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Wang L, Di J, Wang Q, Zhang H, Zhao W, Shi X, Di Q, Ji JS, Liang W, Huang C. Heat exposure induced risks of preterm birth mediated by maternal hypertension. Nat Med 2024; 30:1974-1981. [PMID: 38750350 DOI: 10.1038/s41591-024-03002-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/15/2024] [Indexed: 07/21/2024]
Abstract
Heat exposure is associated with an increased risk of preterm birth (PTB), with previous work suggesting that maternal blood pressure may play a role in these associations. Here we conducted a cohort study of 197,080 singleton live births across 8 provinces in China from 2015 to 2018. The study first estimated the associations between heat exposure, maternal hypertension and clinical subtypes of PTB, and then quantified the role of maternal hypertension in heat and PTB using mediation analyses. We show that heat exposure (>85th, 90th and 95th percentiles of local temperature distributions) spanning from conception to the 20th gestational week was associated with a 15-21% increase in PTB, and a 20-22% increase in medically indicated PTB. Heat exposure is likely to increase the risk of maternal hypertension and elevated blood pressure. Maternal hypertension mediated 15.7% and 33.9% of the effects of heat exposure (>90th percentile) on PTB and medically indicated PTB, respectively. Based on this large-population study, we found that exposure to heat in early pregnancy can increase the risk of maternal hypertension, thereby affecting the incidence of PTB.
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Affiliation(s)
- Liyun Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Jiangli Di
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qiong Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Huanhuan Zhang
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Wei Zhao
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Xiaoming Shi
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qian Di
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - John S Ji
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute of Healthy China, Tsinghua University, Beijing, China
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China.
- Institute of Healthy China, Tsinghua University, Beijing, China.
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Atkin K, Christopulos G, Turk R, Bernhardt JM, Simmonds K. Educating Pregnant Women About the Dangers of Extreme Heat and Air Pollution. J Obstet Gynecol Neonatal Nurs 2024; 53:438-446. [PMID: 38346676 DOI: 10.1016/j.jogn.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 06/22/2024] Open
Abstract
Climate change poses a serious threat to the health and well-being of pregnant women and their developing fetuses. Certain populations are at greater risk of adverse outcomes from air pollution, a contributing factor to climate change. In addition, heightened exposure to extreme heat, a consequence of climate change, exacerbates the existing health care inequities in the United States. Nurses, midwives, and other health care clinicians are uniquely positioned to reduce the harmful effects of climate change by educating pregnant women and their families and advocating for systems and policies that can decelerate climate change. The purpose of this article is to provide resources for clinicians to use in educating pregnant women about the risks of extreme heat and air pollution, their potential effects on pregnancy and neonatal outcomes, and strategies to help mitigate risk. We conclude with implications for practice, opportunities for advocacy, and areas for future research.
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Pan R, Song J, Yi W, Liu J, Song R, Li X, Liu L, Yuan J, Wei N, Cheng J, Huang Y, Zhang X, Su H. Heatwave characteristics complicate the association between PM 2.5 components and schizophrenia hospitalizations in a changing climate: Leveraging of the individual residential environment. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 271:115973. [PMID: 38219619 DOI: 10.1016/j.ecoenv.2024.115973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND In the era characterized by global environmental and climatic changes, understanding the effects of PM2.5 components and heatwaves on schizophrenia (SCZ) is essential for implementing environmental interventions at the population level. However, research in this area remains limited, which highlights the need for further research and effort. We aim to assess the association between exposure to PM2.5 components and hospitalizations for SCZ under different heatwave characteristics. METHODS We conducted a 16 municipalities-wide, individual exposure-based, time-stratified, case-crossover study from January 1, 2017, to December 31, 2020, encompassing 160736 hospitalizations in Anhui Province, China. Daily concentrations of PM2.5 components were obtained from the Tracking Air Pollution in China dataset. Conditional logistic regression models were used to investigate the association between PM2.5 components and hospitalizations. Additionally, restricted cubic spline models were used to identify protective thresholds of residential environment in response to environmental and climate change. RESULTS Our findings indicate a positive correlation between PM2.5 and its components and hospitalizations. Significantly, a 1 μg/m3 increase in black carbon (BC) was associated with the highest risk, at 1.58% (95%CI: 0.95-2.25). Exposure to heatwaves synergistically enhanced the impact of PM2.5 components on hospitalization risks, and the interaction varied with the intensity and duration of heatwaves. Under the 99th percentile heatwave events, the impact of PM2.5 and its components on hospitalizations was most pronounced, which were PM2.5 (2-4d: 4.59%, 5.09%, and 5.09%), sulfate (2-4d: 21.73%, 23.23%, and 25.25%), nitrate (2-4d: 17.51%, 16.93%, and 20.31%), ammonium (2-4d: 27.49%, 31.03%, and 32.41%), organic matter (2-4d: 32.07%, 25.42%, and 24.48%), and BC (2-4d: 259.36%, 288.21%, and 152.52%), respectively. Encouragingly, a protective effect was observed when green and blue spaces comprised more than 17.6% of the residential environment. DISCUSSION PM2.5 components and heatwave exposure were positively associated with an increased risk of hospitalizations, although green and blue spaces provided a mitigating effect.
