Gebelikte Hava Kirliliğine Maruz Kalma ve Sağlık İlişkisi

Hava kirliligi gunumuzde saglik uzerinde en buyuk risk olusturan cevresel faktor olarak bilinmektedir. 2019’da yayinlanan Kuresel Hava Raporuna gore hava kirliligi 2017 icin 4.9 milyon olum ve 147 milyon yasam yili kaybi ile iliskilendirilmis ve dunya genelinde besinci en yuksek risk faktoru olarak ortaya konmustur(1). Dunya nufusunun %90’indan fazlasi Dunya Saglik Orgutu’nun saglikli hava icin olan kilavuz seviyelerini asan bolgelerde yasamaktadir(2). Hava kirliligine maruz kalmanin insan sagligina olasi etkileri arasinda; kronik obstruktif akciger hastaligi, iskemik kalp hastaligi, inme, akciger kanserleri, solunumsal hastaliklar, diyabet, ateroskleroz ve olumsuz dogum etkileri gibi mortalite ve morbiditeyi arttiran durumlar ile iliski bulunmustur(3). Ancak gebelikte hava kirliligine maruz kalmanin etkileri uzerindeki calismalar henuz sinirlidir. Gebeler uzerindeki etkilerin anlasilmasi hem anne sagligi hem cocugun hayat boyu yasam kalitesini etkileyebilecek saglik olaylari acisindan onemlidir. Gebelikte hava kirliligine maruz kalma saglik sonuclari konusunda bilgiler kisitli olsa da son yillarda anne ve bebek sagligi ile ilgili yapilan calismalar artmistir ve farkli arastirma yontemleriyle bircok olumsuz iliski raporlanmistir. Spontan abortus ve fetal mortalite ile PM10, NO2, SO2, CO, O3 ve NO konsantrasyonlari arasinda anlamli iliskiler bildirilmistir(4-6). Hava kirliligine maruz kalmanin preterm dogum riskini arttirabilecegi bununla birlikte preterm dogumlu bebeklerde hava kirliligine maruz kalmanin preterm bebeklerde hâlihazirda olan postnatal mortalite riskini derinlestirebilecegi dusunulmektedir(7-9). Yapilan arastirmalarda dusuk dogum agirligi ve intrauterin gelisim bozuklugu, konjenital defektler, konjenital kalp ve aort hastaliklari, fetal femur kisaligi gibi genis saglik etkileri ongoren ve bu hastaliklar ile iliskileri ortaya koyan calisma sonuclari mevcuttur(10-18). Gebelikte maruz kalinan hava kirliliginin anne sagligi uzerindeki etkilerini inceleyen calismalarsa: maternal stress, preeklamsi ve gebelige bagli diger hipertansif bozukluklarin gorulme riskini anlamli olarak arttirabilecegini raporlanmistir(19-22). Hava kirliliginin anne ve cocuk uzerindeki olumsuz etkilerinin anlasilmasinin hava kalitesi ile ilgili yapilan calismalara ve hava kalite yonetimine daha da onem kazandirmasi beklenmektedir. Neden sonuc iliskilerinin daha net ve kesin sekillerde anlasilmasi icin riskleri daha iyi ortaya koyan nitelikli ve genis capta arastirmalara ihtiyac duyuldugu gorulmektedir. Ancak bu zamana kadar yapilan arastirmalarda raporlanan sonuclar gebelikte maruz kalinan hava kirliliginin hem gebe hem fetus uzerine olumsuz saglik etkileri oldugunu acik sekilde gostermektedir. Koruyucu halk sagligi gorusuyle, guncel verilerin, hava kirletici konsantrasyonlarini kilavuz seviyelerin altinda tutmak icin yeterli nedenleri olusturdugu dusunulmektedir. 1. Global Burden of Air Pollution [Internet]. Institute for Health Metrics and Evaluation. 2016 [cited 2019 Sep 27]. Available from: http://www.healthdata.org/infographic/global-burden-air-pollution 2. Read the Report | State of Global Air [Internet]. [cited 2019 Sep 27]. Available from: https://www.stateofglobalair.org/report 3. Review of evidence on health aspects of air pollution – REVIHAAP project: final technical report [Internet]. 2017 [cited 2019 Sep 27]. Available from: http://www.euro.who.int/en/health-topics/environment-and-health/air-quality/publications/2013/review-of-evidence-on-health-aspects-of-air-pollution-revihaap-project-final-technical-report 4. Moridi M, Ziaei S, Kazemnejad A. Exposure to ambient air pollutants and spontaneous abortion. J Obstet Gynaecol Res. 2014 Mar;40(3):743–8. 