Environmental Contaminants Exposure and Preterm Birth: A Systematic Review<\/a> (1)\u201d makalesinde, \u00e7evresel toksik maddelere maruz kalman\u0131n PTD’deki olas\u0131 rol\u00fcne ili\u015fkin yay\u0131nlanm\u0131\u015f \u00e7al\u0131\u015fmalar\u0131 inceleyip ve \u00f6zetleyecek.<\/p>\nBu derlemeye Ocak 1992’den Ocak 2019’a kadar PubMed ve Scopus veritabanlar\u0131nda toksik maddelere maruz kalma ve PTD olu\u015fumu hakk\u0131nda yay\u0131nlanan, makaleler, klinik \u00e7al\u0131\u015fmalar, orijinal \u00e7al\u0131\u015fmalar ve incelemeler dahil olmak \u00fczere \u0130ngilizce yaz\u0131lm\u0131\u015f, tam metin makaleler olarak eri\u015filebilen t\u00fcm \u00e7al\u0131\u015fmalar dahil edilmi\u015f.<\/p>\n
\u00c7evresel kirleticiler alt gruplara ayr\u0131larak incelenmi\u015f.<\/p>\n
\u00c7evresel Bile\u015fikler<\/strong><\/p>\nHava Kirleticileri: <\/strong><\/p>\nHava kirlili\u011fi genel olarak do\u011frudan \u00e7e\u015fitli kaynaklardan sal\u0131nan veya atmosferdeki birincil kirleticilerin etkile\u015fimi ile olu\u015fan karma\u015f\u0131k (\u00f6rne\u011fin, karbon monoksik [CO], nitrojen monoksit [NO], nitrojen dioksit [NO2], k\u00fck\u00fcrt dioksit [SO2], ozon [O3], partik\u00fcl [kat\u0131\/s\u0131v\u0131]) bir gaz kar\u0131\u015f\u0131m\u0131 olarak tan\u0131mlanabilir.<\/p>\n
Hava kirlili\u011fi ve obstetrik komplikasyonlar aras\u0131ndaki ili\u015fki b\u00fcy\u00fck ilgi g\u00f6rm\u00fc\u015ft\u00fcr; asl\u0131nda, epidemiyolojik kan\u0131tlar hamilelik s\u0131ras\u0131nda hava kirlili\u011fine maruz kalma ile d\u00fc\u015f\u00fck do\u011fum a\u011f\u0131rl\u0131\u011f\u0131 (LBW), intrauterin geli\u015fme gerili\u011fi (IUGR) ve PTB gibi olumsuz gebelik sonu\u00e7lar\u0131 aras\u0131nda \u00f6nemli bir ili\u015fki oldu\u011funu g\u00f6stermi\u015ftir. Bu ili\u015fkilerin fizyopatolojik temeli tam olarak anla\u015f\u0131lamam\u0131\u015ft\u0131r, ancak inflamasyon ve oksidatif stresin \u00f6nemli bir rol oynad\u0131\u011f\u0131 g\u00f6r\u00fclmektedir (2). Hava kirleticileri, alveolar h\u00fccre farkl\u0131la\u015fmas\u0131n\u0131 ve olgunla\u015fmas\u0131n\u0131 de\u011fi\u015ftirerek neonatal respiratuar distres sendromuna ve reaktif hava yolu hastal\u0131\u011f\u0131na neden olabilir (3).<\/p>\n
Partik\u00fcl Madde <\/strong><\/p>\nPartik\u00fcl madde (PM) bile\u015fimleri ve boyutlar\u0131, toksisiteleriyle g\u00fc\u00e7l\u00fc bir \u015fekilde ili\u015fkilidir: partik\u00fcller ne kadar k\u00fc\u00e7\u00fckse, akci\u011ferin derin b\u00f6lgelerine n\u00fcfuz etme ve sistemik dola\u015f\u0131ma ge\u00e7me kapasiteleri nedeniyle toksik etkileri de o kadar b\u00fcy\u00fck olur. Hamilelik s\u0131ras\u0131nda maruziyet, y\u00fcksek kan bas\u0131nc\u0131 ve y\u00fcksek preeklampsi riski ile ili\u015fkilidir. 2017 y\u0131l\u0131nda Liu ve arkada\u015flar\u0131 taraf\u0131ndan y\u00fcr\u00fct\u00fclen bir meta-analiz, hamilelik s\u0131ras\u0131nda PM 2.5 (aerodinamik \u00e7ap < 2.5 \u03bcm) maruziyetinin PTD i\u00e7in \u00f6nemli bir risk fakt\u00f6r\u00fcn\u00fc temsil etti\u011fini bildirmi\u015ftir (4).<\/p>\n
Polisiklik Aromatik Hidrokarbonlar <\/strong><\/p>\nPolisiklik aromatik hidrokarbonlar (PAH), ara\u00e7lardan ve end\u00fcstrilerden yanma s\u00fcre\u00e7leri s\u0131ras\u0131nda sal\u0131nan bir madde olmakla birlikte, maruziyet inhalasyon yoluyla meydana gelebilir. 2012’de Guo ve arkada\u015flar\u0131, anne maruziyetinin bir belirteci olarak yeni do\u011fanlar\u0131n do\u011fumunda g\u00f6bek kordon kan\u0131nda y\u00fcksek bir PAH konsantrasyonu bularak bu ili\u015fkiyi do\u011frulam\u0131\u015ft\u0131r (5).<\/p>\n
