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Ha S, Abatzoglou JT, Adebiyi A, Ghimire S, Martinez V, Wang M, Basu R. Impacts of heat and wildfire on preterm birth. ENVIRONMENTAL RESEARCH 2024; 252:119094. [PMID: 38723988 DOI: 10.1016/j.envres.2024.119094] [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: 01/30/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Climate change continues to increase the frequency, intensity, and duration of heat events and wildfires, both of which are associated with adverse pregnancy outcomes. Few studies simultaneously evaluated exposures to these increasingly common exposures. OBJECTIVES We investigated the relationship between exposure to heat and wildfire smoke and preterm birth (PTB). METHODS In this time-stratified case-crossover study, participants consisted of 85,806 California singleton PTBs (20-36 gestational weeks) from May through October of 2015-2019. Birthing parent ZIP codes were linked to high-resolution daily weather, PM2.5 from wildfire smoke, and ambient air pollution data. Heat day was defined as a day with apparent temperature >98th percentile within each ZIP code and heat wave was defined as ≥2 consecutive heat days. Wildfire-smoke day was defined as a day with any exposure to wildfire-smoke PM2.5. Conditional logistic regression was used to calculate the odds ratio (OR) and 95% confidence intervals (CI) comparing exposures during a hazard period (lags 0-6) compared to control periods. Analyses were adjusted for relative humidity, fine particles, and ozone. RESULTS Wildfire-smoke days were associated with 3.0% increased odds of PTB (ORlag0: 1.03, CI: 1.00-1.05). Compared with white participants, associations appeared stronger among Black, Hispanic, Asian, and American Indians/Alaskan Native participants. Heatwave days (ORlag2: 1.07, CI: 1.02-1.13) were positively associated with PTB, with stronger associations among those simultaneously exposed to wildfire smoke days (ORlag2: 1.19, CI: 1.11-1.27). Similar findings were observed for heat days and when other temperature metrics (e.g., maximum, minimum) were used. DISCUSSION Heat and wildfire increased PTB risk with evidence of synergism. As the occurrence and co-occurrence of these events increase, exposure reduction among pregnant people is critical, especially among racial/ethnic minorities.
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Affiliation(s)
- Sandie Ha
- Department of Public Health, School of Social Sciences, Humanities and Arts, Health Science Research Institute, University of California, 5200 N Lake Rd, 95343, Merced, CA, USA.
| | - John T Abatzoglou
- Department of Management of Complex Systems, School of Engineering, University of California, Merced, USA
| | - Adeyemi Adebiyi
- Department of Life and Environmental Sciences, School of Natural Sciences, University of California, Merced, USA
| | - Sneha Ghimire
- Department of Public Health, School of Social Sciences, Humanities and Arts, Health Science Research Institute, University of California, 5200 N Lake Rd, 95343, Merced, CA, USA
| | - Valerie Martinez
- Department of Public Health, School of Social Sciences, Humanities and Arts, Health Science Research Institute, University of California, 5200 N Lake Rd, 95343, Merced, CA, USA
| | - Meng Wang
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Rupa Basu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA
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Runkle JD, Sugg MM, Berry A, Reed C, Cowan K, Wertis L, Ryan S. Association of Psychiatric Emergency Visits and Warm Ambient Temperature during Pregnancy: A Time-Stratified Case-Crossover Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:67001. [PMID: 38829735 PMCID: PMC11166382 DOI: 10.1289/ehp13293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Acute exposure to high ambient temperature and heat waves during the warm season has been linked with psychiatric disorders. Emerging research has shown that pregnant people, due to physiological and psychological changes, may be more sensitive to extreme heat, and acute exposure has been linked to increased risk of pregnancy complications; however, few studies have examined psychiatric complications. OBJECTIVE Our objective was to examine the association between acute exposure to warm ambient temperatures and emergency department (ED) visits for mental disorders during pregnancy. METHODS A time-stratified case-crossover design with conditional logistic regression was performed on ∼ 206,000 psychiatric ED visits for pregnant patients in North Carolina, from May to September 2016 to 2019. Daily average ambient temperature was the main exposure and was linked to daily visits by maternal zip code of residence for prenatal mood and anxiety disorders (PMAD), severe mental illness (SMI), mental disorder of pregnancy (MDP), suicidal thoughts (SUIC), and any psychiatric disorder (Any). Effect modification by trimester, residential segregation, economic segregation, urbanicity, and availability of greenspace was also investigated. RESULTS Each 5 ° C increase in same-day exposure to warm ambient temperature on case days was associated with an increase in incidence rate ratio (IRR) for any psychiatric disorder [IRR = 1.07; 95% confidence interval (CI): 1.01, 1.14] including anxiety (IRR = 1.14; 95% CI: 1.00, 1.30), bipolar disorder (IRR = 1.28; 95% CI: 0.98, 1.67), and suicidal thoughts (IRR = 1.28; 95% CI: 1.00, 1.65) compared to control days. In general, the associations were strongest for warm season temperatures on the same day of exposure or for temperatures averaged over the 3 or 6 d preceding the ED visit. The greatest risk of an incident ED admission for PMAD (RR = 1.20; 95% CI: 1.04, 1.39), particularly for anxiety (RR = 1.30; 95% CI: 1.07, 1.59), and any psychiatric disorder (RR = 1.17; 95% CI: 1.07, 1.28) occurred following cumulative exposure to hot temperatures the week before admission. Higher psychiatric burden from temperature was observed in urban areas and on extreme heat days. CONCLUSIONS For this pregnant population in the southeastern United States, short-term exposure to high ambient temperatures during the warm season was associated with a greater risk of ED visits for an array of psychiatric disorders. Findings show that climate-related increases in ambient temperature may contribute to psychiatric morbidity in pregnant people. https://doi.org/10.1289/EHP13293.
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Affiliation(s)
- Jennifer D. Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, Asheville, North Carolina, USA
| | - Margaret M. Sugg
- Department of Geography and Planning, Appalachian State University, Boone, North Carolina, USA
| | - Anne Berry
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Charlie Reed
- North Carolina Institute for Climate Studies, North Carolina State University, Asheville, North Carolina, USA
| | - Kristen Cowan
- North Carolina Institute for Climate Studies, North Carolina State University, Asheville, North Carolina, USA
| | - Luke Wertis
- Department of Geography and Planning, Appalachian State University, Boone, North Carolina, USA
| | - Sophie Ryan
- Department of Geography and Planning, Appalachian State University, Boone, North Carolina, USA
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Darrow LA, Huang M, Warren JL, Strickland MJ, Holmes HA, Newman AJ, Chang HH. Preterm and Early-Term Delivery After Heat Waves in 50 US Metropolitan Areas. JAMA Netw Open 2024; 7:e2412055. [PMID: 38787560 PMCID: PMC11127119 DOI: 10.1001/jamanetworkopen.2024.12055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/16/2024] [Indexed: 05/25/2024] Open
Abstract
Importance Heat waves are increasing in frequency, intensity, and duration and may be acutely associated with pregnancy outcomes. Objective To examine changes in daily rates of preterm and early-term birth after heat waves in a 25-year nationwide study. Design, Setting, and Participants This cohort study of singleton births used birth records from 1993 to 2017 from the 50 most populous US metropolitan statistical areas (MSAs). The study included 53 million births, covering 52.8% of US births over the period. Data were analyzed between October 2022 and March 2023 at the National Center for Health Statistics. Exposures Daily temperature data from Daymet at 1-km2 resolution were averaged over each MSA using population weighting. Heat waves were defined in the 4 days (lag, 0-3 days) or 7 days (lag, 0-6 days) preceding birth. Main Outcomes and Measures Daily counts of preterm birth (28 to <37 weeks), early-term birth (37 to <39 weeks), and ongoing pregnancies in each gestational week on each day were enumerated in each MSA. Rate ratios for heat wave metrics were obtained from time-series models restricted to the warm season (May to September) adjusting for MSA, year, day of season, and day of week, and offset by pregnancies at risk. Results There were 53 154 816 eligible births in the 50 MSAs from 1993 to 2017; 2 153 609 preterm births and 5 795 313 early-term births occurring in the warm season were analyzed. A total of 30.0% of mothers were younger than 25 years, 53.8% were 25 to 34 years, and 16.3% were 35 years or older. Heat waves were positively associated with daily rates of preterm and early-term births, showing a dose-response association with heat wave duration and temperatures and stronger associations in the more acute 4-day window. After 4 consecutive days of mean temperatures exceeding the local 97.5th percentile, the rate ratio for preterm birth was 1.02 (95% CI, 1.00-1.03), and the rate ratio for early-term birth was 1.01 (95% CI, 1.01-1.02). For the same exposure, among those who were 29 years of age or younger, had a high school education or less, and belonged to a racial or ethnic minority group, the rate ratios were 1.04 (95% CI, 1.02-1.06) for preterm birth and 1.03 (95% CI, 1.02-1.05) for early-term birth. Results were robust to alternative heat wave definitions, excluding medically induced deliveries, and alternative statistical model specifications. Conclusions and Relevance In this cohort study, preterm and early-term birth rates increased after heat waves, particularly among socioeconomically disadvantaged subgroups. Extreme heat events have implications for perinatal health.
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Affiliation(s)
- Lyndsey A. Darrow
- Department of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Nevada, Reno
| | - Mengjiao Huang
- Department of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Nevada, Reno
- Geriatric Research and Education Clinical Center, Veterans Affairs Health Care Systems, Palo Alto, California
| | - Joshua L. Warren
- Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut
| | - Matthew J. Strickland
- Department of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Nevada, Reno
| | - Heather A. Holmes
- Department of Chemical Engineering, John and Marcia Price College of Engineering, University of Utah, Salt Lake City
| | - Andrew J. Newman
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, Colorado
| | - Howard H. Chang
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Weeda LJZ, Bradshaw CJA, Judge MA, Saraswati CM, Le Souëf PN. How climate change degrades child health: A systematic review and meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 920:170944. [PMID: 38360325 DOI: 10.1016/j.scitotenv.2024.170944] [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: 11/01/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Children are more vulnerable than adults to climate-related health threats, but reviews examining how climate change affects human health have been mainly descriptive and lack an assessment of the magnitude of health effects children face. This is the first systematic review and meta-analysis that identifies which climate-health relationships pose the greatest threats to children. OBJECTIVES We reviewed epidemiologic studies to analyse various child health outcomes due to climate change and identify the relationships with the largest effect size. We identify population-specific risks and provide recommendations for future research. METHODS We searched four large online databases for observational studies published up to 5 January 2023 following PRISMA (systematic review) guidelines. We evaluated each included study individually and aggregated relevant quantitative data. We used quantitative data in our meta-analysis, where we standardised effect sizes and compared them among different groupings of climate variables and health outcomes. RESULTS Of 1301 articles we identified, 163 studies were eligible for analysis. We identified many relationships between climate change and child health, the strongest of which was increasing risk (60 % on average) of preterm birth from exposure to temperature extremes. Respiratory disease, mortality, and morbidity, among others, were also influenced by climate changes. The effects of different air pollutants on health outcomes were considerably smaller compared to temperature effects, but with most (16/20 = 80 %) pollutant studies indicating at least a weak effect. Most studies occurred in high-income regions, but we found no geographical clustering according to health outcome, climate variable, or magnitude of risk. The following factors were protective of climate-related child-health threats: (i) economic stability and strength, (ii) access to quality healthcare, (iii) adequate infrastructure, and (iv) food security. Threats to these services vary by local geographical, climate, and socio-economic conditions. Children will have increased prevalence of disease due to anthropogenic climate change, and our quantification of the impact of various aspects of climate change on child health can contribute to the planning of mitigation that will improve the health of current and future generations.
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Affiliation(s)
- Lewis J Z Weeda
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
| | - Corey J A Bradshaw
- Global Ecology | Partuyarta Ngadluku Wardli Kuu, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia; Australian Research Council Centre of Excellence for Australian Biodiversity and Heritage, EpicAustralia.org.au, Australia
| | - Melinda A Judge
- Telethon Kids Institute, Perth, Western Australia, Australia; Department of Mathematics and Statistics, University of Western Australia, Perth, Western Australia, Australia
| | | | - Peter N Le Souëf
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia; Telethon Kids Institute, Perth, Western Australia, Australia
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Guo J, Xue T, Cao M, Han X, Pan Z, Huang D, Sun W, Mi J, Liu Y, Guan T. Ambient temperature anomalies induce electrocardiogram abnormalities: Findings from a nationwide longitudinal study. ENVIRONMENTAL RESEARCH 2024; 246:117996. [PMID: 38128602 DOI: 10.1016/j.envres.2023.117996] [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: 09/13/2023] [Revised: 12/02/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023]
Abstract
Electrocardiogram (ECG) outcomes serve as early manifestations of cardiovascular functional or structural changes. While temperature fluctuation has been demonstrated to be a risk factor for cardiovascular diseases, few epidemiological studies have reported its relationship with ECG outcomes. In this study, we employed temperature anomaly (TA) as an innovative indicator of temperature fluctuation to quantify its detrimental impacts on ECG outcomes. A longitudinal study design was conducted using the repeated ECG records of the China National Stroke Screening Survey from 2013 to 2019. Only individuals undergoing at least two ECG tests were included. The daily temperature was assimilated by combining three kinds of data: in situ observations, satellite remote sensing measurements and weather research forecast simulations. We used generalized estimating equations to control for autocorrelation among repeated records and to estimate the association between TA and the risk of ECG abnormalities. We found 6837 events of ECG abnormalities in 47,286 individuals with 102,030 visits. Each unit increment of TA increased the risk of ECG abnormalities [odds ratio (OR) = 1.009, 95% confidence interval (CI): 1.001-1.017] and the risk of myocardial ischemia (OR = 1.061, 95% CI: 1.012-1.111). Hierarchic analyses presented a similar association of TA with both ECG abnormalities (OR = 1.017, 95% CI: 1.008-1.026) and myocardial ischemia (OR = 1.061, 95%CI: 1.011-1.114) in Northern China, but not in Southern China. The exposure-response relationship was estimated as a U-shaped curve centered at the TA value of zero. Sudden warming tended to increase the risk of ECG abnormalities and myocardial ischemia, and sudden cooling tended to increase the risk of atrial fibrillation. All these detrimental effects of TA could be modified by specific individual characteristics. In summary, ambient temperature fluctuation increased the risk of ECG abnormalities. This result indicated that regular ECG tests could be an early-warning measure for monitoring the adverse health effects of temperature fluctuations.