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Affiliation(s)
- Rubing Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Center for Big Data and Population Health of IHM, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Jian Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Center for Big Data and Population Health of IHM, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Weizhuo Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Center for Big Data and Population Health of IHM, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Jintao Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Center for Big Data and Population Health of IHM, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Rong Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Center for Big Data and Population Health of IHM, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Xuanxuan Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Center for Big Data and Population Health of IHM, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Li Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Center for Big Data and Population Health of IHM, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Jiajun Yuan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Center for Big Data and Population Health of IHM, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Ning Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Center for Big Data and Population Health of IHM, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Jian Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Center for Big Data and Population Health of IHM, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Yuee Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Wannan Medical College, 241002 Wuhu, Anhui, China
| | - Xulai Zhang
- Anhui Mental Health Center (Affiliated Psychological Hospital of Anhui Medical University), Hefei, Anhui, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Center for Big Data and Population Health of IHM, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China.
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Mehta M, Basu R, Ghosh R. Adverse effects of temperature on perinatal and pregnancy outcomes: methodological challenges and knowledge gaps. Front Public Health 2023; 11:1185836. [PMID: 38026314 PMCID: PMC10646498 DOI: 10.3389/fpubh.2023.1185836] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023] Open
Abstract
Evidence linking temperature with adverse perinatal and pregnancy outcomes is emerging. We searched for literature published until 30 January 2023 in PubMed, Web of Science, and reference lists of articles focusing on the outcomes that were most studied like preterm birth, low birth weight, stillbirth, and hypertensive disorders of pregnancy. A review of the literature reveals important gaps in knowledge and several methodological challenges. One important gap is the lack of knowledge of how core body temperature modulates under extreme ambient temperature exposure during pregnancy. We do not know the magnitude of non-modulation of body temperature during pregnancy that is clinically significant, i.e., when the body starts triggering physiologic counterbalances. Furthermore, few studies are conducted in places where extreme temperature conditions are more frequently encountered, such as in South Asia and sub-Saharan Africa. Little is also known about specific cost-effective interventions that can be implemented in vulnerable communities to reduce adverse outcomes. As the threat of global warming looms large, effective interventions are critically necessary to mitigate its effects.