5. Collins JJ, Kasap HS, Holland WW. ENVIRONMENTAL FACTORS IN CHILD MORTALITY IN ENGLAND AND WALES. Am J Epidemiol. 1971 Jan 1;93(1):10–22. 6. Litchfield IJ, Ayres JG, Jaakkola JJK, Mohammed NI. Is ambient air pollution associated with onset of sudden infant death syndrome: a case-crossover study in the UK. BMJ Open. 2018 Apr 1;8(4):e018341. 7. Howson CP, Kinney MV, McDougall L, Lawn JE. Born Toon Soon: Preterm birth matters. Reprod Health. 2013 Nov 15;10(Suppl 1):S1. 8. Shah PS, Balkhair T, Knowledge Synthesis Group on Determinants of Preterm/LBW births. Air pollution and birth outcomes: a systematic review. Environ Int. 2011 Feb;37(2):498–516. 9. Liu S, Krewski D, Shi Y, Chen Y, Burnett RT. Association between gaseous ambient air pollutants and adverse pregnancy outcomes in Vancouver, Canada. Environ Health Perspect. 2003 Nov;111(14):1773–8. 10. Dadvand P, Parker J, Bell ML, Bonzini M, Brauer M, Darrow LA, et al. Maternal exposure to particulate air pollution and term birth weight: a multi-country evaluation of effect and heterogeneity. Environ Health Perspect. 2013 Mar;121(3):267–373. 11. Ha S, Sundaram R, Buck Louis GM, Nobles C, Seeni I, Sherman S, et al. Ambient air pollution and the risk of pregnancy loss: a prospective cohort study. Fertil Steril. 2018;109(1):148–53. 12. Fleischer NL, Merialdi M, van Donkelaar A, Vadillo-Ortega F, Martin RV, Betran AP, et al. Outdoor air pollution, preterm birth, and low birth weight: analysis of the world health organization global survey on maternal and perinatal health. Environ Health Perspect. 2014 Apr;122(4):425–30. 13. Malmqvist E, Liew Z, Kallen K, Rignell-Hydbom A, Rittner R, Rylander L, et al. Fetal growth and air pollution - A study on ultrasound and birth measures. Environmental Research. 2017 Jan 1;152:73–80. 14. Jedrychowski W, Bendkowska I, Flak E, Penar A, Jacek R, Kaim I, et al. Estimated Risk for Altered Fetal Growth Resulting from Exposure to Fine Particles during Pregnancy: An Epidemiologic Prospective Cohort Study in Poland. Environ Health Perspect. 2004 Oct;112(14):1398–402. 15. Ostro BD, Lipsett MJ, Mann JK, Krupnick A, Harrington W. Air pollution and respiratory morbidity among adults in southern California. Am J Epidemiol. 1993 Apr 1;137(7):691–700. 16. van den Hooven EH, Pierik FH, de Kluizenaar Y, Hofman A, van Ratingen SW, Zandveld PYJ, et al. Air pollution exposure and markers of placental growth and function: the generation R study. Environ Health Perspect. 2012 Dec;120(12):1753–9. 17. Dadvand P, Rankin J, Rushton S, Pless-Mulloli T. Ambient air pollution and congenital heart disease: a register-based study. Environ Res. 2011 Apr;111(3):435–41. 18. The effects of air pollution on adverse birth outcomes [Internet]. [cited 2019 Sep 27]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4262551/ 19. Lin Y, Zhou L, Xu J, Luo Z, Kan H, Zhang J, et al. The impacts of air pollution on maternal stress during pregnancy. Sci Rep [Internet]. 2017 Jan 18 [cited 2019 Sep 27];7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241869/ 20. Dadvand Payam, Figueras Francesc, Basagana Xavier, Beelen Rob, Martinez David, Cirach Marta, et al. Ambient Air Pollution and Preeclampsia: A Spatiotemporal Analysis. Environmental Health Perspectives. 2013 Jan 1;121(11–12):1365–71. 21. Pedersen M, Halldorsson TI, Olsen SF, Hjortebjerg D, Ketzel M, Grandstrom C, et al. Impact of Road Traffic Pollution on Pre-eclampsia and Pregnancy-induced Hypertensive Disorders. Epidemiology. 2017;28(1):99–106. 22. Xu X, Hu H, Ha S, Roth J. Ambient air pollution and hypertensive disorder of pregnancy. J Epidemiol Community Health. 2014 Jan 1;68(1):13–20.

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