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Affiliation(s)
- Jian Guo
- State Key Laboratory for Complex, Severe, and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China; Department of Cardiology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Tao Xue
- Department of Epidemiology and Biostatistics/Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Centre, Beijing, 100191, China; State Environmental Protection Key Laboratory of Atmospheric Exposure and Health Risk Management, Center for Environment and Health, Peking University, Beijing, 100871, China; Advanced Institute of Information Technology, Peking University, Hangzhou, China.
| | - Man Cao
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10005, China
| | - Xueyan Han
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10005, China
| | - Zhaoyang Pan
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10005, China
| | - Dengmin Huang
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10005, China
| | - Wei Sun
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10005, China
| | - Jiarun Mi
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10005, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10005, China
| | - Tianjia Guan
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10005, China.
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6
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Khosravipour M, Golbabaei F. Short-term ambient temperature variations and incidence of preterm birth: A systematic review and meta-analysis. Int J Hyg Environ Health 2024; 256:114319. [PMID: 38171266 DOI: 10.1016/j.ijheh.2023.114319] [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: 06/23/2023] [Revised: 12/18/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024]
Abstract
This study aimed to determine the short-term effects of ambient temperature variations exposures on the incidence of preterm birth (PTB) for each single lag day (lag0 to lag6) and cumulative lag days (lag0-1 to lag0-6) up to a week before birth. To find relevant publications, online databases, including Web of Science, PubMed, and Scopus were searched with appropriate keywords and Mesh terms from their inception to October 25, 2023. Overall, the number of 39 observational studies with 12.5 million pregnant women and 700.000 cases of PTB met our eligibility criteria. The associations of temperature variations with the incidence of PTB were investigated with two different meta-analyses, including the percentile meta-analysis (comparing different percentiles (P1 to P99) with a referent percentile (P50)), and the linear meta-analysis (per 5 °C increment of the temperature levels). For the percentile meta-analysis, we observed both extreme cold (P1, only lag 0) and heat (P95 and P99 with the highest risk at lag1 and lag0-6) exposures can be significantly associated with a higher risk of PTB. The pooled RR (95 % CI) per 5 °C increase in the temperature levels at lag0-6 was estimated as 1.038 (1.018, 1.058) for the overall analysis. Subgroup analysis based on the season shows a significant association in the warm season (RR = 1.082 and 95 % CI = 1.036, 1.128) at all lag days but not the cold season. For the single lag day, we observed the risk of PTB is the highest at lag1 and decreased with moving to lag6. In sum, we suppose there is a nearly V-shape non-linear association between air temperature levels and the incidence of PTB with the linear relationship for each unit increase (also decrease) in the temperature levels above (also below) moderate temperature limits. Future studies should investigate possible association of occupational heat and cold exposure during pregnancy on the incidence of adverse birth outcomes such as PTB.
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Affiliation(s)
- Masoud Khosravipour
- Occupational Health Engineering Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Farideh Golbabaei
- Occupational Health Engineering Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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7
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Laporta J, Khatib H, Zachut M. Review: Phenotypic and molecular evidence of inter- and trans-generational effects of heat stress in livestock mammals and humans. Animal 2024:101121. [PMID: 38531705 DOI: 10.1016/j.animal.2024.101121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
Internal and external factors can change an individual's phenotype. A significant external threat to humans and livestock is environmental heat load, a combination of high ambient temperatures and humidity. A heat stress response occurs when an endothermal animal is exposed to a heat load that challenges its' thermoregulation capacity. With the ongoing climate change trends, the incidence of chronically elevated temperatures causing heat stress is expected to rise, posing an even greater risk to the health and survival of all species. Heat stress is generally related to adverse effects on food intake, health, and performance in mammal livestock species and humans. Evidence from epidemiological and experimental studies of humans and livestock demonstrated that exposing pregnant females to heat stress affects the phenotype of the newborn in various ways. For instance, in utero heat stress is related to lower BW at birth and changes in metabolic and immune functions in the newborn. In cows, the effects of heat stress on the performance of the offspring last for three or four generations, suggesting intergenerational effects. The molecular mechanism orchestrating these effects of heat stress may be epigenetic regulation, as various epigenetic mechanisms control genome reprogramming. Epigenetic modifications are attached to DNA and histone proteins and can influence how specific genes are expressed, resulting in phenotypic changes. Epigenetic modifications can be triggered in response to environmental heat stress without altering the DNA sequence. Heat stress insults during critical periods of organ development (i.e., fetal exposure) can trigger epigenetic modifications that impact health and productivity across generations. Thus, epigenetic changes caused by extreme temperatures can be passed down to the offspring if the mother is exposed to the insult during pregnancy. Understanding the phenotypic and molecular consequences of maternal heat stress, including the carry-over lingering effects on the resulting progeny, is necessary to develop effective mitigation strategies and gain translational knowledge about the fundamental processes leading to intergenerational and transgenerational inheritance. This review examines the phenotypic and molecular evidence of how maternal exposure to extreme heat can affect future generations in several species, including humans, swine, sheep, goats, and cattle. The current knowledge of the molecular mechanisms involved in intergenerational and transgenerational epigenetic inheritance will also be presented and discussed.
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Affiliation(s)
- J Laporta
- Department of Animal and Dairy Sciences, The University of Wisconsin-Madison, Madison, WI 53705, USA.
| | - H Khatib
- Department of Animal and Dairy Sciences, The University of Wisconsin-Madison, Madison, WI 53705, USA
| | - M Zachut
- Department of Ruminant Science, Institute of Animal Science, Volcani Institute, Rishon LeZion 7505101, Israel
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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9
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Kim HHR, Leschied JR, Noda SM, Sarma A, Pruthi S, Iyer RS. Planetary health: an imperative for pediatric radiology. Pediatr Radiol 2024; 54:20-26. [PMID: 37962606 DOI: 10.1007/s00247-023-05807-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
The global temperature has been increasing resulting in climate change. This negatively impacts planetary health that disproportionately affects the most vulnerable among us, especially children. Extreme weather events, such as hurricanes, tornadoes, wildfires, flooding, and heatwaves, are becoming more frequent and severe, posing a significant threat to our patients' health, safety, and security. Concurrently, shifts in environmental exposures, including air pollution, allergens, pathogenic vectors, and microplastics, further exacerbate the risks faced by children. In this paper, we provide an overview of pediatric illnesses that are becoming more prevalent and severe because of extreme weather events, global temperature increases, and shifts in environmental exposures. As members of pediatric health care teams, it is crucial for pediatric radiologists to be knowledgeable about the impacts of climate change on our patients, and continue to advocate for safe, healthier environments for our patients.
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Affiliation(s)
- Helen H R Kim
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Jessica R Leschied
- Department of Radiology, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sakura M Noda
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Asha Sarma
- Department of Radiology, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sumit Pruthi
- Department of Radiology, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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10
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Pandipati S, Leong M, Basu R, Abel D, Hayer S, Conry J. Climate change: Overview of risks to pregnant persons and their offspring. Semin Perinatol 2023; 47:151836. [PMID: 37863676 DOI: 10.1016/j.semperi.2023.151836] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Climate change is one of the greatest challenges confronting humanity. Pregnant persons, their unborn children, and offspring are particularly vulnerable, as evidenced by adverse perinatal outcomes and increased rates of childhood illnesses. Environmental inequities compound the problem of maternal health inequities, and have given rise to the environmental justice movement. The International Federation of Gynecology and Obstetrics and other major medical societies have worked to heighten awareness and address the deleterious health effects of climate change and toxic environmental exposures. As part of routine prenatal, neonatal, and pediatric care, neonatal-perinatal care providers should incorporate discussions with their patients and families on potential harms and also identify actions to mitigate climate change effects on their health. This article provides clinicians with an overview of how climate change affects their patients, practical guidance in caring for them, and a frame setting of the articles to follow. Clinicians have a critical role to play, and the time to act is now.
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Affiliation(s)
- Santosh Pandipati
- Maternal-Fetal Medicine, Obstetrix of San Jose, e-Lōvu Health, United States.
| | - Melanie Leong
- Attending Neonatologist, Neonatal ECMO Services, The Regional Neonatal Center of Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, United States; Assistant Professor of Pediatrics, New York Medical College, United States
| | - Rupa Basu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California EPA, United States
| | - David Abel
- Maternal-Fetal Medicine, Oregon Health Sciences University, United States
| | - Sarena Hayer
- Obstetrics & Gynecology, Oregon Health Sciences University, United States
| | - Jeanne Conry
- International Federation of Gynecology and Obstetrics, United States
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11
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Shankar K, Hwang K, Westcott JL, Saleem S, Aziz SA, Jessani S, Patel A, Kavi A, Somannavar MS, Goudar SS, Hibberd PL, Derman RJ, Hoffman M, Wylie BJ, Goldenberg RL, Thorsten VR, McClure EM, Krebs NF. Associations between ambient temperature and pregnancy outcomes from three south Asian sites of the Global Network Maternal Newborn Health Registry: A retrospective cohort study. BJOG 2023; 130 Suppl 3:124-133. [PMID: 37581948 PMCID: PMC10843605 DOI: 10.1111/1471-0528.17616] [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: 05/10/2023] [Accepted: 06/30/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE Growing evidence suggests that environmental heat stress negatively influences fetal growth and pregnancy outcomes. However, few studies have examined the impact of heat stress on pregnancy outcomes in low-resource settings. We combined data from a large multi-country maternal-child health registry and meteorological data to assess the impacts of heat stress. DESIGN Retrospective cohort study. SETTING Three sites based in south Asia as part of the Global Network for Women's and Children's Health research in India (Belagavi and Nagpur) and Pakistan (Thatta). POPULATION OR SAMPLE Data from women enrolled between 2014 and 2020 in the Global Network's Maternal Newborn Health Registry (MNHR), a prospective, population-based registry of pregnancies, were used. METHODS A total of 126 273 pregnant women were included in this analysis. Daily maximal air temperatures (Tmax ) were acquired from local meteorological records. Associations between averages of daily maximal temperatures for each trimester and main outcomes were analysed using a modified Poisson regression approach. MAIN OUTCOMES MEASURES Incidence of stillbirth, preterm birth, low birthweight (<2500 g) or evidence of pregnancy hypertension or pre-eclampsia. RESULTS In the overall cohort, risk of preterm birth was positively associated with greater temperature in the second trimester (relative risk [RR] 1.05, 95% CI 1.02-1.07, p = 0.0002). Among individual sites, the risk of preterm birth was greatest in Nagpur (RR 1.07, 95% CI 1.03-1.11, p = 0.0005) and associated with second-trimester temperature. The overall risk of low birthweight was associated with ambient temperature in second trimester (RR 1.02, 95% CI 1.01-1.04, p = 0.01). The risk for LBW was associated with first-trimester heat in Thatta and with second-trimester heat in Nagpur. Finally, the overall risk of gestational hypertensive disease was associated with greater temperature in the third trimester among all sites (RR 1.07, 95% CI 1.02-1.12, p = 0.005) and was particularly significant for Nagpur (RR 1.13, 95% CI 1.05-1.23, p = 0.002). These findings highlight the increased risk of detrimental obstetric and neonatal outcomes with greater temperature. CONCLUSION In a multi-country, community-based study, greater risk of adverse outcomes was observed with increasing temperature. The study highlights the need for deeper understanding of covarying factors and intervention strategies, especially in regions where high temperatures are common.