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Affiliation(s)
- Maitry Mehta
- Sawyer Business School, Suffolk University, Boston, MA, United States
| | - Rupa Basu
- California Environmental Protection Agency, Office of Environmental Health Hazard Assessment, Oakland, CA, United States
| | - Rakesh Ghosh
- Sawyer Business School, Suffolk University, Boston, MA, United States
- Institute for Health and Aging, University of California, San Francisco, San Francisco, CA, United States
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Gordon M, Casey JA, McBrien H, Gemmill A, Hernández D, Catalano R, Chakrabarti S, Bruckner T. Disparities in preterm birth following the July 1995 Chicago heat wave. Ann Epidemiol 2023; 87:S1047-2797(23)00166-7. [PMID: 37678645 PMCID: PMC10842513 DOI: 10.1016/j.annepidem.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE To evaluate if changes in preterm birth (PTB, <37 weeks of gestation) incidence differed between non-Hispanic (NH) Black and NH white births following the July 1995 Chicago heat wave-among the most severe U.S. heat waves since 1950. METHODS We used an ecologic study design. We obtained birth data from January 1990-December 1996 from the National Vital Statistics File to calculate the mean monthly PTB incidence in Chicago's Cook County, Illinois. Births between July 1995 and February 1996 were potentially exposed to the heat wave in utero. We generated time series models for NH Black and NH white births, which incorporated synthetic controls of Cook County based on unexposed counties. We ran a secondary analysis considering socioeconomic status (SES). RESULTS From 1990-1996, the mean monthly PTB incidence among NH Black births was 18.6% compared to 7.8% among NH white births. The mean monthly PTB incidence among NH Black births from August 1995-January 1996 was 16.7% higher than expected (three additional PTBs per 100 live births per month [95% confidence interval (CI): 1, 5]). A similar increase occurred among low-SES NH Black births. No increase appeared among NH white births. CONCLUSIONS Severe heat waves may increase racial disparities in PTB incidence.
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Affiliation(s)
- Milo Gordon
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Joan A Casey
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY; Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA
| | - Heather McBrien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Alison Gemmill
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Diana Hernández
- Sociomedical Sciences Department, Columbia University Mailman School of Public Health, New York, NY
| | - Ralph Catalano
- School of Public Health, University of California, Berkeley
| | | | - Tim Bruckner
- Program in Public Health, University of California, Irvine.
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Choi ES, Lee JS, Hwang Y, Lee KS, Ahn KH. Association between early preterm birth and maternal exposure to fine particular matter (PM10): A nation-wide population-based cohort study using machine learning. PLoS One 2023; 18:e0289486. [PMID: 37549180 PMCID: PMC10406328 DOI: 10.1371/journal.pone.0289486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/19/2023] [Indexed: 08/09/2023] Open
Abstract
Although preterm birth (PTB), a birth before 34 weeks of gestation accounts for only less than 3% of total births, it is a critical cause of various perinatal morbidity and mortality. Several studies have been conducted on the association between maternal exposure to PM and PTB, but the results were inconsistent. Moreover, no study has analyzed the risk of PM on PTB among women with cardiovascular diseases, even though those were thought to be highly susceptible to PM considering the cardiovascular effect of PM. Therefore, we aimed to evaluate the effect of PM10 on early PTB according to the period of exposure, using machine learning with data from Korea National Health Insurance Service (KNHI) claims. Furthermore, we conducted subgroup analysis to compare the risk of PM on early PTB among pregnant women with cardiovascular diseases and those without. A total of 149,643 primiparous singleton women aged 25 to 40 years who delivered babies in 2017 were included. Random forest feature importance and SHAP (Shapley additive explanations) value were used to identify the effect of PM10 on early PTB in comparison with other well-known contributing factors of PTB. AUC and accuracy of PTB prediction model using random forest were 0.9988 and 0.9984, respectively. Maternal exposure to PM10 was one of the major predictors of early PTB. PM10 concentration of 5 to 7 months before delivery, the first and early second trimester of pregnancy, ranked high in feature importance. SHAP value showed that higher PM10 concentrations before 5 to 7 months before delivery were associated with an increased risk of early PTB. The probability of early PTB was increased by 7.73%, 10.58%, or 11.11% if a variable PM10 concentration of 5, 6, or 7 months before delivery was included to the prediction model. Furthermore, women with cardiovascular diseases were more susceptible to PM10 concentration in terms of risk for early PTB than those without cardiovascular diseases. Maternal exposure to PM10 has a strong association with early PTB. In addition, in the context of PTB, pregnant women with cardiovascular diseases are a high-risk group of PM10 and the first and early second trimester is a high-risk period of PM10.