Organik Kirleticiler<\/strong><\/p>\n\u0130\u00e7me Suyu Kirleticileri<\/strong><\/p>\n\u0130\u00e7me suyu kaynaklar\u0131nda bir\u00e7ok kimyasal bulunabilir. \u0130\u00e7me suyunun klor ile ar\u0131t\u0131lmas\u0131, dezenfeksiyon yan \u00fcr\u00fcnlerinin (DY\u00dc) sal\u0131nmas\u0131na neden olur, bunlar; trihalometanlar (THM: kloroform, bromoform, bromodiklorometan ve diklorobromometan) ve haloasetik asitlerdir (HAA: kloroasetik asit, dikloroasetik asit, trikloroasetik asit, bromoasetik asit ve dibromo asetik asit). Bu kirleticilere maruz kalma ile PTD aras\u0131ndaki ili\u015fki net de\u011fildir. Hatta \u00e7o\u011fu \u00e7al\u0131\u015fmada DY\u00dc ile PTD aras\u0131nda bir ili\u015fki saptanmam\u0131\u015ft\u0131r.<\/p>\n
Jaakkola ve arkada\u015flar\u0131 taraf\u0131ndan y\u00fcr\u00fct\u00fclen bir meta-analizde, ba\u015flang\u0131\u00e7taki hipotezlerinin aksine, muhtemelen hamilelik s\u0131ras\u0131nda anne enfeksiyonlar\u0131n\u0131 \u00f6nlemede klorlu suyun oynad\u0131\u011f\u0131 koruyucu rol nedeniyle, PTD riskinde bir azalma oldu\u011fu saptanm\u0131\u015ft\u0131r (6).<\/p>\n
Rinsky ve arkada\u015flar\u0131, atrazin maruziyeti ile PTD aras\u0131nda bir ili\u015fki tan\u0131mlam\u0131\u015ft\u0131r (7). Atrazin (6-kloro N-etil-N-(1-metiletil)-1,3,5-triazin-2,4-diamin), geni\u015f yaprakl\u0131 ve \u00e7imenli yabani otlar\u0131n yay\u0131lmas\u0131n\u0131 kontrol etmek i\u00e7in d\u00fcnya \u00e7ap\u0131nda kullan\u0131lan bir herbisittir. Bu bile\u015fik i\u00e7me suyunda bulunabilir ve endokrin bozucu olarak hareket ederek endokrin homeostaz\u0131na m\u00fcdahale edebilir. Bu \u00e7al\u0131\u015fma, gebelik s\u0131ras\u0131nda y\u00fcksek oranda maruz kalan annelerde kontrollere k\u0131yasla daha y\u00fcksek PTD insidans\u0131 bulmu\u015ftur (7).<\/p>\n
Kal\u0131c\u0131 Organik Kirleticiler Organoklorin Bile\u015fikleri ve Perfloroalkillenmi\u015f Maddeler <\/strong><\/p>\nOrganoklorin bile\u015fikleri (OCP), end\u00fcstride, tar\u0131mda ve g\u0131dada yayg\u0131n olarak kullan\u0131lan her yerde bulunan toksik kimyasallard\u0131r. Pestisitler, end\u00fcstriyel kimyasallar veya end\u00fcstriyel s\u00fcre\u00e7lerin yan \u00fcr\u00fcnleri veya organik kimyasallar\u0131n yanmas\u0131 sonucu ortaya \u00e7\u0131kan \u00fcr\u00fcnlerdir. Bunlara maruz kalman\u0131n \u00e7e\u015fitli \u00fcreme bozukluklar\u0131 ve endometriozis gibi jinekolojik hastal\u0131klarla ili\u015fkili oldu\u011fu g\u00f6r\u00fclmektedir. Bu maddeler, g\u00fc\u00e7l\u00fc lipofilik yap\u0131lar\u0131 ve d\u00fc\u015f\u00fck bozulma h\u0131zlar\u0131 nedeniyle lipidden zengin dokularda birikirler. OCP kan, plasenta dokusu, amniyotik s\u0131v\u0131 ve anne s\u00fct\u00fc gibi farkl\u0131 insan dokular\u0131nda bulunmu\u015ftur. Maruz kalan anneler bu kimyasallar\u0131 plasenta, kan ve anne s\u00fct\u00fc yoluyla fet\u00fcse ve yenido\u011fana aktarabilirler. Bu aktar\u0131m birka\u00e7 \u00e7al\u0131\u015fma taraf\u0131ndan do\u011frulanm\u0131\u015ft\u0131r. Hamilelik s\u0131ras\u0131nda bu bile\u015fiklere s\u00fcrekli maruz kalma, hormonal dengeyi de\u011fi\u015ftirebilir: fizyolojik olarak, progesteron rahim inaktivitesini destekler; \u00f6strojenler ise uterotonik ajanlara kar\u015f\u0131 artan reaktivite ile miyometriyal aktivasyonu te\u015fvik eder. OCP, do\u011fal hormonlar\u0131n sal\u0131n\u0131m\u0131n\u0131, ta\u015f\u0131nmas\u0131n\u0131, metabolizmas\u0131n\u0131 veya ortadan kald\u0131r\u0131lmas\u0131n\u0131 mod\u00fcle eden endokrin kimyasallar\u0131 bozucu olarak hareket edebilir. Memelilerde ve bal\u0131klarda, Hekzaklorosikloheksan (HCH) izomerlerinin en tehlikelisi olan \u03b2-HCH, kseno\u00f6strojen g\u00f6revi g\u00f6rerek, y\u00fcksek PTD riski ile uterus kas\u0131lmas\u0131n\u0131 aktive eder.<\/p>\n