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Affiliation(s)
- Kartik Shankar
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kay Hwang
- RTI International, Durham, North Carolina, USA
| | - Jamie L. Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | | | | | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Avinash Kavi
- KLE Academy Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | | | - Shivaprasad S. Goudar
- KLE Academy Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | | | | | - Matthew Hoffman
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Christiana Care Health System, Delaware, USA
| | - Blair J. Wylie
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | | | | | - Nancy F. Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA
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12
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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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13
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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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14
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Miles G. How can healthcare systems become more resilient to the impacts of climate change? Med Confl Surviv 2023; 39:281-290. [PMID: 37431659 DOI: 10.1080/13623699.2023.2231692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
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15
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Yu G, Yang L, Liu M, Wang C, Shen X, Fan L, Zhang J. Extreme Temperature Exposure and Risks of Preterm Birth Subtypes Based on a Nationwide Survey in China. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:87009. [PMID: 37585350 PMCID: PMC10431497 DOI: 10.1289/ehp10831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Previous studies have reported that ambient temperature may affect perinatal outcomes. However, whether extreme temperature affects the risk of preterm birth (PTB) remains controversial. Studies on the associations of extreme temperature with PTB subtypes are lacking. OBJECTIVES We aimed to investigate the associations of extreme climate events with the risks of PTB and its subtypes, discerning possible modifiers. METHODS Data on all singleton deliveries were obtained from the China Labor and Delivery Survey (CLDS), a nationwide investigation implemented in 2015 and 2016. PTB was defined as gestational weeks < 37 and then categorized as early (24-34 wk) and late PTBs (35-36 wk), and clinical subtypes [spontaneous PTB, preterm premature rupture of the fetal membranes (PPROM), iatrogenic PTB]. Ambient temperature data were provided by the China National Weather Data Sharing System. Five heat indexes and five cold indexes were used to define heat waves and cold spells. Generalized linear mixed models with a random term by hospital unit were used to assess the associations of short-term prenatal extreme temperature exposure. The Cox proportional hazard regression model was applied to assess the nonlinear associations of low- or high-temperature exposure at the whole and different trimesters of pregnancy with the risk of PTB. Stratified analyses were conducted to assess the possible modification by geographic region and fetal sex. RESULTS A total of 70,818 singleton births from 96 hospitals in China were included, among which 4,965 (7.01%) were PTBs. Exposure to extreme cold events 1 wk before delivery was associated with an increased PTB risk, with an adjusted odds ratio (aOR) [95% confidence intervals (CIs)] of 1.07 (95% CI: 1.04, 1.10) and 1.06 (1.04, 1.09) for the total days when the daily average temperature below the fifth percentile (fifth-days) and the 10th percentile (10th-days), 1.18 (1.04, 1.34) for the cold spells when the daily average temperature below the fifth percentile for two consecutive days (fifth-2D), 1.09 (1.03, 1.16) and 1.12 (1.06, 1.19) for the cold spells when the daily average temperature below the 10th percentile for three and two consecutive days (10th-3D and 10th-2D), respectively. Results of extreme temperature exposure during 2 weeks before delivery showed similarly significant associations. The association between cold spells and PTB tended to be stronger for late PTB than for early PTB. Cold spells were mainly associated with spontaneous PTB and late PPROM. A stratified analysis indicated that pregnant women in western and northern regions tended to be more sensitive to cold spells, and pregnant women with a female fetus appeared to be at a higher risk of PTB when exposed to cold spells. Pregnant women in late pregnancy were more susceptible to extreme temperatures. No significant or stable association was found between heat waves and preterm birth. DISCUSSION Exposure to cold spells was associated with an increased risk of PTB, especially late, spontaneous PTB and PPROM. The associations appeared to be more pronounced in the north and west regions and in pregnancies with female fetuses. https://doi.org/10.1289/EHP10831.
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Affiliation(s)
- Guoqi Yu
- Ministry of Education – Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling Yang
- Hainan Women and Children’s Medical Center, Hainan, China
| | - Ming Liu
- Department of Obstetrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Cuiping Wang
- Ministry of Education – Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoli Shen
- Shanghai Jiao Tong University School of Public Health, Shanghai, China
| | - Lichun Fan
- Hainan Women and Children’s Medical Center, Hainan, China
| | - Jun Zhang
- Ministry of Education – Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Jiao Tong University School of Public Health, Shanghai, China
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16
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Rekha S, Nalini SJ, Bhuvana S, Kanmani S, Vidhya V. A Comprehensive Review on Hot Ambient Temperature and its Impacts on Adverse Pregnancy Outcomes. JOURNAL OF MOTHER AND CHILD 2023; 27:10-20. [PMID: 37368943 PMCID: PMC10298495 DOI: 10.34763/jmotherandchild.20232701.d-22-00051] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/18/2022] [Indexed: 06/29/2023]
Abstract
INTRODUCTION High workplace/ambient temperatures have been associated with Adverse Pregnancy Outcomes (APO). Millions of women working in developing nations suffer due to the rising temperatures caused by climate change. There are few pieces of research linking occupational heat stress to APO, and fresh evidence is required. METHODOLOGY We used databases including PubMed, Google Scholar, and Science Direct to search for research on high ambient/workplace temperatures and their effects. Original articles, newsletters, and book chapters were examined. The literature we analysed was categorised as follows: Heat, strain, and physical activity harming both mother and fetus. After categorising the literature, it was examined to identify the major results. RESULTS We found a definite association between heat stress and APOs such as miscarriages, premature birth, stillbirth, low birthweight, and congenital abnormalities in 23 research articles. Our work provides important information for future research into the biological mechanisms that create APOs and various prevention measures. CONCLUSION Our data suggest that temperature has long-term and short-term effects on maternal and fetal health. Though small in number, this study stressed the need for bigger cohort studies in tropical developing countries to create evidence for coordinated policies to safeguard pregnant women.
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Affiliation(s)
- Shanmugam Rekha
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sirala Jagadeesh Nalini
- Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Srinivasan Bhuvana
- Department of Obstetrics and Gynecology, Sri Ramachandra Medical Centre, Chennai, Tamil Nadu, India
| | - S. Kanmani
- Centre for Environmental Studies, College of Engineering Guindy, Anna University, Chennai, Tamil Nadu, India
| | - Venugopal Vidhya
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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17
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Huang M, Strickland MJ, Richards M, Warren JL, Chang HH, Darrow LA. Confounding by Conception Seasonality in Studies of Temperature and Preterm Birth: A Simulation Study. Epidemiology 2023; 34:439-449. [PMID: 36719763 PMCID: PMC10993929 DOI: 10.1097/ede.0000000000001588] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Seasonal patterns of conception may confound acute associations between birth outcomes and seasonally varying exposures. We aim to evaluate four epidemiologic designs (time-stratified case-crossover, time-series, pair-matched case-control, and time-to-event) commonly used to study acute associations between ambient temperature and preterm births. METHODS We conducted simulations assuming no effect of temperature on preterm birth. We generated pseudo-birth data from the observed seasonal patterns of birth in the United States and analyzed them in relation to observed temperatures using design-specific seasonality adjustments. RESULTS Using the case-crossover approach (time-stratified by calendar month), we observed a bias (among 1,000 replicates) = 0.016 (Monte-Carlo standard error 95% CI: 0.015-0.018) in the regression coefficient for every 10°C increase in mean temperature in the warm season (May-September). Unbiased estimates obtained using the time-series approach required accounting for both the pregnancies-at-risk and their weighted probability of birth. Notably, adding the daily weighted probability of birth from the time-series models to the case-crossover models corrected the bias in the case-crossover approach. In the pair-matched case-control design, where the exposure period was matched on gestational window, we observed no bias. The time-to-event approach was also unbiased but was more computationally intensive than others. CONCLUSIONS Most designs can be implemented in a way that yields estimates unbiased by conception seasonality. The time-stratified case-crossover design exhibited a small positive bias, which could contribute to, but not fully explain, previously reported associations.
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Affiliation(s)
| | | | | | | | - Howard H. Chang
- Rollins School of Public Health, Emory University, Atlanta, GA
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18
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Fan W, Zlatnik MG. Climate Change and Pregnancy: Risks, Mitigation, Adaptation, and Resilience. Obstet Gynecol Surv 2023; 78:223-236. [PMID: 37043299 PMCID: PMC10508966 DOI: 10.1097/ogx.0000000000001116] [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] [Indexed: 04/13/2023]
Abstract
Importance Climate change is affecting the earth, resulting in more extreme temperatures and weather, rising sea levels, more frequent natural disasters, and displacement of populations of plants and animals, including people and insects. These changes affect food and housing security, vector-borne illnesses, and access to clean air and water, all of which influence human health. Evidence and Results There are a number of adverse health outcomes linked to heat, air pollution from wildfires, stress from natural disasters, and other elements of climate change. Pregnant people are especially vulnerable to the health harms resulting from climate change, namely, preterm birth, small for gestational age, hypertensive disorders of pregnancy, and other adverse reproductive health and birth outcomes. Strategies to minimize these harms include mitigation and adaptation. Conclusions and Relevance Physicians are in a unique position to protect the health of pregnant persons and children by advocating for policy changes that address climate change and providing clinical recommendations for patients to protect themselves from the health impacts of climate hazards.
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Affiliation(s)
| | - Marya G Zlatnik
- Professor, Maternal Fetal Medicine, Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, Western States Pediatric Environmental Health Specialty Unit, University of California San Francisco, San Francisco, CA
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19
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Morello-Frosch R, Obasogie OK. The Climate Gap and the Color Line - Racial Health Inequities and Climate Change. N Engl J Med 2023; 388:943-949. [PMID: 36884328 DOI: 10.1056/nejmsb2213250] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Affiliation(s)
- Rachel Morello-Frosch
- From the Department of Environmental Science, Policy, and Management and the Divisions of Environmental Health Sciences and Community Health Sciences, School of Public Health (R.M.-F.), and the School of Law and Joint Medical Program, School of Public Health (O.K.O.), University of California, Berkeley
| | - Osagie K Obasogie
- From the Department of Environmental Science, Policy, and Management and the Divisions of Environmental Health Sciences and Community Health Sciences, School of Public Health (R.M.-F.), and the School of Law and Joint Medical Program, School of Public Health (O.K.O.), University of California, Berkeley
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20
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Machine learning-based risk factor analysis of necrotizing enterocolitis in very low birth weight infants. Sci Rep 2022; 12:21407. [PMID: 36496465 PMCID: PMC9741654 DOI: 10.1038/s41598-022-25746-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
This study used machine learning and a national prospective cohort registry database to analyze the major risk factors of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants, including environmental factors. The data consisted of 10,353 VLBW infants from the Korean Neonatal Network database from January 2013 to December 2017. The dependent variable was NEC. Seventy-four predictors, including ambient temperature and particulate matter, were included. An artificial neural network, decision tree, logistic regression, naïve Bayes, random forest, and support vector machine were used to evaluate the major predictors of NEC. Among the six prediction models, logistic regression and random forest had the best performance (accuracy: 0.93 and 0.93, area under the receiver-operating-characteristic curve: 0.73 and 0.72, respectively). According to random forest variable importance, major predictors of NEC were birth weight, birth weight Z-score, maternal age, gestational age, average birth year temperature, birth year, minimum birth year temperature, maximum birth year temperature, sepsis, and male sex. To the best of our knowledge, the performance of random forest in this study was among the highest in this line of research. NEC is strongly associated with ambient birth year temperature, as well as maternal and neonatal predictors.
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21
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Hough I, Rolland M, Guilbert A, Seyve E, Heude B, Slama R, Lyon-Caen S, Pin I, Chevrier C, Kloog I, Lepeule J. Early delivery following chronic and acute ambient temperature exposure: a comprehensive survival approach. Int J Epidemiol 2022:6765151. [DOI: 10.1093/ije/dyac190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/16/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Ambient temperature, particularly heat, is increasingly acknowledged as a trigger for preterm delivery but study designs have been limited and results mixed. We aimed to comprehensively evaluate the association between ambient temperature throughout pregnancy and preterm delivery.
Methods
We estimated daily temperature throughout pregnancy using a cutting-edge spatiotemporal model for 5347 live singleton births from three prospective cohorts in France, 2002–2018. We performed Cox regression (survival analysis) with distributed lags to evaluate time-varying associations with preterm birth simultaneously controlling for exposure during the first 26 weeks and last 30 days of pregnancy. We examined weekly mean, daytime, night-time and variability of temperature, and heatwaves accounting for adaptation to location and season.
Results
Preterm birth risk was higher following cold (5th vs 50th percentile of mean temperature) 7–9 weeks after conception [relative risk (RR): 1.3, 95% CI: 1.0–1.6 for 2°C vs 11.6°C] and 10–4 days before delivery (RR: 1.6, 95% CI: 1.1–2.1 for 1.2°C vs 12.1°C). Night-time heat (95th vs 50th percentile of minimum temperature; 15.7°C vs 7.4°C) increased risk when exposure occurred within 5 weeks of conception (RR: 2.0, 95% CI: 1.05–3.8) or 20–26 weeks after conception (RR: 2.9, 95% CI: 1.2–6.8). Overall and daytime heat (high mean and maximum temperature) showed consistent effects. We found no clear associations with temperature variability or heatwave indicators, suggesting they may be less relevant for preterm birth.
Conclusions
In a temperate climate, night-time heat and chronic and acute cold exposures were associated with increased risk of preterm birth. These results suggest night-time heat as a relevant indicator. In the context of rising temperatures and more frequent weather hazards, these results should inform public health policies to reduce the growing burden of preterm births.