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Affiliation(s)
- Eun-Saem Choi
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jue Seong Lee
- Department of Pediatrics, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Yujin Hwang
- Department of Pediatrics, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
- AI Center, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Kwang-Sig Lee
- AI Center, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
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Baharav Y, Nichols L, Wahal A, Gow O, Shickman K, Edwards M, Huffling K. The Impact of Extreme Heat Exposure on Pregnant People and Neonates: A State of the Science Review. J Midwifery Womens Health 2023; 68:324-332. [PMID: 37218676 DOI: 10.1111/jmwh.13502] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 05/24/2023]
Abstract
The relationship between heat exposure and perinatal morbidity and mortality is of increasing concern as global temperatures rise and extreme heat events become more frequent and intense. Heat exposure can lead to a multitude of harmful outcomes for pregnant individuals and neonates, including hospitalization and death. This state of the science review explored the evidence on the associations between heat exposure and negative health outcomes during pregnancy and the neonatal period. Findings suggest that improving health care provider and patient awareness of heat-related risks and implementing specific interventions could mitigate adverse outcomes. Furthermore, public health and other policy interventions are needed to increase thermal comfort and reduce societal exposure to extreme heat and related risks. Early warning systems, medical alerts, provider and patient education, and increased access to health care and thermal comfort may improve pregnancy and early life health outcomes.
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Affiliation(s)
- Yuval Baharav
- Adrienne Arsht-Rockefeller Foundation Resilience Center, Atlantic Council, Washington, District of Columbia
| | - Lilly Nichols
- Adrienne Arsht-Rockefeller Foundation Resilience Center, Atlantic Council, Washington, District of Columbia
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Anya Wahal
- Adrienne Arsht-Rockefeller Foundation Resilience Center, Atlantic Council, Washington, District of Columbia
| | - Owen Gow
- Adrienne Arsht-Rockefeller Foundation Resilience Center, Atlantic Council, Washington, District of Columbia
| | - Kurt Shickman
- Adrienne Arsht-Rockefeller Foundation Resilience Center, Atlantic Council, Washington, District of Columbia
| | - Maya Edwards
- Adrienne Arsht-Rockefeller Foundation Resilience Center, Atlantic Council, Washington, District of Columbia
| | - Katie Huffling
- Alliance of Nurses for Healthy Environments, Mount Rainier, Maryland
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Wu L, Yin WJ, Yu LJ, Wang YH, Jiang XM, Zhang Y, Tao FB, Tao RX, Zhu P. Prenatal Exposure to Air Pollution and Pre-Labor Rupture of Membranes in a Prospective Cohort Study: The Role of Maternal Hemoglobin and Iron Supplementation. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:47013. [PMID: 37074185 PMCID: PMC10116877 DOI: 10.1289/ehp11134] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Exposure to air pollution in prenatal period is associated with prelabor rupture of membranes (PROM). However, the sensitive exposure time windows and the possible biological mechanisms underlying this association remain unclear. OBJECTIVE We aimed to identify the sensitive time windows of exposure to air pollution for PROM risk. Further, we examined whether maternal hemoglobin levels mediate the association between exposure to air pollution and PROM, as well as investigated the potential effect of iron supplementation on this association. METHOD From 2015 to 2021, 6,824 mother-newborn pairs were enrolled in the study from three hospitals in Hefei, China. We obtained air pollutant data [particulate matter (PM) with aerodynamic diameter ≤2.5μm (PM2.5), PM with aerodynamic diameter ≤10μm (PM10), sulfur dioxide (SO2), and carbon monoxide (CO)] from the Hefei City Ecology and Environment Bureau. Information on maternal hemoglobin levels, gestational anemia, iron supplementation, and PROM was obtained from medical records. Logistic regression models with distributed lags were used to identify the sensitive time window for the effect of prenatal exposure to air pollutant on PROM. Mediation analysis estimated the mediated effect of maternal hemoglobin in the third trimester, linking prenatal air pollution with PROM. Stratified analysis was used to investigate the potential effect of iron supplementation on PROM risk. RESULTS We found significant association between prenatal exposure to air pollution and increased PROM risk after adjusting for confounders, and the critical exposure windows of PM2.5, PM10, SO2 and CO were the 21th to 24th weeks of pregnancy. Every 10-μg/m3 increase in PM2.5 and PM10, 5-μg/m3 increase in SO2, and 0.1-mg/m3 increase in CO was associated with low maternal hemoglobin levels [-0.94g/L (95% confidence interval (CI): -1.15, -0.73), -1.31g/L (95% CI: -1.55, -1.07), -2.96g/L (95% CI: -3.32, -2.61), and -1.11g/L (95% CI: -1.31, -0.92), respectively] in the third trimester. The proportion of the association between air pollution and PROM risk mediated by hemoglobin levels was 20.61% [average mediation effect (95% CI): 0.02 (0.01, 0.05); average direct effect (95%): 0.08 (0.02, 0.14)]. The PROM risk associated with exposure to low-medium air pollution could be attenuated by maternal iron supplementation in women with gestational anemia. CONCLUSIONS Prenatal exposure to air pollution, especially in the 21st to 24th weeks of pregnancy, is associated with PROM risk, which is partly mediated by maternal hemoglobin levels. Iron supplementation in anemia pregnancies may have protective effects against PROM risk associated with exposure to low-medium air pollution. https://doi.org/10.1289/EHP11134.