Ayr\u0131ca, Tyagi ve arkada\u015flar\u0131 bu bile\u015fiklerin, inflamatuar yolaklarda ve prostaglandinlerde yer alan genlerin mRNA ekspresyonunu art\u0131rd\u0131\u011f\u0131n\u0131, uterus kas\u0131lmalar\u0131n\u0131 ve servikal modifikasyonlar\u0131 g\u00fc\u00e7lendirdi\u011fini g\u00f6stermi\u015ftir (8).<\/p>\n
Perfloroalkil maddeler (PFAS), bir karbon-flor omurgas\u0131ndan olu\u015fan sentetik bile\u015fikler ailesidir. Bir\u00e7ok PFAS ya\u011fa ve suya dayan\u0131kl\u0131d\u0131r ve bu nedenle leke tutmaz \u00fcr\u00fcnlerin (\u00f6rne\u011fin hal\u0131lar ve kuma\u015flar), yap\u0131\u015fmaz kaplamalar\u0131n ve g\u0131da ambalajlar\u0131n\u0131n imalat\u0131nda faydal\u0131d\u0131r. De Felip ve arkada\u015flar\u0131 s\u0131\u011f\u0131r, domuz, kuzu, jambon ve salam, bal\u0131k ve deniz \u00fcr\u00fcnleri t\u00fcketen kad\u0131nlarda daha y\u00fcksek serum perflorooktan s\u00fclfonat (PFOS) ve perflorooktanoik asit (PFOA) konsantrasyonlar\u0131 oldu\u011funu g\u00f6stermi\u015ftir. Peynir, yumurta, karaci\u011fer ve sebzelerden zengin bir diyete sahip kad\u0131nlarda da daha y\u00fcksek PFOA seviyeleri bulunmu\u015ftur (9). Sagiv ve arkada\u015flar\u0131, y\u00fcksek PFOS konsantrasyonlar\u0131 olan kad\u0131nlarda, d\u00fc\u015f\u00fck konsantrasyonu olanlarla kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda iki kat erken do\u011fum ihtimali bulundu (odds oran\u0131 = 2.4, %95 GA: 1.3, 4.4) (10).<\/p>\n
Kal\u0131c\u0131 Olmayan Organik Kirleticiler: Fitalatlar, Fenoller ve Parabenler <\/strong><\/p>\nFitalatlar, plastiklerde esnekli\u011fi art\u0131rmak i\u00e7in kullan\u0131lan kal\u0131c\u0131 olmayan organik kirleticilerdir ve bir\u00e7ok ki\u015fisel bak\u0131m \u00fcr\u00fcn\u00fc ve oyuncakta da bulunur. Bu maddelere maruz kalma, yutma, deri yoluyla uygulama ve soluma yoluyla yay\u0131l\u0131r. Endokrin bozucular olarak hareket edebilirler. PTD’si olan (<37 gebelik haftas\u0131) 30 kad\u0131nda \u00fc\u00e7\u00fcnc\u00fc trimester idrar fitalat metabolit konsantrasyonlar\u0131n\u0131 30 kontrol grubu (\u226537 gebelik haftas\u0131) ile kar\u015f\u0131la\u015ft\u0131ran Meksikal\u0131 bir kohort \u00e7al\u0131\u015fmas\u0131, fitalat maruziyetinin PTD ile ili\u015fkili olabilece\u011fini bulmu\u015ftur (11) . Ferguson ve arkada\u015flar\u0131, 130 PTD vakas\u0131 ve 352 kontrol\u00fc i\u00e7eren bir vaka-kontrol \u00e7al\u0131\u015fmas\u0131nda, hamileli\u011fin erken ve ge\u00e7 d\u00f6nemlerinde fitalatlara maruz kalan kad\u0131nlar\u0131n PTD riskini \u00f6nemli \u00f6l\u00e7\u00fcde art\u0131rd\u0131\u011f\u0131n\u0131 bulmu\u015flard\u0131r (12,13).<\/p>\n
Fenollere ve parabenlere maruz kalma, ortamdaki y\u00fcksek da\u011f\u0131l\u0131mlar\u0131n\u0131n bir sonucu olarak son derece yayg\u0131nd\u0131r. G\u0131da ve ki\u015fisel bak\u0131m \u00fcr\u00fcnlerinin yan\u0131 s\u0131ra bir\u00e7ok farmas\u00f6tik bile\u015fikte bulunurlar. Daha s\u0131k bulunan fenol ve parabenlerden baz\u0131lar\u0131 bisfenol S (BPS), benzofenon 3 (BP3), triklosan (TCS), triklokarban (TCB), metil-paraben (MPB), etil-paraben (EPB), propil-paraben ( PPB) ve butil-parabendir (BPB). Bu toksik bile\u015fiklerin olumsuz gebelik sonu\u00e7lar\u0131ndaki rol\u00fc tart\u0131\u015fmal\u0131d\u0131r, \u00e7\u00fcnk\u00fc ba\u011f\u0131\u015f\u0131kl\u0131k sistemi \u00fczerinde ikili bir etkiye, yani bir proinflamatuar veya bir anti-inflamatuar etkiye sahip olabilirler.<\/p>\n