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Affiliation(s)
- Ian Hough
- Université Grenoble Alpes, INSERM, CNRS, Institute for Advanced Biosciences (IAB), Team of Environmental Epidemiology Applied to Development and Respiratory Health , La Tronche, France
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev , Be’er Sheva, Israel
| | - Matthieu Rolland
- Université Grenoble Alpes, INSERM, CNRS, Institute for Advanced Biosciences (IAB), Team of Environmental Epidemiology Applied to Development and Respiratory Health , La Tronche, France
| | - Ariane Guilbert
- Université Grenoble Alpes, INSERM, CNRS, Institute for Advanced Biosciences (IAB), Team of Environmental Epidemiology Applied to Development and Respiratory Health , La Tronche, France
| | - Emie Seyve
- Université Grenoble Alpes, INSERM, CNRS, Institute for Advanced Biosciences (IAB), Team of Environmental Epidemiology Applied to Development and Respiratory Health , La Tronche, France
- Université de Paris Cité, Inserm, INRAE, Centre of Research in Epidemiology and StatisticS (CRESS) , Paris, France
| | - Barbara Heude
- Université de Paris Cité, Inserm, INRAE, Centre of Research in Epidemiology and StatisticS (CRESS) , Paris, France
| | - Rémy Slama
- Université Grenoble Alpes, INSERM, CNRS, Institute for Advanced Biosciences (IAB), Team of Environmental Epidemiology Applied to Development and Respiratory Health , La Tronche, France
| | - Sarah Lyon-Caen
- Université Grenoble Alpes, INSERM, CNRS, Institute for Advanced Biosciences (IAB), Team of Environmental Epidemiology Applied to Development and Respiratory Health , La Tronche, France
| | - Isabelle Pin
- Université Grenoble Alpes, INSERM, CNRS, Institute for Advanced Biosciences (IAB), Team of Environmental Epidemiology Applied to Development and Respiratory Health , La Tronche, France
- Department of Paediatric Pneumology, Grenoble Teaching Hospital , La Tronche, France
| | - Cécile Chevrier
- Université Rennes, INSERM, EHESP, IRSET (Research Institute for Environmental and Occupational Health) , Rennes, France
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev , Be’er Sheva, Israel
| | - Johanna Lepeule
- Université Grenoble Alpes, INSERM, CNRS, Institute for Advanced Biosciences (IAB), Team of Environmental Epidemiology Applied to Development and Respiratory Health , La Tronche, France
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22
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Berberian AG, Gonzalez DJX, Cushing LJ. Racial Disparities in Climate Change-Related Health Effects in the United States. Curr Environ Health Rep 2022; 9:451-464. [PMID: 35633370 PMCID: PMC9363288 DOI: 10.1007/s40572-022-00360-w] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Climate change is causing warming over most parts of the USA and more extreme weather events. The health impacts of these changes are not experienced equally. We synthesize the recent evidence that climatic changes linked to global warming are having a disparate impact on the health of people of color, including children. RECENT FINDINGS Multiple studies of heat, extreme cold, hurricanes, flooding, and wildfires find evidence that people of color, including Black, Latinx, Native American, Pacific Islander, and Asian communities are at higher risk of climate-related health impacts than Whites, although this is not always the case. Studies of adults have found evidence of racial disparities related to climatic changes with respect to mortality, respiratory and cardiovascular disease, mental health, and heat-related illness. Children are particularly vulnerable to the health impacts of climate change, and infants and children of color have experienced adverse perinatal outcomes, occupational heat stress, and increases in emergency department visits associated with extreme weather. The evidence strongly suggests climate change is an environmental injustice that is likely to exacerbate existing racial disparities across a broad range of health outcomes.
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Affiliation(s)
- Alique G Berberian
- Department of Environmental Health Sciences, University of California, 650 Charles E. Young Drive South, 71-259 CHS, Los Angeles, CA, 90095, USA
| | - David J X Gonzalez
- School of Public Health and Department of Environmental Science, Policy, and Management, University of California, Berkeley, CA, USA
| | - Lara J Cushing
- Department of Environmental Health Sciences, University of California, 650 Charles E. Young Drive South, 71-259 CHS, Los Angeles, CA, 90095, USA.
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Climate Change, Environmental Disasters, and Health Inequities: The Underlying Role of Structural Inequalities. Curr Environ Health Rep 2022; 9:80-89. [PMID: 35338470 DOI: 10.1007/s40572-022-00336-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW We review and analyze recent literature in public health, urban planning, and disaster management to better understand the relationships between climate change, natural disasters, and root causes of health disparities in the USA. RECENT FINDINGS Existing scholarship establishes clear linkages between climate change and increasing occurrences and severity of natural disasters across the USA. The frequency and types of disasters vary by region and impact both short and long-term health outcomes. Current research highlights health inequities affecting lower income and minoritized communities disproportionately, but data-driven studies critically examining the role of structural inequalities in climate-induced health disparities are sparse. Adding to the body of knowledge, our conceptual framework maps how long-standing structural inequalities in policy, practice, and funding shape vulnerability of lower-income, racially and ethnically marginalized individuals. Vulnerability follows three common pathways: disparities in "exposure", "sensitivity", and "resiliency" before, during, and after a climate disaster. We recommend that future research, policy, and practice shift towards solutions that unearth and address the structural biases that cause environmental disaster and health inequities.
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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: 25] [Impact Index Per Article: 12.5] [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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Cushing L, Morello-Frosch R, Hubbard A. Extreme heat and its association with social disparities in the risk of spontaneous preterm birth. Paediatr Perinat Epidemiol 2022; 36:13-22. [PMID: 34951022 DOI: 10.1111/ppe.12834] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Climate change is increasing the frequency and intensity of heatwaves. Prior studies associate high temperature with preterm birth. OBJECTIVES We tested the hypotheses that acute exposure to extreme heat was associated with higher risk of live spontaneous preterm birth (≥20 and <37 completed weeks), and that risks were higher among people of colour and neighbourhoods with heat-trapping landcover or concentrated racialised economic disadvantage. METHODS We conducted a retrospective cohort study of people giving birth between 2007 and 2011 in Harris County, Texas (Houston metropolitan area) (n = 198,013). Exposures were daily ambient apparent temperature (ATmax in 5°C increments) and dry-bulb temperatures (Tmax and Tmin >historical [1971-2000] summertime 99th percentile) up to a week prior for each day of pregnancy. Survival analysis controlled for individual-level risk factors, secular and seasonal trends. We considered race/ethnicity, heat-trapping neighbourhood landcover and Index of Concentration at the Extremes as effect modifiers. RESULTS The frequency of preterm birth was 10.3%. A quarter (26.8%) of people were exposed to ATmax ≥40°C, and 22.8% were exposed to Tmax and Tmin >99th percentile while at risk. The preterm birth rate among the exposed was 8.9%. In multivariable models, the risk of preterm birth was 15% higher following extremely hot days (hazard ratio [HR] 1.15 (95% confidence interval [CI] 1.01, 1.30) for ATmax ≥40°C vs. <20°C; HR 1.15 (95% CI 1.02, 1.28) for Tmax and Tmin >99th percentile). Censoring at earlier gestational ages suggested stronger associations earlier in pregnancy. The risk difference associated with extreme heat was higher in neighbourhoods of concentrated racialised economic disadvantage. CONCLUSIONS Ambient heat was associated with spontaneous preterm birth, with stronger associations earlier in pregnancy and in racially and economically disadvantaged neighbourhoods, suggesting climate change may worsen existing social inequities in preterm birth rates.
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Affiliation(s)
- Lara Cushing
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Rachel Morello-Frosch
- Department of Environmental Science, Policy & Management, University of California, Berkeley, California, USA.,School of Public Health, University of California, Berkeley, California, USA
| | - Alan Hubbard
- School of Public Health, University of California, Berkeley, California, USA
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Jegasothy E, Randall DA, Ford JB, Nippita TA, Morgan GG. Maternal factors and risk of spontaneous preterm birth due to high ambient temperatures in New South Wales, Australia. Paediatr Perinat Epidemiol 2022; 36:4-12. [PMID: 34850413 DOI: 10.1111/ppe.12822] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Exposure to high ambient temperatures has been shown to increase the risk of spontaneous preterm birth. Determining which maternal factors increase or decrease this risk will inform climate adaptation strategies. OBJECTIVES This study aims to assess the risk of spontaneous preterm birth associated with exposure to ambient temperature and differences in this relationship between mothers with different health and demographic characteristics. METHODS We used quasi-Poisson distributed lag non-linear models to estimate the effect of high temperature-measured as the 95th percentile of daily minimum, mean and maximum compared with the median-on risk of spontaneous preterm birth (23-36 weeks of gestation) in pregnant women in New South Wales, Australia. We estimated the cumulative lagged effects of daily temperature and analyses on population subgroups to assess increased or decreased vulnerability to this effect. RESULTS Pregnant women (n = 916,678) exposed at the 95th percentile of daily mean temperatures (25ºC) had an increased risk of preterm birth (relative risk 1.14, 95% confidence interval 1.07, 1.21) compared with the median daily mean temperature (17℃). Similar effect sizes were seen for the 95th percentile of minimum and maximum daily temperatures compared with the median. This risk was slightly higher among women with diabetes, hypertension, chronic illness and women who smoked during pregnancy. CONCLUSIONS Higher temperatures increase the risk of preterm birth and women with pre-existing health conditions and who smoke during pregnancy are potentially more vulnerable to these effects.
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Affiliation(s)
- Edward Jegasothy
- The University of Sydney, Sydney School of Public Health, University Centre for Rural Health, Sydney, NSW, Australia.,The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW, Australia.,NSW Ministry of Health, NSW Biostatistics Training Program, Sydney, NSW, Australia
| | - Deborah A Randall
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW, Australia.,Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW, Australia
| | - Jane B Ford
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW, Australia.,Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW, Australia
| | - Tanya A Nippita
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW, Australia.,Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW, Australia.,Northern Sydney Local Health District, Department of Obstetrics and Gynecology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Geoffrey G Morgan
- The University of Sydney, Sydney School of Public Health, University Centre for Rural Health, Sydney, NSW, Australia
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Giudice LC, Llamas-Clark EF, DeNicola N, Pandipati S, Zlatnik MG, Decena DCD, Woodruff TJ, Conry JA. Climate change, women's health, and the role of obstetricians and gynecologists in leadership. Int J Gynaecol Obstet 2021; 155:345-356. [PMID: 34694628 PMCID: PMC9298078 DOI: 10.1002/ijgo.13958] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/16/2021] [Accepted: 09/28/2021] [Indexed: 11/07/2022]
Abstract
Climate change is one of the major global health threats to the world's population. It is brought on by global warming due in large part to increasing levels of greenhouse gases resulting from human activity, including burning fossil fuels (carbon dioxide), animal husbandry (methane from manure), industry emissions (ozone, nitrogen oxides, sulfur dioxide), vehicle/factory exhaust, and chlorofluorocarbon aerosols that trap extra heat in the earth's atmosphere. Resulting extremes of weather give rise to wildfires, air pollution, changes in ecology, and floods. These in turn result in displacement of populations, family disruption, violence, and major impacts on water quality and availability, food security, public health and economic infrastructures, and limited abilities for civil society to maintain citizen safety. Climate change also has direct impacts on human health and well-being. Particularly vulnerable populations are affected, including women, pregnant women, children, the disabled, and the elderly, who comprise the majority of the poor globally. Additionally, the effects of climate change disproportionally affect disadvantaged communities, including low income and communities of color, and lower-income countries that are at highest risk of adverse impacts when disasters occur due to inequitable distribution of resources and their socioeconomic status. The climate crisis is tilting the risk balance unfavorably for women's sexual and reproductive health and rights as well as newborn and child health. Obstetrician/gynecologists have the unique opportunity to raise awareness, educate, and advocate for mitigation strategies to reverse climate change affecting our patients and their families. This article puts climate change in the context of women's reproductive health as a public health issue, a social justice issue, a human rights issue, an economic issue, a political issue, and a gender issue that needs our attention now for the health and well-being of this and future generations. FIGO joins a broad coalition of international researchers and the medical community in stating that the current climate crisis presents an imminent health risk to pregnant people, developing fetuses, and reproductive health, and recognizing that we need society-wide solutions, government policies, and global cooperation to address and reduce contributors, including fossil fuel production, to climate change.
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Affiliation(s)
- Linda C Giudice
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Erlidia F Llamas-Clark
- Department of Obstetrics and Gynecology, Division of Ultrasound, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Nathaniel DeNicola
- Department of Obstetrics and Gynecology, Johns Hopkins Health System, Washington, District of Columbia, USA
| | - Santosh Pandipati
- Obstetrix Medical Group/Mednax (Maternal-Fetal Medicine), Campbell, California, USA
| | - Marya G Zlatnik
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal Fetal Medicine, Program on Reproductive Health and the Environment, Environmental Research and Translation for Health (EaRTH) Center, University of California, San Francisco, San Francisco, California, USA
| | - Ditas Cristina D Decena
- Departments of Anatomy, Clinical Epidemiology and Public Health International, University of Santo Tomas, Manila, Philippines
| | - Tracey J Woodruff
- Program on Reproductive Health and the Environment, Environmental Research and Translation for Health (EaRTH) Center, University of California, San Francisco, San Francisco, California, USA
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Braveman P, Dominguez TP, Burke W, Dolan SM, Stevenson DK, Jackson FM, Collins JW, Driscoll DA, Haley T, Acker J, Shaw GM, McCabe ERB, Hay WW, Thornburg K, Acevedo-Garcia D, Cordero JF, Wise PH, Legaz G, Rashied-Henry K, Frost J, Verbiest S, Waddell L. Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:684207. [PMID: 36303973 PMCID: PMC9580804 DOI: 10.3389/frph.2021.684207] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
In 2017–2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.
