前言：兒童肥胖為全球公共衛生的重要議題，近年來的研究指出，除了遺傳及生活方式因素外，環境因素如孕期空氣污染暴露，可能與兒童期肥胖風險增加有關。本研究旨在探討母親孕期暴露於空氣污染物對兒童過重或肥胖的影響，並進一步評估早產的中介角色。

方法：本研究利用2005年台灣出生世代研究(Taiwan Birth Cohort Study, TBCS)的資料，共納入19,578對母嬰配對，進行前瞻性世代研究分析。空氣污染物的暴露評估方式為混合(hybrid)使用克里金估算法(kriging)、土地利用回歸方法(land-use regression)和機器學習(machine learning)，統計模型採用修正後的卜瓦松回歸模型(modified Poisson regression model)及廣義線性混合模型(Generalized Linear Mixed Model, GLMM)，分別進行單一時間點與多時間點分析，以探討孕期不同空氣污染物暴露與兒童出生時至5.5歲過重或肥胖風險之相關性，並透過因果中介來分析探討早產的潛在影響，統計模型中控制的潛在干擾因子包含有：母親相關因素(生產時之年齡、教育程度、孕期抽菸狀況、孕期二手菸暴露狀況、母親國籍、有無哺餵母乳、家庭月收入、孕期家中焚香習慣和婚姻狀態)以及嬰兒相關因素(性別、胎次、低出生體重、早產和生產方式)。

結果：單一時間點分析結果顯示，孕婦第三孕期暴露PM2.5(Particulate Matter with diameter less than or equal to 2.5 micrometers )與兒童6個月、1歲和3歲時過重或肥胖風險呈正相關(Relative Risk, RR=1.05, 95%CI=1.02 – 1.08；RR=1.13, 95%CI=1.05 – 1.21；RR=1.06, 95%CI=1.04 – 1.12)。孕婦第三孕期暴露O₃(Ozone)與兒童1歲和3歲時過重或肥胖風險呈正相關(RR=1.12, 95%CI=1.07 – 1.17；RR=1.07, 95%CI=1.02 – 1.11)。而多時間點分析結果指出，孕期暴露空氣污染物與兒童時期(出生至5.5歲)過重或肥胖風險之相關性則未達統計上的顯著相關。此外，因果中介分析之結果呈現，胎兒早產並非孕期暴露空氣污染物與兒童時期(出生至5.5歲)過重或肥胖風險之中介因子。

結論：本研究在單一時間點分析結果顯示特定孕期暴露PM2.5、O3與兒童6個月、1歲和3歲時過重或肥胖風險呈現正相關，但在多時間點分析結果中顯示孕期暴露空氣污染物與兒童時期(出生至5.5歲)並沒有達到統計上顯著相關。而在因果中介分析中也未顯示胎兒早產具有中介作用。建議未來其他出生世代研究納入更完整的潛在干擾因子(如：室內空氣污染物)，來驗證本研究結果。

This study investigated the association between prenatal exposure to air pollution and the risk of childhood overweight or obesity, using data from 19,578 mother–child pairs in the Taiwan Birth Cohort Study (TBCS). Air pollution exposure during pregnancy was estimated using a hybrid approach combining kriging, land-use regression, and machine learning. Cross-sectional analyses showed that third-trimester exposure to PM₂.₅ and ozone (O₃) was significantly associated with increased risk of overweight or obesity in children at 6 months, 1 year, and 3 years of age. However, longitudinal analyses did not find statistically significant associations between prenatal exposure and overweight/obesity risk up to 5.5 years. Causal mediation analysis indicated that preterm birth did not mediate this relationship. These findings highlight the potential short-term impact of air pollution during pregnancy on early childhood weight outcomes and underscore the need for future studies to consider additional confounding factors, such as indoor air pollution.

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