T\u00fct\u00fcn Duman\u0131 ve Elektronik Sigara Aerosol\u00fc<\/strong><\/p>\nBir\u00e7ok \u00e7al\u0131\u015fma, t\u00fct\u00fcn duman\u0131 ile PTD aras\u0131nda bir ili\u015fki oldu\u011funu g\u00f6stermi\u015ftir (14, 15). Sigara i\u00e7mek kontrol edilebilecek risk fakt\u00f6rlerinden biridir; bu nedenle hamilelik s\u0131ras\u0131nda maruziyet azalt\u0131labilir. Bununla birlikte, PTD ile t\u00fct\u00fcn duman\u0131na pasif maruz kalma aras\u0131ndaki ili\u015fki hakk\u0131nda hala \u00e7eli\u015fkili veriler bulunmaktad\u0131r. Sigaralar, nikotine ek olarak CO, siyan\u00fcr, anilin, metanol, hidrojen s\u00fclf\u00fcr, arsenik, kur\u015fun, kadmiyum ve di\u011fer toksinler veya kanserojenler gibi toksik etkilere sahip olabilen bir dizi madde i\u00e7erir. Sigara i\u00e7mek, fetal b\u00fcy\u00fcme k\u0131s\u0131tlamas\u0131 ile vazokonstriksiyonu belirleyebilen oksidatif stresin arac\u0131l\u0131k etti\u011fi endotel hasar\u0131na neden olur. Ayr\u0131ca, hemoglobin i\u00e7in daha fazla ba\u011flanma afinitesi ile CO’nun artmas\u0131, fet\u00fcse oksijen dif\u00fczyonunu azalt\u0131r. PTD ile ili\u015fkili olarak, sigara i\u00e7mek erken membran r\u00fcpt\u00fcr\u00fc (PPROM) riskini artt\u0131rabilir. Ayr\u0131ca, sigara i\u00e7mek fetal membranlar\u0131n elastikiyetini azalt\u0131r, fetal membranda y\u0131rt\u0131lma ve PTD riski daha y\u00fcksektir. Cui H. ve arkada\u015flar\u0131 taraf\u0131ndan 2016 y\u0131l\u0131nda ger\u00e7ekle\u015ftirilen ve PTD yapm\u0131\u015f 5607 kad\u0131n\u0131 i\u00e7eren 24 \u00e7al\u0131\u015fmay\u0131 i\u00e7eren bir meta-analizde, \u00e7evresel t\u00fct\u00fcn pasif maruziyetinin PTD riskini d\u0131\u015far\u0131da ve ev ortam\u0131nda s\u0131ras\u0131yla %20 ile %16 aras\u0131nda art\u0131rd\u0131\u011f\u0131n\u0131 bulmu\u015ftur (16).<\/p>\n
2017’de Chen ve arkada\u015flar\u0131, fare modellerini kullanarak annenin hamilelik s\u0131ras\u0131nda elektronik sigara bile\u015fiklerine maruz kalmas\u0131n\u0131n etkisi hakk\u0131nda bir ara\u015ft\u0131rma yapm\u0131\u015ft\u0131r. Elektronik sigara kullan\u0131m\u0131 art\u0131k yayg\u0131nla\u015fm\u0131\u015ft\u0131r ve bu sigaralar\u0131n zarars\u0131z oldu\u011fu yayg\u0131n bir kan\u0131d\u0131r ve kullan\u0131mlar\u0131 yakla\u015f\u0131k %15’lik bir oranla hamile kad\u0131nlar aras\u0131nda s\u0131k g\u00f6r\u00fclmektedir (17). Bu cihazlarda bulunabilen nikotine ek olarak, bu sigaralar\u0131n aerosol\u00fcnde ba\u015fka toksik bile\u015fiklerin varl\u0131\u011f\u0131 da ortaya konmu\u015ftur. Bildi\u011fimiz kadar\u0131yla, e-sigara maruziyeti ve PTD riski hakk\u0131nda \u00e7al\u0131\u015fma yoktur.<\/p>\n
Zehirli Metaller<\/strong><\/p>\nMetal maruziyetlerinin \u00fcreme ve klinik etkileri Singh ve arkada\u015flar\u0131 taraf\u0131ndan iyi tan\u0131mlanm\u0131\u015ft\u0131r. Bu metaller, endotel h\u00fccrelerinde reaktif oksijen t\u00fcrleri (ROS) ve reaktif nitrojen t\u00fcrleri (RNS) gibi serbest radikallerin d\u00fczensiz \u00fcretiminde rol oynayabilir. Sonu\u00e7 olarak, bu etkile\u015fimler plasenta dokular\u0131nda DNA, membran lipidleri ve enzimlere zarar verebilir.<\/p>\n