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Affiliation(s)
- Lin Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenic, Anhui Medical University, Hefei, China
| | - Wan-jun Yin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenic, Anhui Medical University, Hefei, China
| | - Li-jun Yu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenic, Anhui Medical University, Hefei, China
| | - Yu-hong Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenic, Anhui Medical University, Hefei, China
| | - Xiao-min Jiang
- Department of Obstetrics and Gynecology, Anhui Women and Child Health Care Hospital, Hefei, China
| | - Ying Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fang-biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenic, Anhui Medical University, Hefei, China
| | - Rui-xue Tao
- Department of Gynecology and Obstetrics, Hefei First People’s Hospital, Hefei, China
| | - Peng Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenic, Anhui Medical University, Hefei, China
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Jurgilevich A, Käyhkö J, Räsänen A, Pörsti S, Lagström H, Käyhkö J, Juhola S. Factors influencing vulnerability to climate change-related health impacts in cities - A conceptual framework. ENVIRONMENT INTERNATIONAL 2023; 173:107837. [PMID: 36921561 DOI: 10.1016/j.envint.2023.107837] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/27/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
Climate change will have adverse impacts on human health, which are amplified in cities. For these impacts, there are direct, indirect, and deferred pathways. The first category is well-studied, while indirect and deferred impacts are not well-understood. Moreover, the factors moderating the impacts have received little attention, although understanding these factors is critical for adaptation. We developed a conceptual framework that shows the pathways of climate impacts on human health, focusing specifically on the factors of urban environment moderating the emergence and severity of these health impacts. Based on the framework and literature review, we illustrate the mechanisms of direct, indirect, and deferred health impact occurrence and the factors that exacerbate or alleviate the severity of these impacts, thus presenting valuable insights for anticipatory adaptation. We conclude that an integrated systemic approach to preventing health risks from climate change can provide co-benefits for adaptation and address multiple health risks. Such an approach should be mainstreamed horizontally to all sectors of urban planning and should account for the spatiotemporal aspects of policy and planning decisions and city complexity.