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Affiliation(s)
- Paula Braveman
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Paula Braveman
| | - Tyan Parker Dominguez
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Wylie Burke
- University of Washington School of Medicine, Seattle, WA, United States
| | - Siobhan M. Dolan
- Albert Einstein College of Medicine, New York, NY, United States
| | | | | | - James W. Collins
- Northwestern University School of Medicine, Chicago, IL, United States
| | - Deborah A. Driscoll
- University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Terinney Haley
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Julia Acker
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Gary M. Shaw
- Stanford University School of Medicine, Stanford, CA, United States
| | - Edward R. B. McCabe
- David Geffen School of Medicine at University of California, Los Angeles, CA, United States
| | | | - Kent Thornburg
- School of Medicine, Oregon State University, Portland, OR, United States
| | | | - José F. Cordero
- University of Georgia College of Public Health, Athens, GA, United States
| | - Paul H. Wise
- Stanford University School of Medicine, Stanford, CA, United States
| | - Gina Legaz
- March of Dimes, White Plains, NY, United States
| | | | | | - Sarah Verbiest
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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He J, Liu R, Zheng W, Guo H, Yang Y, Zhao R, Yao W. High ambient temperature exposure during late gestation disrupts glycolipid metabolism and hepatic mitochondrial function tightly related to gut microbial dysbiosis in pregnant mice. Microb Biotechnol 2021; 14:2116-2129. [PMID: 34272826 PMCID: PMC8449678 DOI: 10.1111/1751-7915.13893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/03/2021] [Indexed: 12/11/2022] Open
Abstract
As global warming intensifies, emerging evidence has demonstrated high ambient temperature during pregnancy negatively affects maternal physiology with compromised pregnant outcomes; however, little is known about the roles of gut microbiota and its underlying mechanisms in this process. Here, for the first time, we explored the potential mechanisms of gut microbiota involved in the disrupted glycolipid metabolism via hepatic mitochondrial function. Our results indicate heat stress (HS) reduces fat and protein contents and serum levels of insulin and triglyceride (TG), while increases that of non-esterified fatty acid (NEFA), β-hydroxybutyric acid (B-HBA), creatinine and blood urea nitrogen (BUN) (P < 0.05). Additionally, HS downregulates both mitochondrial genes (mtDNA) and nuclear encoding mitochondrial functional genes with increasing serum levels of malondialdehyde (MDA) and 8-hydroxydeoxyguanosine (8-OHdG) (P < 0.05). Regarding microbial response, HS boosts serum levels of lipopolysaccharide (LPS) (P < 0.05) and alters β-diversity (ANOSIM, P < 0.01), increasing the proportions of Escherichia-Shigella, Acinetobacter and Klebsiella (q < 0.05), while reducing that of Ruminiclostridium, Blautia, Lachnospiraceae_NK4A136_group, Clostridium VadinBB60 and Muribaculaceae (q < 0.05). PICRUSt analysis predicts that HS upregulates 11 KEGG pathways, mainly including bile secretion and bacterial invasion of epithelial cells. The collective results suggest that microbial dysbiosis due to late gestational HS has strong associations with damaged hepatic mitochondrial function and disrupted metabolic profiles.
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Affiliation(s)
- Jianwen He
- College of Animal Science and Technology, Nanjing Agricultural University, Nanjing, 210095, China.,Affiliated Hospital of Shaanxi University of Chinese Medicine, Shaanxi University of Chinese Medicine, Xianyang, 712000, China
| | - Riliang Liu
- College of Animal Science and Technology, Nanjing Agricultural University, Nanjing, 210095, China
| | - Weijiang Zheng
- College of Animal Science and Technology, Nanjing Agricultural University, Nanjing, 210095, China
| | - Huiduo Guo
- College of Animal Science and Technology, Nanjing Agricultural University, Nanjing, 210095, China
| | - Yunnan Yang
- College of Animal Science and Technology, Nanjing Agricultural University, Nanjing, 210095, China
| | - Ruqian Zhao
- Key Lab of Animal Physiology and Biochemistry, Nanjing Agricultural University, Ministry of Agriculture and Rural Affairs of the People's Republic of China, Nanjing, 210095, China
| | - Wen Yao
- College of Animal Science and Technology, Nanjing Agricultural University, Nanjing, 210095, China.,Key Lab of Animal Physiology and Biochemistry, Nanjing Agricultural University, Ministry of Agriculture and Rural Affairs of the People's Republic of China, Nanjing, 210095, China
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Impact of ambient temperature on ovarian reserve. Fertil Steril 2021; 116:1052-1060. [PMID: 34116830 DOI: 10.1016/j.fertnstert.2021.05.091] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the association between ambient temperature and antral follicle count (AFC), a standard measure of ovarian reserve. DESIGN Prospective cohort study. SETTING Fertility center at an academic hospital in the northeastern United States. PATIENT(S) 631 women attending the Massachusetts General Hospital Fertility Center (2005-2015) who participated in the Environment and Reproductive Health Study. INTERVENTION(S) Daily temperature at the women's residential address was estimated for the 90 days before their antral follicle scan using a spatially refined gridded climate data set. We evaluated the associations between temperature and AFC using Poisson regression with robust standard errors, adjusting for relative humidity, fine particulate matter exposure, age, education, smoking status, year and month of AFC, and diagnosis of diminished ovarian reserve and ovulation disorders. MAIN OUTCOME MEASURE(S) Antral follicle count as measured with transvaginal ultrasonography. RESULT(S) A 1°C increase in average maximum temperature during the 90 days before ovarian reserve testing was associated with a -1.6% (95% confidence interval [CI], -2.8, -0.4) lower AFC. Associations remained negative, but were attenuated, for average maximum temperature exposure in the 30 days (-0.9%, 95% CI, -1.8, 0.1) and 14 days (-0.8%, 95% CI, -1.6, 0.0) before AFC. The negative association between average maximum temperature and AFC was stronger in November through June than during the summer months, suggesting that timing of heat exposure and acclimatization to heat may be important factors to consider in future research. CONCLUSION(S) Exposure to higher temperatures was associated with lower ovarian reserve. These results raise concern that rising ambient temperatures worldwide may result in accelerated reproductive aging among women.
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Huang M, Strickland MJ, Richards M, Holmes HA, Newman AJ, Garn JV, Liu Y, Warren JL, Chang HH, Darrow LA. Acute associations between heatwaves and preterm and early-term birth in 50 US metropolitan areas: a matched case-control study. Environ Health 2021; 20:47. [PMID: 33892728 PMCID: PMC8066488 DOI: 10.1186/s12940-021-00733-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/15/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The effect of heatwaves on adverse birth outcomes is not well understood and may vary by how heatwaves are defined. The study aims to examine acute associations between various heatwave definitions and preterm and early-term birth. METHODS Using national vital records from 50 metropolitan statistical areas (MSAs) between 1982 and 1988, singleton preterm (< 37 weeks) and early-term births (37-38 weeks) were matched (1:1) to controls who completed at least 37 weeks or 39 weeks of gestation, respectively. Matching variables were MSA, maternal race, and maternal education. Sixty heatwave definitions including binary indicators for exposure to sustained heat, number of high heat days, and measures of heat intensity (the average degrees over the threshold in the past 7 days) based on the 97.5th percentile of MSA-specific temperature metrics, or the 85th percentile of positive excessive heat factor (EHF) were created. Odds ratios (OR) for heatwave exposures in the week preceding birth (or corresponding gestational week for controls) were estimated using conditional logistic regression adjusting for maternal age, marital status, and seasonality. Effect modification by maternal education, age, race/ethnicity, child sex, and region was assessed. RESULTS There were 615,329 preterm and 1,005,576 early-term case-control pairs in the analyses. For most definitions, exposure to heatwaves in the week before delivery was consistently associated with increased odds of early-term birth. Exposure to more high heat days and more degrees above the threshold yielded higher magnitude ORs. For exposure to 3 or more days over the 97.5th percentile of mean temperature in the past week compared to zero days, the OR was 1.027 for early-term birth (95%CI: 1.014, 1.039). Although we generally found null associations when assessing various heatwave definitions and preterm birth, ORs for both preterm and early-term birth were greater in magnitude among Hispanic and non-Hispanic black mothers. CONCLUSION Although associations varied across metrics and heatwave definitions, heatwaves were more consistently associated with early-term birth than with preterm birth. This study's findings may have implications for prevention programs targeting vulnerable subgroups as climate change progresses.
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Affiliation(s)
- Mengjiao Huang
- School of Community Health Sciences, University of Nevada, 1664 N. Virginia Street, Reno, NV, 89557, USA.
| | - Matthew J Strickland
- School of Community Health Sciences, University of Nevada, 1664 N. Virginia Street, Reno, NV, 89557, USA
| | - Megan Richards
- School of Community Health Sciences, University of Nevada, 1664 N. Virginia Street, Reno, NV, 89557, USA
| | - Heather A Holmes
- Department of Chemical Engineering, University of Utah, Salt Lake City, UT, USA
| | | | - Joshua V Garn
- School of Community Health Sciences, University of Nevada, 1664 N. Virginia Street, Reno, NV, 89557, USA
| | - Yan Liu
- School of Community Health Sciences, University of Nevada, 1664 N. Virginia Street, Reno, NV, 89557, USA
| | - Joshua L Warren
- Department of Biostatistics, Yale University, New Haven, CT, USA
| | - Howard H Chang
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lyndsey A Darrow
- School of Community Health Sciences, University of Nevada, 1664 N. Virginia Street, Reno, NV, 89557, USA
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Li C, Bloom MS, Lin S, Ren M, Hajat S, Wang Q, Zhang W, Ho HC, Zhao Q, Lin Y, Huang C. Temperature variation and preterm birth among live singleton deliveries in Shenzhen, China: A time-to-event analysis. ENVIRONMENTAL RESEARCH 2021; 195:110834. [PMID: 33548292 DOI: 10.1016/j.envres.2021.110834] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/30/2020] [Accepted: 01/29/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Ambient temperature extremes due to heat exposure was an established risk factor for preterm birth (<37 gestational weeks). However, there is insufficient epidemiological evidence on the effects of temperature variation(TV), although TV is also associated with heat exposure and can influence human health risk. This study aimed to investigate the relationship between inter- and intraday TV and preterm birth (PTB). METHOD A total of 1,388,994 live singleton births were collected from January 2003 to December 2012, from the Shenzhen Birth registry system. Daily temperature range (DTR) was defined as the difference between the highest and lowest recorded daily temperature. Intraday TV was defined as the maximum daily diurnal temperature range in a given week (Max-DTR). Inter-day TV was defined as the maximum increase or decrease in daily mean temperature between days t and t-1in a given week; either an increase (Temp-inc) or a decrease (Temp-dec). We used Cox proportional hazards models to estimate TV-related PTB risks during the first trimester, the second trimester, and in late pregnancy. RESULTS The maximum values for DTR, Temp-inc, and Temp-dec were 17 °C, 8 °C and 11 °C, respectively. The greatest TV-related PTB risk occurred in the second trimester, with 5.8% (95%CI: 3.3%, 8.3%), 23.7% (95%CI: 19.6%, 27.9%), and 4.4% (95%CI: 1.8%, 7.1%) differences per 1 °C increase in Max-DTR, Temp-inc, and Temp-dec, respectively. Greater TV was associated with elevated PTB risk during the warm season. The association between TV and PTB was modified by seasons, maternal education and chronic conditions. CONCLUSIONS Sharp TV is a likely risk factor for PTB. Policy makers and clinicians should recognize the potential role of TV in the etiology of PTB so that interventions can be designed to protect pregnant women and their fetuses against extreme temperatures.
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Affiliation(s)
- Changchang Li
- Department of Sexually Transmitted Diseases Prevention and Control, Southern Medical University, No. Lujing Road, Guangzhou, 510095, China; Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, No.74 Zhongshan Road #2, Guangzhou, 510080, China.
| | - Michael S Bloom
- Departments of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, USA; Department of Global and Community Health, George Mason University, Fairfax, VA, USA.
| | - Shao Lin
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA.
| | - Meng Ren
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, No.74 Zhongshan Road #2, Guangzhou, 510080, China.
| | - Shakoor Hajat
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, USA.
| | - Qiong Wang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, China; Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-sen University, China.
| | - Wangjian Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA.
| | - Hung Chak Ho
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, China; School of Geography and Remote Sensing, Guangzhou University, Guangzhou, China.
| | - Qingguo Zhao
- Epidemiology Research Office of Key Laboratory of Male Reproduction and Genetics (National Health Commission), Family Planning Institute of Guangdong Province/Family Planning Special Hospital of Guangdong Province, Guangzhou, China.
| | - Yan Lin
- Department of Children Health Care, Shenzhen Women and Children Hospital, China.
| | - Cunrui Huang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, No.74 Zhongshan Road #2, Guangzhou, 510080, China; Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, 200030, China; School of Public Health, Zhengzhou University, Zhengzhou, 450001, China.