Ayr\u0131ca toksik metaller; glutatyon (GSH), s\u00fcperoksit dismutaz (SOD) ve katalaz gibi antioksidan biyobelirte\u00e7lerin seviyelerini de\u011fi\u015ftirerek fetal b\u00fcy\u00fcme k\u0131s\u0131tlamas\u0131, preeklampsi ve PTB gibi k\u00f6t\u00fc gebelik sonu\u00e7lar\u0131na yol a\u00e7abilir.<\/p>\n
<\/p>\n
\n\n\nZehirli Metal<\/strong><\/td>\n\u0130\u00e7me Suyundaki S\u0131n\u0131r De\u011feri (DS\u00d6)<\/strong><\/td>\nMaruziyet Kayna\u011f\u0131<\/strong><\/td>\nHamilelikte Maruz Kalma Riskleri<\/strong><\/td>\n<\/tr>\n\nKur\u015fun (Pb) <\/strong><\/td>\n| 0.05 mg\/L<\/p>\n <\/td>\n | Su, yemek, hava, toz<\/p>\n <\/td>\n | Plasenta dokusuna pasif dif\u00fczyon<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Oksidatif stres<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Plasental doku yaralanmas\u0131<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Y\u00fcksek erken do\u011fum oran\u0131<\/td>\n<\/tr>\n | \nKadmiyum (Cd) <\/strong><\/td>\n| 0.003 mcg\/L<\/p>\n <\/td>\n | Lif a\u00e7\u0131s\u0131ndan zengin g\u0131dalar:<\/p>\n \u2022 Sebzeler<\/p>\n \u2022 Tah\u0131llar<\/p>\n \u2022 Patates<\/p>\n \u2022 Ispanak<\/p>\n Hava kirlili\u011fi<\/p>\n T\u00fct\u00fcn i\u00e7mek<\/td>\n | Vill\u00f6z h\u00fccreler \u00fczerinde toksik etkiye ba\u011fl\u0131 g\u00f6r\u00fclebilecek riskler<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Intrauterin geli\u015fme gerili\u011fi<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Erken do\u011fum<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Plasental kanama<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hormonal dengesizlik<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Genotoksisite<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Fetotoksisite<\/td>\n<\/tr>\n | \nCiva (Hg) <\/strong><\/td>\n| 1 mcg\/L<\/p>\n <\/td>\n | G\u0131da (bal\u0131k)<\/p>\n Kozmetik koruyucular<\/p>\n B\u00f6cek \u00f6ld\u00fcr\u00fcc\u00fcler<\/td>\n | Plasental doku \u00fczerinde y\u00fcksek d\u00fczeyde ba\u011flanma \u015funlara yol a\u00e7ar:<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Oksidatif stres<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Gebelik ya\u015f\u0131na g\u00f6re d\u00fc\u015f\u00fck do\u011fum a\u011f\u0131rl\u0131\u011f\u0131<\/td>\n<\/tr>\n | \nArsenik<\/strong><\/td>\n| 10 mcg\/L<\/p>\n <\/td>\n | Ev fayans<\/p>\n Sanayi<\/p>\n Tar\u0131m<\/td>\n | Anormal plasental vask\u00fclarizasyon ve oksidatif stres:<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 D\u00fc\u015f\u00fck<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00d6l\u00fc do\u011fum<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Erken do\u011fum<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Yenido\u011fan \u00f6l\u00fcm\u00fc<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n <\/p>\n Yaln\u0131zca \u00c7evresel Zehirli Bile\u015fikler De\u011fil: K\u00fcresel Is\u0131nman\u0131n Rol\u00fc<\/strong><\/p>\nSon y\u0131llarda hem \u00e7evreye etkisi hem de insan sa\u011fl\u0131\u011f\u0131na etkisi a\u00e7\u0131s\u0131ndan k\u00fcresel \u0131s\u0131nmaya artan bir ilgi mevcuttur. Bir\u00e7ok ara\u015ft\u0131rmac\u0131, k\u00fcresel \u0131s\u0131nma ile PTD ve di\u011fer olumsuz gebelik komplikasyonlar\u0131n ortaya \u00e7\u0131kmas\u0131 aras\u0131nda bir korelasyon olup olmad\u0131\u011f\u0131 hakk\u0131nda \u00e7al\u0131\u015fmalar yapm\u0131\u015ft\u0131r.