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Affiliation(s)
| | - Janina Käyhkö
- University of Helsinki, Environment and Ecosystems Research Programme, Finland
| | | | | | - Hanna Lagström
- University of Turku, Centre for Population Health Research and Turku University Hospital, Finland
| | - Jukka Käyhkö
- University of Turku, Department of Geography and Geology, Finland
| | - Sirkku Juhola
- University of Helsinki, Environment and Ecosystems Research Programme, Finland
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Zhang H, Zhang X, Feng D, Gao Z, Gong Y, Zhang J, Song S, Yu Z, Huang C. Interaction effects of night-time temperature and PM 2.5 on preterm birth in Huai River Basin, China. ENVIRONMENT INTERNATIONAL 2023; 171:107729. [PMID: 36623379 DOI: 10.1016/j.envint.2023.107729] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/26/2022] [Accepted: 01/01/2023] [Indexed: 06/17/2023]
Abstract
Nocturnal temperature is observed increasing with global warming. However, evidence on night-time non-optimal temperature on the risk of preterm birth (PTB) is limited, and the potential interactions with air pollution on PTB has not been well clarified. We therefore conducted a population-based retrospective cohort study to evaluate the effect of night-time temperature extremes on the risk of PTB and its interaction with air pollution. Records of 196,780 singleton births from 4 counties in Huai River Basin (2013-2018) were obtained. Gridded data on night-time temperature were collected from a high-quality Chinese Air Quality Reanalysis dataset. We used a multivariate logistic regression to evaluate the effects of night-time heat and cold exposure on the risk of PTB as well as its subtypes. Potential interactions between night-time temperature extremes and fine particulate matter < 2.5 µm (PM2.5) were examined using the relative excess risk due to interaction (RERI). We found that the risk of PTB was positively associated with third trimester night-time extremely heat and cold exposure, with adjusted OR of 1.898 (95 %CI: 1.655-2.177) and 2.044 (95 %CI: 1.786-2.339). Similar effects were observed for PTB subtypes, moderately PTB (mPTB) and very PTB (vPTB). Synergistic effects (RERI greater than 0) of each trimester night-time temperature extremes exposure and PM2.5 on PTB were observed. We identified consistent positive interactions between night-time temperature extremes and PM2.5 on mPTB. No significant interaction of night-time temperature extremes and PM2.5 on vPTB was found. In conclusion, this large retrospective cohort study found that third trimester night-time heat and cold exposure significantly increased the risk of PTB and its subtypes. There is a synergistic effect between night-time temperature extremes and high PM2.5 levels on PTB and mPTB. In the context of climate warming, our results add new evidence to the current understanding of night-time non-optimal temperature exposure on PTB.
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Affiliation(s)
- Huanhuan Zhang
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China; School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaoan Zhang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Zhengzhou, China
| | - Demin Feng
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Zhengzhou, China
| | - Zhan Gao
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Yuting Gong
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Junxi Zhang
- NHC Key Laboratory of Birth Defects Prevention & Henan Key Laboratory of Population Defects Prevention, Zhengzhou, China
| | - Shuaixing Song
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zengli Yu
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China; NHC Key Laboratory of Birth Defects Prevention & Henan Key Laboratory of Population Defects Prevention, Zhengzhou, China.
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Yu Z, Zhang X, Zhang J, Feng Y, Zhang H, Wan Z, Xiao C, Zhang H, Wang Q, Huang C. Gestational exposure to ambient particulate matter and preterm birth: An updated systematic review and meta-analysis. ENVIRONMENTAL RESEARCH 2022; 212:113381. [PMID: 35523275 DOI: 10.1016/j.envres.2022.113381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/17/2022] [Accepted: 04/26/2022] [Indexed: 06/14/2023]
Abstract
Previous studies on gestational particulate matter (PM) exposure and preterm birth (PTB) showed inconsistent results, and no study systematically examined the short-term effect of PM exposure on PTB subtypes. To investigate both long- and short-term effects of the evidence to date in general population, we searched for epidemiological studies on PM exposure and PTB that published in PubMed, Web of Science, Embase and Cochrane Library up to March 31, 2022. The protocol for this review was registered with PROSPERO (CRD42021265202). Heterogeneity was assessed by Cochran's Q test and I2 statistic. Publication bias was evaluated using funnel plots and Egger's tests. Subgroup analysis, meta-regression and sensitivity analysis were performed. Of 16,801 records, 84 eligible studies were finally included. The meta-analysis of long-term effect showed that per 10 μg/m3 increase in PM2.5 and PM10 during entire pregnancy were associated with PTB, the pooled odds ratios (ORs) were 1.084 (95% CI: 1.055-1.113) and 1.034 (95% CI: 1.018-1.049). Positive associations were found between PM2.5 in second trimester and PTB subtypes. For the short-term exposure, we observed that PTB was positively associated with a 10 μg/m3 increment in PM2.5 on lag day 2 and 3, the pooled ORs and 95% CIs were 1.003 (1.001-1.004) and 1.003 (1.001-1.005), with I2 of 65.30% and 76.60%. PM10 exposure on ave day 1 increased the risk of PTB, the pooled OR was 1.001 (95% CI: 1.000, 1.001). We also found that PM10 exposure in 2 weeks prior to birth increased PTB risk. Our results support the hypothesis of both long- and short-term PM2.5 exposure increase the risk of PTB. Further well-designed longitudinal studies and investigations into potential biological mechanisms are warranted.