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Mayvaneh F, Entezari A, Sadeghifar F, Baaghideh M, Guo Y, Atabati A, Zhao Q, Zhang Y. Exposure to suboptimal ambient temperature during specific gestational periods and adverse outcomes in mice. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:45487-45498. [PMID: 32789805 DOI: 10.1007/s11356-020-10416-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 08/05/2020] [Indexed: 06/11/2023]
Abstract
Exposure to suboptimal ambient temperature during pregnancy has been reported as a potential teratogen of fetal development. However, limited animal evidence is available regarding the impact of extreme temperatures on maternal pregnancy and the subsequent adverse pregnancy outcomes. Our objective in this study is to investigate the relationship between temperature and maternal stress during pregnancy in mice. This study used the Naval Medical Research Institute (NMRI) mice during the second and third pregnant weeks with the gestational day (GD) (GD 6.5-14.5 and GD 14.5-17.5). Mice were exposed to suboptimal ambient temperature (1 °C, 5 °C, 10 °C, 15 °C, 40 °C, 42 °C, 44 °C, 46 °C, and 48 °C for the experimental group and 23 °C for the control group) 1 h per day, 7 days a weekin each trimester. Measurements of placental development (placental weight [PW] and placental diameter [PD]) and fetal growth (fetal weight [FW] and crown-to-rump length [CRL]) between experimental and control groups were compared using analysis of variance (ANOVA). Data on the occurrence of preterm birth (PTB) and abnormalities were also collected. The results showed that exposure to both cold and heat stress in the second and third weeks of pregnancy caused significant decreases in measurements of placental development (PW and PD) and fetal growth (FW and CRL). For all temperature exposures, 15 °C was identified as the optimal temperature in the development of the embryo. Most PTB occurrences were observed in high-temperature stress groups, with the highest PTB number seen in the exposure group at 48 °C, whereas PTB occurred only at 1 °C among cold stress groups. In the selected exposure experiments, an approximate U-shaped relation was observed between temperature and number of abnormality occurrence. The highest percentage of these anomalies occurred at temperatures of 1 °C and 48 °C, while no abnormalities were observed at 15 °C and in the control group. Our findings strengthened the evidence that exposure to suboptimal ambient temperatures may trigger adverse pregnancy outcomes and worsen embryo and fetal development in mice.
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Affiliation(s)
- Fatemeh Mayvaneh
- Faculty of Geography and Environmental Sciences, Hakim Sabzevari University, Khorasan Razavi, Sabzevar, 9617916487, Iran
| | - Alireza Entezari
- Faculty of Geography and Environmental Sciences, Hakim Sabzevari University, Khorasan Razavi, Sabzevar, 9617916487, Iran.
| | - Fatemeh Sadeghifar
- Department of Science, Hakim Sabzevari University, Khorasan Razavi, Sabzevar, 9617916487, Iran
| | - Mohammad Baaghideh
- Faculty of Geography and Environmental Sciences, Hakim Sabzevari University, Khorasan Razavi, Sabzevar, 9617916487, Iran
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Azadeh Atabati
- Faculty of Geography and Environmental Sciences, Hakim Sabzevari University, Khorasan Razavi, Sabzevar, 9617916487, Iran
| | - Qi Zhao
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yunquan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, 430065, China.
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, 430065, China.
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Chersich MF, Pham MD, Areal A, Haghighi MM, Manyuchi A, Swift CP, Wernecke B, Robinson M, Hetem R, Boeckmann M, Hajat S. Associations between high temperatures in pregnancy and risk of preterm birth, low birth weight, and stillbirths: systematic review and meta-analysis. BMJ 2020; 371:m3811. [PMID: 33148618 PMCID: PMC7610201 DOI: 10.1136/bmj.m3811] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess whether exposure to high temperatures in pregnancy is associated with increased risk for preterm birth, low birth weight, and stillbirth. DESIGN Systematic review and random effects meta-analysis. DATA SOURCES Medline and Web of Science searched up to September 2018, updated in August 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Clinical studies on associations between high environmental temperatures, and preterm birth, birth weight, and stillbirths. RESULTS 14 880 records and 175 full text articles were screened. 70 studies were included, set in 27 countries, seven of which were countries with low or middle income. In 40 of 47 studies, preterm births were more common at higher than lower temperatures. Exposures were classified as heatwaves, 1°C increments, and temperature threshold cutoff points. In random effects meta-analysis, odds of a preterm birth rose 1.05-fold (95% confidence interval 1.03 to 1.07) per 1°C increase in temperature and 1.16-fold (1.10 to 1.23) during heatwaves. Higher temperature was associated with reduced birth weight in 18 of 28 studies, with considerable statistical heterogeneity. Eight studies on stillbirths all showed associations between temperature and stillbirth, with stillbirths increasing 1.05-fold (1.01 to 1.08) per 1°C rise in temperature. Associations between temperature and outcomes were largest among women in lower socioeconomic groups and at age extremes. The multiple temperature metrics and lag analyses limited comparison between studies and settings. CONCLUSIONS Although summary effect sizes are relatively small, heat exposures are common and the outcomes are important determinants of population health. Linkages between socioeconomic status and study outcomes suggest that risks might be largest in low and middle income countries. Temperature rises with global warming could have major implications for child health. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD 42019140136 and CRD 42018118113.
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Affiliation(s)
- Matthew Francis Chersich
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Hillbrow, Johannesburg 2001, South Africa
| | - Minh Duc Pham
- Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ashtyn Areal
- Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Marjan Mosalam Haghighi
- The Children's Hospital at Westmead, Cardiology Centre, University of Sydney, Sydney, NSW, Australia
| | - Albert Manyuchi
- Global Change Institute, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Bianca Wernecke
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg, South Africa
- Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, South Africa
| | | | - Robyn Hetem
- School of Animal, Plant and Environmental Sciences, Faculty of Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Melanie Boeckmann
- Department of Environment and Health, School of Public Health, Bielefeld University, Germany
| | - Shakoor Hajat
- Department of Public Health, Environments and Society, and the Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
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Sun Y, Ilango SD, Schwarz L, Wang Q, Chen JC, Lawrence JM, Wu J, Benmarhnia T. Examining the joint effects of heatwaves, air pollution, and green space on the risk of preterm birth in California. ENVIRONMENTAL RESEARCH LETTERS : ERL [WEB SITE] 2020; 15:104099. [PMID: 34659452 PMCID: PMC8516119 DOI: 10.1088/1748-9326/abb8a3] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Exposure to high air temperature in late pregnancy is increasingly recognized as a risk factor for preterm birth (PTB). However, the combined effects of heatwaves with air pollution and green space are still unexplored. In the context of climate change, investigating the interaction between environmental factors and identifying communities at higher risk is important to better understand the etiological mechanisms and design targeted interventions towards certain women during pregnancy. OBJECTIVES To examine the combined effects of heatwaves, air pollution and green space exposure on the risk of PTB. METHODS California birth certificate records for singleton births (2005-2013) were obtained. Residential zip code-specific daily temperature during the last week of gestation was used to create 12 definitions of heatwave with varying temperature thresholds and durations. We fit multi-level Cox proportional hazard models with time to PTB as the outcome and gestational week as the temporal unit. Relative risk due to interaction (RERI) was applied to estimate the additive interactive effect of air pollution and green space on the effect of heatwaves on PTB. RESULTS In total, 1,967,300 births were included in this study. For PM2.5, PM10 and O3, we found positive additive interactions (RERIs >0) between heatwaves and higher air pollution levels. Combined effects of heatwaves and green space indicated negative interactions (RERIs <0) for less intense heatwaves (i.e., shorter duration or relatively low temperature), whereas there were potential positive interactions (RERIs >0) for more intense heatwaves. CONCLUSION This study found synergistic harmful effects for heatwaves with air pollution, and potential positive interactions with lack of green space on PTB. Implementing interventions, such as heat warning systems and behavioral changes, targeted toward pregnant women at risk for high air pollution and low green space exposures may optimize the benefits of reducing acute exposure to extreme heat before delivery.
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Affiliation(s)
- Yi Sun
- Department of Environmental and Occupational Health, University of California, Irvine, CA 92697-3957, USA
| | - Sindana D. Ilango
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA 92093, USA
- School of Public Health, San Diego State University, San Diego, CA, 92182, USA
| | - Lara Schwarz
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA 92093, USA
- School of Public Health, San Diego State University, San Diego, CA, 92182, USA
| | - Qiong Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jiu-Chiuan Chen
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Jean M. Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jun Wu
- Department of Environmental and Occupational Health, University of California, Irvine, CA 92697-3957, USA
- Program in Public Health, 653 East Peltason Drive, University of California, Irvine CA 92697-3957, USA
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA 92093, USA
- Scripps Institution of Oceanography, UC San Diego, La Jolla, CA, 92037, USA
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Association of Summer Heat Waves and the Probability of Preterm Birth in Minnesota: An Exploration of the Intersection of Race and Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176391. [PMID: 32887349 PMCID: PMC7503599 DOI: 10.3390/ijerph17176391] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 11/17/2022]
Abstract
Preterm birth (PTB) is common and has negative impacts on infant health. While some maternal risk factors have been identified, including age under 20 or over 40, substance abuse, low BMI, and racism, less is known about the impact of environmental exposures like high heat. We combined 154,157 records of live births occurring in Minnesota between 2009 and 2015 with hourly weather records collected from the Minneapolis–St. Paul airport. We tested if maternal heat wave exposure (a seven-day period with a mean daily high temp of 37 °C) immediately prior to birth leads to a higher risk of preterm birth. Additional covariates included maternal age, race/ethnicity, educational status, and residence in the seven-county Minneapolis–St. Paul metro area. Pregnant women exposed to a seven-day heat wave of 37 °C or higher experienced a higher relative risk of PTB compared to women who did not experience a heat wave (1.14 risk ratio (RR), 1.0–1.3 95% confidence interval (CI)). The result is robust to controls for a woman’s age, race/ethnicity, educational attainment, place of residence, and year of the birth. Children born to Black women with college degrees who are exposed to heat waves experience a higher relative risk of PTB compared to White women with college degrees in a heat wave (2.97 RR, 1.5–6.1 95% CI). Summer heat waves are associated with higher risk of PTB in late-term pregnancies in Minnesota.
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Wang YY, Li Q, Guo Y, Zhou H, Wang QM, Shen HP, Zhang YP, Yan DH, Li S, Chen G, Zhou S, He Y, Yang Y, Peng ZQ, Wang HJ, Ma X. Ambient temperature and the risk of preterm birth: A national birth cohort study in the mainland China. ENVIRONMENT INTERNATIONAL 2020; 142:105851. [PMID: 32585501 DOI: 10.1016/j.envint.2020.105851] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/24/2020] [Accepted: 05/16/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Little is known about the effect of ambient temperature on preterm birth, especially for the trimester-specific effects. OBJECTIVE To evaluate whether exposure to relatively low or high temperature during pregnancy is associated with increasing risk of preterm birth or not. METHOD We analysed the data of a birth cohort with 1,281,859 singleton pregnancies during 2013-2014 and matched the home address of each pregnant women to the model based daily meteorological and air pollution data. Then we used the Cox proportional hazard regression models with random effect to estimate the non-linear associations between exposure to relatively low or high temperature at each trimester of pregnancy and the risk of preterm birth, after controlling for air pollution and individual-level covariates. FINDING The overall preterm birth rate was 8.1% (104,493 preterm births). Exposure to relatively low or high temperatures during the entire pregnancy significantly increase the risk of preterm birth, with hazard ratios (HRs) [95% confidence intervals (CIs)] of 1.03 (95%CI: 1.02, 1.04) for relatively low (9.1 ℃, the 5th percentile) temperature and 1.55 (95%CI: 1.48, 1.61) for relatively high (23.0 ℃, the 95th percentile) temperature in comparison with the thresholds (12.0 ℃). Pregnant women at the early pregnancy (the 1st and 2nd trimester) are more susceptible to high temperatures while pregnant women at the late pregnancy (the 3rd trimester) are more susceptible to low temperatures. CONCLUSION These findings provide new evidence that exposure to relatively low or high temperatures during pregnancy increases the risk of preterm birth, which can serve as scientific evidence for prevention of preterm birth.
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Affiliation(s)
- Yuan-Yuan Wang
- National Human Genetic Resources Center, Beijing, China; National Research Institute for Family Planning, Beijing, China
| | - Qin Li
- National Human Genetic Resources Center, Beijing, China; Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China; Center for Reproductive Medical, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Hong Zhou
- National Human Genetic Resources Center, Beijing, China; Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Qiao-Mei Wang
- Department of Maternal and Child Health, National Health Commission of the PRC, Beijing, China
| | - Hai-Ping Shen
- Department of Maternal and Child Health, National Health Commission of the PRC, Beijing, China
| | - Yi-Ping Zhang
- Department of Maternal and Child Health, National Health Commission of the PRC, Beijing, China
| | - Dong-Hai Yan
- Department of Maternal and Child Health, National Health Commission of the PRC, Beijing, China
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gongbo Chen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Shuang Zhou
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Yuan He
- National Research Institute for Family Planning, Beijing, China
| | - Ying Yang
- National Research Institute for Family Planning, Beijing, China
| | - Zuo-Qi Peng
- National Research Institute for Family Planning, Beijing, China
| | - Hai-Jun Wang
- National Human Genetic Resources Center, Beijing, China; Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China.
| | - Xu Ma
- National Human Genetic Resources Center, Beijing, China; National Research Institute for Family Planning, Beijing, China.