<\/p>\n Zhong ve arkada\u015flar\u0131, 2018’de, PTD olu\u015fumunda hamilelik s\u0131ras\u0131nda \u0131s\u0131ya maruz kalman\u0131n kritik periyodunu belirlemek i\u00e7in bir kohort \u00e7al\u0131\u015fmas\u0131 ger\u00e7ekle\u015ftirdi. Yazarlar, \u00f6zellikle s\u0131cak mevsimlerde s\u0131ca\u011fa maruz kalma s\u00fcresiyle orant\u0131l\u0131 olarak artan bir PTD riski bulmu\u015flard\u0131r, \u00f6zellikle gebeli\u011fin ikinci trimesterinde maruziyette riskin artt\u0131\u011f\u0131n\u0131 saptam\u0131\u015flard\u0131r (18). Ayn\u0131 zamanda, literat\u00fcr\u00fcn ba\u015fka bir incelemesi hem s\u0131ca\u011f\u0131n hem de so\u011fu\u011fun daha y\u00fcksek PTD riski ile ili\u015fkili oldu\u011funu bildirmi\u015ftir.<\/p>\n Bu bulgulara ek olarak, Guo ve arkada\u015flar\u0131 gebelik \u00f6ncesi d\u00f6nemde de kritik bir pencere g\u00f6stermi\u015ftir. Hamilelikten \u00f6nceki son \u00fc\u00e7 ayl\u0131k d\u00f6nemde so\u011fu\u011fa maruz kalman\u0131n koruyucu bir rol\u00fc oldu\u011funu bulmu\u015flard\u0131r. Bu ili\u015fkinin alt\u0131nda yatan mekanizma belirsizli\u011fini korumaktad\u0131r. Is\u0131ya maruz kalman\u0131n, uterusa giden kan ak\u0131\u015f\u0131n\u0131n azalmas\u0131 ve yo\u011fun oksitosin sal\u0131n\u0131m\u0131 nedeniyle kas\u0131lmalar\u0131n ba\u015flamas\u0131yla birlikte akut strese yol a\u00e7abilece\u011fi varsay\u0131lm\u0131\u015ft\u0131r (19).<\/p>\n <\/p>\n Sonu\u00e7 olarak;<\/p>\n \n- Son birka\u00e7 y\u0131lda, PTD insidans\u0131nda bir art\u0131\u015f mevcuttur.<\/li>\n
- PTD sendromu d\u00fcnya \u00e7ap\u0131nda bir problemdir ve m\u00fcmk\u00fcn oldu\u011funda \u00f6nlemek ve ilgili komplikasyonlar\u0131 azaltmak i\u00e7in anneye ve fet\u00fcse daha iyi bir tedavi sunmak i\u00e7in altta yatan mekanizmalar\u0131n anla\u015f\u0131lmas\u0131 gereklidir.<\/li>\n
- PTD’nin nedeni her zaman a\u00e7\u0131k de\u011fildir. PTD’nin en s\u0131k tan\u0131mlanan nedenleri enfeksiy\u00f6z ve inflamatuar fakt\u00f6rlerle ilgilidir. Kimyasal bile\u015fiklere ve kirleticilere maruz kalman\u0131n, tam olarak enflamatuvar sitokinlerin aktivasyonu yoluyla bu obstetrik komplikasyonla ili\u015fkili olabilece\u011fi g\u00f6r\u00fclmektedir.<\/li>\n
- PTD olu\u015fumunda \u00e7evresel kirleticilerin rol\u00fcne ili\u015fkin mevcut veriler \u00e7eli\u015fkili sonu\u00e7lar vermektedir. Farkl\u0131 \u00e7al\u0131\u015fma tasar\u0131mlar\u0131, analitik y\u00f6ntemler ve \u00e7al\u0131\u015fmalar\u0131n y\u00fcr\u00fct\u00fcld\u00fc\u011f\u00fc co\u011frafi alanlar nedeniyle veriler iyi bir \u015fekilde kar\u015f\u0131la\u015ft\u0131r\u0131lamamaktad\u0131r. Bu nedenle, \u00e7evresel kirleticiler ve PTD aras\u0131ndaki ili\u015fki belirsizli\u011fini korumaya devam etmektedir.<\/li>\n
- Ancak, bu maddelerin PTD i\u00e7in risk fakt\u00f6rleri olarak rol\u00fcn\u00fc a\u00e7\u0131klayabilecek baz\u0131 mekanizmalar vard\u0131r.\n
\n- DNA hasar\u0131<\/em><\/strong> yaparak, fetal geli\u015fimi de\u011fi\u015ftirebilir.<\/li>\n
- Hemoglobine yar\u0131\u015fmal\u0131 olarak ba\u011flanarak doku oksijen sunumuna etki eder ve fetal hipoksi<\/em><\/strong>ye neden olabilir.<\/li>\n
- Bir\u00e7ok \u00e7evresel bile\u015fik, amniyokoryal membran\u0131n b\u00fct\u00fcnl\u00fc\u011f\u00fcn\u00fcn de\u011fi\u015fmesi ve\/veya servikal olgunla\u015fman\u0131n aktivasyonu ile h\u00fccresel oksidatif stres<\/em><\/strong>e neden olabilir.<\/li>\n
- Toksik bile\u015fikler ayr\u0131ca hamilelik ve fetal geli\u015fim bozukluklar\u0131 i\u00e7in ciddi sonu\u00e7larla birlikte inflamatuar yollar\u0131 aktive<\/em><\/strong><\/li>\n