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Affiliation(s)
- Zengli Yu
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaoan Zhang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junxi Zhang
- National Health Commission Key Laboratory of Birth Defects Prevention; Key Laboratory of Population Defects Prevention, Zhengzhou, China
| | - Yang Feng
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Han Zhang
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zhongxiao Wan
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Chenglong Xiao
- School of Earth Sciences, Chengdu University of Technology, Chengdu, China
| | - Huanhuan Zhang
- School of Public Health, Zhengzhou University, Zhengzhou, China; National Health Commission Key Laboratory of Birth Defects Prevention; Key Laboratory of Population Defects Prevention, Zhengzhou, China.
| | - Qiong Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Segal TR, Giudice LC. Systematic review of climate change effects on reproductive health. Fertil Steril 2022; 118:215-223. [PMID: 35878942 DOI: 10.1016/j.fertnstert.2022.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/07/2022] [Indexed: 12/26/2022]
Abstract
Climate change is a major risk factor for overall health, including reproductive health, and well-being. Increasing temperatures, due mostly to increased greenhouse gases trapping excess heat in the atmosphere, result in erratic weather patterns, wildfires, displacement of large communities, and stagnant water resulting in vector-borne diseases that, together, have set the stage for new and devastating health threats across the globe. These conditions disproportionately affect disadvantaged and vulnerable populations, including women, pregnant persons, young children, the elderly, and the disabled. This review reports on the evidence for the adverse impacts of air pollution, wildfires, heat stress, floods, toxic chemicals, and vector-borne diseases on male and female fertility, the developing fetus, and obstetric outcomes. Reproductive health care providers are uniquely positioned and have an unprecedented opportunity to educate patients and policy makers about mitigating the impact of climate change to assure reproductive health in this and future generations.
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Affiliation(s)
- Thalia R Segal
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California
| | - Linda C Giudice
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California.
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Syed S, O’Sullivan TL, Phillips KP. Extreme Heat and Pregnancy Outcomes: A Scoping Review of the Epidemiological Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042412. [PMID: 35206601 PMCID: PMC8874707 DOI: 10.3390/ijerph19042412] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 12/04/2022]
Abstract
Background: Extreme heat caused by climate change is a major public health concern, disproportionately affecting poor and racialized communities. Gestational heat exposure is a well-established teratogen in animal studies, with a growing body of literature suggesting human pregnancies are similarly at risk. Characterization of extreme heat as a pregnancy risk is problematic due to nonstandard definitions of heat waves, and variable study designs. To better focus future research in this area, we conducted a scoping review to assess the effects of extreme heat on pregnancy outcomes. Methods: A scoping review of epidemiological studies investigating gestational heat-exposure and published 2010 and 2020, was conducted with an emphasis on study design, gestational windows of sensitivity, adverse pregnancy outcomes and characterization of environmental temperatures. Results: A sample of 84 studies was identified, predominantly set in high-income countries. Preterm birth, birthweight, congenital anomalies and stillbirth were the most common pregnancy outcome variables. Studies reported race/ethnicity and/or socioeconomic variables, however these were not always emphasized in the analysis. Conclusion: Use of precise temperature data by most studies avoided pitfalls of imprecise, regional definitions of heat waves, however inconsistent study design, and exposure windows are a significant challenge to systematic evaluation of this literature. Despite the high risk of extreme heat events and limited mitigation strategies in the global south, there is a significant gap in the epidemiological literature from these regions. Greater consistency in study design and exposure windows would enhance the rigor of this field.
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