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Bekkar B, Pacheco S, Basu R, DeNicola N. Association of Air Pollution and Heat Exposure With Preterm Birth, Low Birth Weight, and Stillbirth in the US: A Systematic Review. JAMA Netw Open 2020; 3:e208243. [PMID: 32556259 PMCID: PMC7303808 DOI: 10.1001/jamanetworkopen.2020.8243] [Citation(s) in RCA: 323] [Impact Index Per Article: 80.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
IMPORTANCE Knowledge of whether serious adverse pregnancy outcomes are associated with increasingly widespread effects of climate change in the US would be crucial for the obstetrical medical community and for women and families across the country. OBJECTIVE To investigate prenatal exposure to fine particulate matter (PM2.5), ozone, and heat, and the association of these factors with preterm birth, low birth weight, and stillbirth. EVIDENCE REVIEW This systematic review involved a comprehensive search for primary literature in Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, PubMed, ClinicalTrials.gov website, and MEDLINE. Qualifying primary research studies included human participants in US populations that were published in English between January 1, 2007, and April 30, 2019. Included articles analyzed the associations between air pollutants or heat and obstetrical outcomes. Comparative observational cohort studies and cross-sectional studies with comparators were included, without minimum sample size. Additional articles found through reference review were also considered. Articles analyzing other obstetrical outcomes, non-US populations, and reviews were excluded. Two reviewers independently determined study eligibility. The Arskey and O'Malley scoping review framework was used. Data extraction was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. FINDINGS Of the 1851 articles identified, 68 met the inclusion criteria. Overall, 32 798 152 births were analyzed, with a mean (SD) of 565 485 (783 278) births per study. A total of 57 studies (48 of 58 [84%] on air pollutants; 9 of 10 [90%] on heat) showed a significant association of air pollutant and heat exposure with birth outcomes. Positive associations were found across all US geographic regions. Exposure to PM2.5 or ozone was associated with increased risk of preterm birth in 19 of 24 studies (79%) and low birth weight in 25 of 29 studies (86%). The subpopulations at highest risk were persons with asthma and minority groups, especially black mothers. Accurate comparisons of risk were limited by differences in study design, exposure measurement, population demographics, and seasonality. CONCLUSIONS AND RELEVANCE This review suggests that increasingly common environmental exposures exacerbated by climate change are significantly associated with serious adverse pregnancy outcomes across the US.
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Affiliation(s)
- Bruce Bekkar
- Retired from Southern California Permanente Medical Group, San Diego
| | - Susan Pacheco
- The University of Texas McGovern Medical School, Houston
| | - Rupa Basu
- California Office of Environmental Health Hazard Assessment, Air and Climate Epidemiology Section, Oakland
- Department of Environmental Health Sciences, University of California Berkeley School of Public Health, Berkeley
| | - Nathaniel DeNicola
- George Washington University School of Medicine and Health Sciences, Washington, DC
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Ilango SD, Weaver M, Sheridan P, Schwarz L, Clemesha RES, Bruckner T, Basu R, Gershunov A, Benmarhnia T. Extreme heat episodes and risk of preterm birth in California, 2005-2013. ENVIRONMENT INTERNATIONAL 2020; 137:105541. [PMID: 32059147 DOI: 10.1016/j.envint.2020.105541] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/16/2020] [Accepted: 02/01/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Preterm birth is a leading cause of infant morbidity and mortality. Identifying potentially modifiable triggers toward the end of gestation, such as extreme heat, can improve understanding of the role of acute stress on early deliveries and inform warning systems. In this study we examined the association between extreme heat, variously defined during the last week of gestation, and risk of preterm birth among mothers in California. METHODS We created a population-based cohort comprised of 1,967,300 mothers who had live, singleton births in California, from May through September 2005-2013. Daily temperature data estimated at the maternal zip code of residence was used to create 12 definitions of extreme heat with varying relative temperatures (75th, 90th, 95th, and 98th percentiles) and durations (at least 2, 3, or 4 consecutive days). We estimated risk of preterm birth (<37 gestational weeks) in relation to exposure to extreme heat during the last week of gestation with multi-level Cox proportional hazard regression models, adjusting for maternal characteristics, sex of neonate, and seasonality. We also included randomly generated data, SAS code, and estimates for reproducibility purposes. RESULTS Approximately 7% of the cohort had a preterm birth. For all definitions of extreme heat, the risk of preterm birth was consistently higher among mothers who experienced an extreme heat episode during their last week of gestation. Hazard ratios ranged from 1.008 (95% CI: 0.997, 1.021) to 1.128 (95% CI: 1.052, 1.210), with increasing associations as the relative temperature and duration of extreme heat episode increased. CONCLUSION This study adds to the previous literature by considering multiple definitions of extreme heat and applying a time-to-event framework. Findings suggest that acute exposure to extreme heat during the last week of gestation may trigger an earlier delivery. Implementing heat warning systems targeted toward pregnant women may improve birth outcomes.
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Affiliation(s)
- Sindana D Ilango
- School of Public Health, San Diego State University, San Diego, CA, United States; Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, United States.
| | - Meschelle Weaver
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, United States
| | - Paige Sheridan
- School of Public Health, San Diego State University, San Diego, CA, United States; Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, United States
| | - Lara Schwarz
- School of Public Health, San Diego State University, San Diego, CA, United States; Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, United States
| | - Rachel E S Clemesha
- Scripps Institution of Oceanography, UC San Diego, La Jolla, CA, United States
| | - Tim Bruckner
- Program in Public Health, UC Irvine, Irvine, CA, United States
| | - Rupa Basu
- Office of Environmental Hazard Assessment, California Environmental Protection Agency, Oakland, CA, United States
| | - Alexander Gershunov
- Scripps Institution of Oceanography, UC San Diego, La Jolla, CA, United States
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, United States; Scripps Institution of Oceanography, UC San Diego, La Jolla, CA, United States
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Gronlund CJ, Yang AJ, Conlon KC, Bergmans RS, Le HQ, Batterman SA, Wahl RL, Cameron L, O'Neill MS. Time series analysis of total and direct associations between high temperatures and preterm births in Detroit, Michigan. BMJ Open 2020; 10:e032476. [PMID: 32029486 PMCID: PMC7045030 DOI: 10.1136/bmjopen-2019-032476] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 12/17/2019] [Accepted: 01/09/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Preterm births (PTBs) represent significant health risks, and several studies have found associations between high outdoor temperatures and PTB. We estimated both the total and natural direct effects (independent of particulate matter, ozone and nitrogen dioxide air pollutants) of the prior 2-day mean apparent temperature (AT) on PTB. We evaluated effect modification by maternal age, race, education, smoking status and prenatal care. DESIGN AND SETTING We obtained birth records and meteorological data for the Detroit, Michigan, USA area, for the warm months (May to September), 1991 to 2001. We used a time series Poisson regression with splines of AT, wind speed, solar radiation and citywide average precipitation to estimate total effects. To accommodate multiple mediators and exposure-mediator interactions, AT inverse odds weights, predicted by meteorological and air pollutant covariates, were added in a subsequent model to estimate direct effects. RESULTS At 24.9°C relative to 18.6°C, 10.6% (95% CI: 3.8% to 17.2%) of PTBs were attributable to the total effects of AT, and 10.4% (95% CI: 2.2% to 17.5%) to direct effects. Relative excess risks of interaction indicated that the risk of PTB with increasing temperature above 18.6°C was significantly lower among black mothers and higher among mothers less than 19, older than 30, with late or no prenatal care and who smoked. CONCLUSION This additional evidence of a direct association between high temperature and PTB may motivate public health interventions to reduce extreme heat exposures among pregnant women, particularly among those who may have enhanced vulnerability.
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Affiliation(s)
- Carina J Gronlund
- Survey Research Center, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
| | - Alyssa J Yang
- Urban Indian Health Institute, Seattle, Washington, USA
| | - Kathryn C Conlon
- Public Health Sciences, University of California Davis, Davis, California, USA
| | - Rachel S Bergmans
- Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Hien Q Le
- Toxicology and Risk Assessment, Chemours Co, Wilmington, Delaware, USA
| | - Stuart A Batterman
- Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert L Wahl
- Surveillance and Program Evaluation Section, Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Lorraine Cameron
- Michigan Climate and Health Adaptation Program, Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Marie S O'Neill
- Environmental Health Sciences and Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
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Sun X, Luo X, Cao G, Zhao C, Xiao J, Liu X, Dong M, Wang J, Zeng W, Guo L, Wan D, Ma W, Liu T. Associations of ambient temperature exposure during pregnancy with the risk of miscarriage and the modification effects of greenness in Guangdong, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 702:134988. [PMID: 31715397 DOI: 10.1016/j.scitotenv.2019.134988] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/13/2019] [Accepted: 10/13/2019] [Indexed: 06/10/2023]
Abstract
Miscarriage is one of the commonest complications of pregnancy. Although previous studies suggested that environmental factors were important causes of miscarriage, evidence is still inadequate. Here, we examined the association of maternal exposure to temperature with the risk of miscarriage and further assessed the modifying effects of surrounding residential greenness. A case-control study was conducted at a large hospital in Guangzhou, China. All participants' information was extracted from hospital records. An inverse distance weighted method was used to estimate the temperature exposure at each residential address, where the greenness was measured by Normalized Difference Vegetation Index (NDVI). A logistic regression model was applied to estimate the association of temperature exposure with the risk of miscarriage. A total of 2044 cases of miscarriage and 2285 controls were included in the present study. We observed a generally non-linear positive relationship between temperature exposure and the risk of miscarriage. More pronounced effects of high temperatures vs. low temperatures were found during the two months prior to hospitalization than in other periods. The odds ratio (OR) of 29.4 °C (95th centile) compared with 15 °C during the first month prior to hospitalization was 1.480 (95% CI: 1.021-2.145). Smaller effects of temperatures were seen on the risk of miscarriage among participants with moderately great surrounding greenness compared with those with less greenness. We concluded that maternal exposure to moderately high temperature during pregnancy may increase the risk of miscarriage, but the modifying effects of greenness on these associations need to be further tested in future studies.
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Affiliation(s)
- Xiaoli Sun
- Gynecology Department, Guangdong Women and Children Hospital, Guangzhou 511442, China
| | - Xiping Luo
- Gynecology Department, Guangdong Women and Children Hospital, Guangzhou 511442, China
| | - Ganxiang Cao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Chunmei Zhao
- Gynecology Department, Guangdong Women and Children Hospital, Guangzhou 511442, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Xin Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Moran Dong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Jiaqi Wang
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Lingchuan Guo
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Donghua Wan
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China; General Practice Center, Nanhai Hospital, Southern Medical University, Foshan 528200, China.
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Ward A, Clark J, McLeod J, Woodul R, Moser H, Konrad C. The impact of heat exposure on reduced gestational age in pregnant women in North Carolina, 2011-2015. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2019; 63:1611-1620. [PMID: 31367892 DOI: 10.1007/s00484-019-01773-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 07/06/2019] [Accepted: 07/22/2019] [Indexed: 06/10/2023]
Abstract
Research on the impact of heat on pregnant women has focused largely on outcomes following extreme temperature events, such as particular heat waves or spells of very cold weather on pregnant women. Consistently, the literature has shown a statistically significant relationship between heat with shortened gestational age with studies concentrated largely in the western states of the USA or other nations. The association between heat and shortened gestational age has not been examined in the Southeastern US where maternal outcomes are some of the most challenging in the nation. Unlike previous studies that focus on the impacts of a single heat wave event, this study seeks to understand the impact of high heat over a 5-year period during the annual warm season (May-September). To achieve this goal, a case-crossover study design is employed to understand the impact of heat on preterm labor across regions in North Carolina (NC). Temperature thresholds for impact and the underlying relationships between preterm labor and heat are investigated using generalized additive models (GAM). Gridded temperature data (PRISM) is used to establish exposure classifications. The results reveal significant impacts to pregnant women exposed to heat with regional variations. The exposure variable with the most stable and significant result was minimum temperature, indicating high overnight temperatures have the most impact on preterm birth. The magnitude of this impact varies across regions from a 1% increase in risk to 6% increase in risk per two-degree increment above established minimum temperature thresholds.