- \u00c7evresel kirleticiler, DNA metilasyonu ve asetilasyonu ve ubiquitination ve histon modifikasyonlar\u0131 gibi epigenetik de\u011fi\u015fiklikler<\/em><\/strong> (translasyon sonras\u0131 modifikasyonlar) yoluyla gen ekspresyonunu de\u011fi\u015ftirebilir.<\/li>\n
- Toksik metallerin mevcudiyeti nedeniyle plasenta dokusunda ROS ve RNS gibi serbest radikaller<\/em><\/strong>in d\u00fczensiz \u00fcretimi ile plasental hasara yol a\u00e7abilir.<\/li>\n
- Endokrin bozucular olarak i\u015flev g\u00f6rerek hormonal homeostaz\u0131 de\u011fi\u015ftirebililir.<\/li>\n
- K\u00fcresel \u0131s\u0131nma gibi fakt\u00f6rlerle daha y\u00fcksek s\u0131cakl\u0131klar\u0131n oksitosinin sal\u0131n\u0131m\u0131na ve uterus kas\u0131lmalar\u0131n\u0131n ba\u015flamas\u0131na yol a\u00e7abilece\u011fi g\u00f6r\u00fclmektedir.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
<\/p>\n KAYNAKLAR<\/strong><\/p>\n1-Porpora, M.G.; Piacenti, I.; Scaramuzzino, S.; Masciullo, L.; Rech, F.; Benedetti Panici, P. Environmental Contaminants Exposure and Preterm Birth: A Systematic Review. Toxics 2019, 7, 11. https:\/\/doi.org\/10.3390\/toxics7010011<\/a><\/p>\n2-Fleischer, N.L.; Merialdi, M.; van Donkelaar, A.; Vadillo-Ortega, F.; Martin, R.V.; Betran, A.P.; O\u2019Neill, M.S. Outdoor air pollution, preterm birth, and low birth weight: Analysis of the world health organization global survey on maternal and perinatal health.\u00a0 Health Perspect.<\/em>2014<\/strong>,\u00a0122<\/em>, 425\u2013430.<\/p>\n3-Pike, K.; Jane Pillow, J.; Lucas, J.S. Long term respiratory consequences of intrauterine growth restriction.\u00a0 Fetal Neonatal Med.<\/em>2012<\/strong>,\u00a017<\/em>, 92\u201398.<\/p>\n4-Liu, C.; Sun, J.; Liu, Y.; Liang, H.; Wang, M.; Wang, C.; Shi, T. Different exposure levels of fine particulate matter and preterm birth: A meta-analysis based on cohort studies.\u00a0 Sci. Pollut. Res. Int.<\/em>2017<\/strong>,\u00a024<\/em>, 17976\u201317984.<\/p>\n5-Guo, Y.; Huo, X.; Wu, K.; Liu, J.; Zhang, Y.; Xu, X. Carcinogenic polycyclic aromatic hydrocarbons in umbilical cord blood of human neonates from Guiyu, China.\u00a0 Total Environ.<\/em>2012<\/strong>,\u00a0427\u2013428<\/em>, 35\u201340.<\/p>\n6-Jaakkola, J.J.; Jaakkola, N.; Zahlsen, K. Fetal growth and length of gestation in relation to prenatal exposure to environmental tobacco smoke assessed by hair nicotine concentration.\u00a0 Health Perspect.<\/em>2001<\/strong>,\u00a0109<\/em>, 557\u2013561.<\/p>\n7-Rinsky, J.L.; Hopenhayn, C.; Golla, V.; Browning, S.; Bush, H.M. Atrazine exposure in public drinking water and preterm birth. Public Health Rep.<\/em>2012<\/strong>,\u00a0127<\/em>, 72\u201380.<\/p>\n8-Tyagi, V.; Mustafa, M.D.; Sharma, T.; Banerjee, B.D.; Ahmed, R.S.; Tripathi, A.K.; Guleria, K. Association of organochlorine pesticides with the mRNA expression of tumour necrosis factor-alpha (TNF-\u03b1) & cyclooxygenase-2 (COX-2) genes in idiopathic preterm birth. Indian J. Med. Res.<\/em>2016<\/strong>,\u00a0143<\/em>, 731.<\/p>\n9-De Felip, E.; Abballe, A.; Albano, F.L.; Battista, T.; Carraro, V.; Conversano, M.; Franchini, S.; Giambanco, L.; Iacovella, N.; Ingelido, A.M.; et al. Current exposure of Italian women of reproductive age to PFOS and PFOA: A human biomonitoring study.\u00a0Chemosphere<\/em>2015<\/strong>,\u00a0137<\/em>, 1\u20138.<\/p>\n10-Sagiv, S.K.; Rifas-Shiman, S.L.; Fleisch, A.F.; Webster, T.F.; Calafat, A.M.; Ye, X.; Gillman, M.W.; Oken, E. Early-Pregnancy Plasma Concentrations of Perfluoroalkyl Substances and Birth Outcomes in Project Viva: Confounded by Pregnancy Hemodynamics?