln 單位：β = -0.63週)。五歲暴露方面，尿液中MBzP 濃度和女童的體重和BMI 呈現負相關。
結論：本研究結果顯示鄰苯二甲酸酯類代謝物濃度和孩童生長結果呈現負向相關。為了保護孩童的成長，應減少塑化劑的暴露。

關鍵字

三鹵甲烷 ； 新生兒發展里程碑 ； 鄰苯二甲酸酯類 ； 台北出生世代研究

並列摘要

Objective: The purpose of our study was to investigate the relationship between the TTHM and early childhood neurobehavioral development.
Methods: We conducted a cohort study of 798 mother-infant pairs in 2004-2007 using information from Taiwan birth cohort study (TBCS) and Waterworks Registry. All subjects were asked to finish questionnaires and the childhood neurobehavioral development scales when the children were at the ages of 6 months. The exposure periods was grouped into prenatal and postnatal period. We used the proportional hazard model to assess the relationship between different exposure levels and the milestone and controlled for potential confounders including infant sex, birth weight, parity, maternal age, maternal education, breast feeding, environmental tobacco smoking exposure, care style, and city.
Results: We found that prenatal and postnatal exposure may increase the risk of the domains “Smile at the main caregiver spontaneously”, “Roll over”, “Transfer objects from one hand to the other “, and “Creep on belly”. And “Smile at the main caregiver spontaneously”, “Transfer objects from one hand to the other “, and “Creep on belly” were elevated in the high exposure compared to the reference category.
Conclusions: The present study suggests that prenatal and postnatal exposure to disinfection by-products increases the risk of delay motor at 6th months. But we still need more valid exposure design to decrease the assign bias.

Objectives: We measure the phthalate metabolite concentration levels in urine and measure the length, weight and head circumference of newborn babies, and collected the growth data of weight, height, head circumference, and body mass index (BMI) up to six years. According those data, we try to figure out the effects of prenatal or postnatal exposure on fetal and child growth.
Methods : The study population consisted of 486 postpartum women collected from four hospitals and clinics in northern Taiwan. We interviewed them by a structured questionnaire after delivery and collected the maternal urine, also collected the 2 and 5-year-old urine sample to stand for exposure at that time. The concentration of phthalates in urine samples was analyzed by ultra-performance liquid chromatography/tandem mass spectrometry (UPLC-MS/MS). We used the mixed model was used to assess the effect of postnatal phthalate exposure on growth between 2 to 2.9, 2 to 5.9, and 5 to 5.9 years.
Results: we found statistically significant relationships between urinary phthalate monoesters and growth parameters. Between urinary phthalate monoesters at age 2 and growth parameters through 2 to 2.9 years old. The association between urinary MEHP with weight (β ± SE = -0.34 ± 0.15, p = 0.03) and BMI (β ± SE =-0.33±0.14, p = 0.02) of all subjects were negative. And urinary MBzP were negative association with height of male (β ± SE = -0.63 ± 0.25, p = 0.015). At the female part, urinary MEHP was association with weight- decrease (β ± SE = -0.58 ± 0.19, p = 0.003) and decrease of BMI (β ± SE = -0.64 ± 0.16, p =0 .002). Between urinary phthalate monoesters at age 2 and growth parameters through 2 to 5.9 years old, we found urinary MEHP were association with a decrease in females’ and all study population’ but not males’ weight and BMI. We investigate the relationship between urinary phthalate monoesters at age 5 and growth parameters through 60 to 72 months, only urinary MBzP were negatively associated with weight (β± SE = -0.97 ± 0.45, p = 0.043) and BMI (β ± SE = -1.02±0.28, p = 0.001) of female.
Conclusions: We found that postnatal exposed to phthalate esters may suppression child growth, including weight, height, head circumference, and BMI. Further studies should rule out other confounders, to strength the relation between phthalates and harm to growth.

並列關鍵字

trihalomethanes ； neurobehavioral development ； developmental milstone ； growth ； Taiwan Birth Panel Study

參考文獻

Arcadi FA, Costa C, Imperatore C, Marchese A, Rapisarda A, Salemi M, Trimarchi GR, Costa G (Oral toxicity of bis(2-ethylhexyl) phthalate during pregnancy and suckling in the Long-Evans rat. Food Chem Toxicol 36:963-970.1998).

Balster RL, Borzelleca JF (Behavioral toxicity of trihalomethane contaminants of drinking water in mice. Environ Health Perspect 46:127-136.1982).

Barber TM, McCarthy MI, Wass JA, Franks S (Obesity and polycystic ovary syndrome. Clin Endocrinol (Oxf) 65:137-145.2006).

Bility MT, Thompson JT, McKee RH, David RM, Butala JH, Vanden Heuvel JP, Peters JM (Activation of mouse and human peroxisome proliferator-activated receptors (PPARs) by phthalate monoesters. Toxicol Sci 82:170-182.2004).

Bove FJ, Fulcomer MC, Klotz JB, Esmart J, Dufficy EM, Savrin JE (Public drinking water contamination and birth outcomes. Am J Epidemiol 141:850-862.1995).