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Affiliation(s)
- Ashley Ward
- Nicholas Institute of Environmental Policy Solution, Duke University, Box 90335, Durham, NC, 27708, USA.
| | - Jordan Clark
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jordan McLeod
- NOAA Southeast Regional Climate Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rachel Woodul
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Haley Moser
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Charles Konrad
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- NOAA Southeast Regional Climate Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Abstract
BACKGROUND Occupational exertion is associated with a higher risk of preterm delivery, although studies of leisure time activities generally document reduced risks. Less is known about the risk of preterm delivery immediately following episodes of moderate or heavy physical exertion. METHODS We conducted a case-crossover study of 722 women interviewed during their hospital stay for early preterm delivery, defined by a gestational age before 34 weeks, and after 20 weeks. Interviews occurred between March 2013 and December 2015 in seven hospitals in Lima, Peru. RESULTS The incidence rate ratio (RR) of early preterm delivery was 5.82-fold higher (95% confidence interval [CI] = 4.29, 7.36) in the hour following moderate or heavy physical exertion compared with other times and returned to baseline in the hours thereafter. The RR of early preterm delivery within an hour of physical exertion was lower for exertion at moderate intensity (RR = 2.43; 95% CI = 1.50, 3.96) than at heavy intensity (RR = 23.62; 95% CI = 15.54, 35.91; P-homogeneity < 0.001). The RR of early preterm delivery was lower in the hour following moderate physical exertion among women who habitually engaged in physical exertion >3 times per week in the year before pregnancy (RR = 1.56; 95% CI = 0.81, 3.00) compared with more sedentary women (RR = 6.91; 95% CI = 3.20, 14.92; P-homogeneity = 0.003). CONCLUSIONS Our study showed a heightened risk of early preterm delivery in the hour following moderate or heavy physical exertion.
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Gronlund CJ, Cameron L, Shea C, O’Neill MS. Assessing the magnitude and uncertainties of the burden of selected diseases attributable to extreme heat and extreme precipitation under a climate change scenario in Michigan for the period 2041-2070. Environ Health 2019; 18:40. [PMID: 31029138 PMCID: PMC6487044 DOI: 10.1186/s12940-019-0483-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 04/16/2019] [Indexed: 05/14/2023]
Abstract
BACKGROUND Extreme heat (EH) and extreme precipitation (EP) events are expected to increase with climate change in many parts of the world. Characterizing the potential future morbidity and mortality burden of EH and EP and associated costs, as well as uncertainties in the estimates, can identify areas for public health intervention and inform adaptation strategies. We demonstrate a burden of disease and uncertainty assessment using data from Michigan, USA, and provide approaches for deriving these estimates for locations lacking certain data inputs. METHODS Case-crossover analysis adapted from previous Michigan-specific modeling was used to characterize the historical EH-mortality relationship by county poverty rate and age group. Historical EH-associated hospitalization and emergency room visit risks from the literature were adapted to Michigan. In the U.S. Environmental Protection Agency's BenMAP software, we used a novel approach, with multiple spatially-varying exposures, to estimate all non-accidental mortality and morbidity occurring on EH days (EH days; days where maximum temperature 32.2-35 C or > 35 C) and EP days. We did so for two time periods: the "historical" period (1971-2000), and the "projected" period (2041-2070), by county. RESULTS The rate of all non-accidental mortality associated with EH days increased from 0.46/100,000 persons historically to 2.9/100,000 in the projected period, for 240 EH-attributable deaths annually. EH-associated ED visits increased from 12/100,000 persons to 68/100,000 persons, for 7800 EH-attributable emergency department visits. EP-associated ED visits increased minimally from 1.7 to 1.9/100,000 persons. Mortality and morbidity were highest among those aged 65+ (91% of all deaths). Projected health costs are dominated by EH-associated mortality ($280 million) and EH-associated emergency department visits ($14 million). A variety of sources contribute to a moderate-to-high degree of uncertainty around the point estimates, including uncertainty in the magnitude of climate change, population composition, baseline health rates, and exposure-response estimates. CONCLUSIONS The approach applied here showed that health burden due to climate may significantly rise for all Michigan counties by midcentury. The costs to health care and uncertainties in the estimates, given the potential for substantial attributable burden, provide additional information to guide adaptation measures for EH and EP.
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Affiliation(s)
- Carina J. Gronlund
- Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029 USA
| | - Lorraine Cameron
- Michigan Climate and Health Adaptation Program, Division of Environmental Health, Michigan Department of Health and Human Services, 333 S. Grand Ave, Lansing, MI 48909 USA
| | - Claire Shea
- Michigan Climate and Health Adaptation Program, Division of Environmental Health, Michigan Department of Health and Human Services, 333 S. Grand Ave, Lansing, MI 48909 USA
| | - Marie S. O’Neill
- Departments of Epidemiology and Environmental Health Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029 USA
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Son JY, Lee JT, Lane KJ, Bell ML. Impacts of high temperature on adverse birth outcomes in Seoul, Korea: Disparities by individual- and community-level characteristics. ENVIRONMENTAL RESEARCH 2019; 168:460-466. [PMID: 30396130 PMCID: PMC6263858 DOI: 10.1016/j.envres.2018.10.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/22/2018] [Accepted: 10/27/2018] [Indexed: 05/04/2023]
Abstract
BACKGROUND Few studies have examined temperature's effect on adverse birth outcomes and relevant effect modifiers. OBJECTIVES We investigated associations between heat and adverse birth outcomes and how individual and community characteristics affect these associations for Seoul, Korea, 2004-2012. METHODS We applied logistic regression to estimate associations between heat index during pregnancy, 4 weeks before delivery, and 1 week before delivery and risk of preterm birth and term low birth weight. We investigated effect modification by individual (infant's sex, mother's age, and mother's educational level) and community characteristics (socioeconomic status (SES) and percentage of green areas near residence at the gu level, which is similar to borough in Western countries). We also evaluated associations by combinations of individual- and community-level SES. RESULTS Heat exposure during whole pregnancy was significantly associated with risk of preterm birth. An interquartile (IQR) increase (5.5 °C) in heat index during whole pregnancy was associated with an odds ratio (OR) of 1.033 (95% CI 1.005, 1.061) with NO2 adjustment, and 1.028 (95% CI 0.998, 1.059) with PM10 adjustment, for preterm birth. We also found significant associations with heat exposure during 4 weeks before delivery and 1 week before delivery on preterm birth. We did not observe significant associations with term low birth weight. Higher risk of heat on preterm birth was associated with some individual characteristics such as infants with younger or older mothers and lower community-level SES. For combinations of individual- and community-level SES, the highest and most significant estimated effect was found for infants with low educated mothers living in low SES communities, with suggestions of effects of both individual-and community-level SES. CONCLUSIONS Our findings have implications for evaluating impacts of high temperatures on birth outcomes, estimating health impacts of climate change, and identifying which subpopulations and factors are most relevant for disparities in this association.
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Affiliation(s)
- Ji-Young Son
- School of Forestry & Environmental Studies, Yale University, CT, USA.
| | - Jong-Tae Lee
- Department of Environmental Health, College of Health Science, Korea University, Seoul, Republic of Korea
| | - Kevin J Lane
- Department of Environmental Health, School of Public Health, Boston University, MA, USA
| | - Michelle L Bell
- School of Forestry & Environmental Studies, Yale University, CT, USA
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Zhong Q, Lu C, Zhang W, Zheng X, Deng Q. Preterm birth and ambient temperature: Strong association during night-time and warm seasons. J Therm Biol 2018; 78:381-390. [DOI: 10.1016/j.jtherbio.2018.11.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 11/03/2018] [Accepted: 11/05/2018] [Indexed: 11/29/2022]
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Yu G, Yang R, Yu D, Cai J, Tang J, Zhai W, Wei Y, Chen S, Chen Q, Zhong G, Qin J. Impact of meteorological factors on mumps and potential effect modifiers: An analysis of 10 cities in Guangxi, Southern China. ENVIRONMENTAL RESEARCH 2018; 166:577-587. [PMID: 29966878 DOI: 10.1016/j.envres.2018.06.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 05/04/2023]
Abstract
BACKGROUND In the current context of global climate change, understanding the impact of climate on respiratory infectious diseases such as mumps and the potential modified factors is crucial, especially in developing countries. However, research on the climate-related incidence of mumps is rare, inconsistent and mainly limited to a single city or region. METHODS Daily mumps cases and meteorological variables of 10 cities in Guangxi, Southern China were collected for 2005-2017. Two-stage analyses were performed to assess the relationship between meteorological factors and mumps incidence during two time-periods: 2005-2012 and 2013-2017, separately. First, a Poisson regression model that allows over-dispersion was used to estimate the city-specific climate-related morbidity after controlling for temporal trends, day of week, and national statutory holidays. Then, we used a multivariate meta-analytical model to pool the city-specific effect estimates and conducted subgroup analyses. Multivariate meta-regression was applied to detect potential effect modifiers. RESULTS Non-linear relationships were observed among mean temperature, wind speed, and mumps incidence in 2005-2012. The impact of high temperature on mumps incidence was short and rapid, whereas the impact of low temperature was long and slow. The total cumulative relative risk (RR) associated with hot temperature was 1.18 [95% Confidence Interval (CI): 0.93, 1.48], which was calculated by comparing the incidence of mumps above the 90th percentile of temperature with its incidence at the median temperature at lag of 0-30 days. Meanwhile, the RR associated with cold temperature was calculated to be 1.50 (95% CI: 1.08, 2.10) by comparing the incidence of mumps below the 10th percentile of temperature with its incidence at the median temperature. Similarly, the RRs associated with windless and windy conditions for the total population were 1.23 (95% CI: 1.04, 1.46) and 0.83 (95% CI: 0.67, 1.02), respectively. Effects based on extreme temperature and wind speed conditions were more prominent in males than in females. Compared with children and adults, adolescents (5-14 years old) were more sensitive to extreme weather conditions. Geographical latitude, Population density, GDP per capita, Number of health institutions, Highly educated population and Inoculation rate were considered the most likely associated modifiers. In addition, the correlation between meteorological factors and the incidence of mumps and modification of socioeconomic factors after 2013 showed similar curves compared with results in 2005-2012, but the cumulative effect was not statistically significant. CONCLUSIONS Meteorological factors, such as temperature and wind speed, exert a significant impact on the incidence of mumps. The relationship varies depending on gender and age. Socioeconomic factors such as vaccination, GDP, geographical latitude, etc. may substantially affect the weather-related mumps incidence.
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Affiliation(s)
- Guoqi Yu
- Department of Environmental and Occupational Health, Guangxi Medical University, Shuangyong Road 22, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Rencong Yang
- Guangxi Center for Disease Control and Prevention, Institute of Vaccination, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Dongmei Yu
- Department of Environmental and Occupational Health, Guangxi Medical University, Shuangyong Road 22, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Jiansheng Cai
- Department of Environmental and Occupational Health, Guangxi Medical University, Shuangyong Road 22, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Jiexia Tang
- Department of Environmental and Occupational Health, Guangxi Medical University, Shuangyong Road 22, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Wenwen Zhai
- Department of Health Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Yi Wei
- Department of Environmental and Occupational Health, Guangxi Medical University, Shuangyong Road 22, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Shiyi Chen
- Department of Environmental and Occupational Health, Guangxi Medical University, Shuangyong Road 22, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Quanhui Chen
- Department of Environmental and Occupational Health, Guangxi Medical University, Shuangyong Road 22, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Ge Zhong
- Guangxi Center for Disease Control and Prevention, Institute of Vaccination, Nanning, Guangxi Zhuang Autonomous Region, China.
| | - Jian Qin
- Department of Environmental and Occupational Health, Guangxi Medical University, Shuangyong Road 22, Nanning, Guangxi Zhuang Autonomous Region, China; Guangxi Colleges and Universities Key Laboratory of Prevention and Control of Highly Prevalent Diseases, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.
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Li S, Chen G, Jaakkola JJK, Williams G, Guo Y. Temporal change in the impacts of ambient temperature on preterm birth and stillbirth: Brisbane, 1994-2013. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 634:579-585. [PMID: 29635200 DOI: 10.1016/j.scitotenv.2018.03.385] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/19/2018] [Accepted: 03/31/2018] [Indexed: 05/24/2023]
Abstract
BACKGROUND Pregnant women are susceptible to ambient temperature which may associate with adverse birth outcomes. These associations might change over time due to adaptation. However, no evidence is available worldwide. OBJECTIVES To examine the effects of ambient temperature at three trimesters of pregnancy on preterm birth and stillbirth, and evaluate the effect changes during 1994-2013. METHODS Information on birth outcomes and meteorological parameters during 1994-2013 were obtained in Brisbane, Australia. Cox proportional hazards models were employed to evaluate the effects of mean temperature during each trimester of pregnancy on preterm birth and stillbirth. An interaction term between time and temperature was used to assess the potential changes in effects of temperature over time. RESULTS Both low and high temperatures at the 3rd trimester of pregnancy significantly increased the risk of preterm birth, with similar hazard ratios (HRs) [95% confidence intervals (CIs)] for low [1.21 (1.16, 1.27)] and high [1.21 (1.16, 1.26)] temperatures in comparison with thresholds. Increased risk of stillbirth was significantly associated with both low and high temperatures at the 2nd trimester of pregnancy, and lower HRs were observed for low temperature [1.23 (1.04, 1.45)] than high temperature [1.47 (1.24, 1.74)], in comparison with thresholds. The effects of low temperature became stronger, whereas the effects of high temperature became weaker from 1994 to 2013 for both preterm birth and stillbirth. CONCLUSIONS Both low and high ambient temperatures during pregnancy increase the risks of preterm birth and stillbirth. Pregnant women should have adapted to high temperature but not low temperature.
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Affiliation(s)
- Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Gongbo Chen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research and Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Gail Williams
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Affiliation(s)
- Rupa Basu
- California Environmental Protection Agency, Office of Environmental Hazard Assessment, Oakland, CA
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