\u00a0 J. Epidemiol.<\/em>2018<\/strong>,\u00a0187<\/em>, 793\u2013802.<\/p>\n11-Meeker, J.D.; Hu, H.; Cantonwine, D.E.; Lamadrid-Figueroa, H.; Calafat, A.M.; Ettinger, A.S.; Hernandez-Avila, M.; Loch-Caruso, R.; T\u00e9llez-Rojo, M.M. Urinary phthalate metabolites in relation to preterm birth in Mexico city.\u00a0 Health Perspect.<\/em>2009<\/strong>,\u00a0117<\/em>, 1587\u20131592.<\/p>\n12-Ferguson, K.K.; McElrath, T.F.; Meeker, J.D. Environmental Phthalate Exposure and Preterm Birth. JAMA Pediatr.<\/em>2014<\/strong>,\u00a0168<\/em>, 61\u201368.<\/p>\n13-Ferguson, K.K.; McElrath, T.F.; Ko, Y.A.; Mukherjee, B.; Meeker, J.D. Variability in urinary phthalate metabolite levels across pregnancy and sensitive windows of exposure for the risk of preterm birth.\u00a0 Int.<\/em>2014<\/strong>,\u00a070<\/em>, 118\u2013124.<\/p>\n14-Crane, J.; Keough, M.; Murphy, P.; Burrage, L.; Hutchens, D. Effects of environmental tobacco smoke on perinatal outcomes: A retrospective cohort study. BJOG<\/em>2011<\/strong>,\u00a0118<\/em>, 865\u2013871.<\/p>\n15-Ion, R.C.; Wills, A.K.; Bernal, A.L. Environmental tobacco smoke exposure in pregnancy is associated with earlier delivery and reduced birth weight.\u00a0 Sci.<\/em>2015<\/strong>,\u00a022<\/em>, 1603\u20131611.<\/p>\n16-Cui, H.; Gong, T.T.; Liu, C.X.; Wu, Q.J. Associations between Passive Maternal Smoking during Pregnancy and Preterm Birth: Evidence from a Meta-Analysis of Observational Studies. PLoS ONE<\/em>2016<\/strong>,\u00a011<\/em>, e0147848.<\/p>\n17-Wagner, N.J.; Camerota, M.; Propper, C. Prevalence and Perceptions of Electronic Cigarette Use during Pregnancy.\u00a0 Child Health J.<\/em>2017<\/strong>,\u00a021<\/em>, 1655\u20131661.<\/p>\n18-Zhong, Q.; Lu, C.; Zhang, W.; Zheng, X.; Deng, Q. Preterm birth and ambient temperature: Strong association during night-time and warm seasons.\u00a0 Therm. Biol.<\/em>2018<\/strong>,\u00a078<\/em>, 381\u2013390.<\/p>\n19-Guo, T.; Wang, Y.; Zhang, H.; Zhang, Y.; Zhao, J.; Wang, Y.; Xie, X.; Wang, L.; Zhang, Q.; Liu, D.; et al. The association between ambient temperature and the risk of preterm birth in China.\u00a0 Total Environ.<\/em>2018<\/strong>,\u00a0613\u2013614<\/em>, 439\u2013446.<\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" Preterm do\u011fum (PTD), hamileli\u011fin 37. haftas\u0131ndan \u00f6nce ger\u00e7ekle\u015fen do\u011fum olarak tan\u0131mlan\u0131r. Erken do\u011fum, hem neonatal d\u00f6nemde hem de ya\u015fam\u0131n ilerleyen d\u00f6nemlerinde y\u00fcksek…<\/p>\n","protected":false},"author":1025,"featured_media":3484,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[10010,10014,10019],"tags":[10033,10032,10022],"class_list":["post-3483","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-slider","category-akademik-blog-yazisi","category-tft","tag-cevresel-atiklar","tag-preterm-dogum","tag-tft"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/3483","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/users\/1025"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/comments?post=3483"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/3483\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media\/3484"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media?parent=3483"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/categories?post=3483"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/tags?post=3483"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}} | | | | | | | | |