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Brink N, Lakhoo DP, Solarin I, Maimela G, von Dadelszen P, Norris S, Chersich MF. Impacts of heat exposure in utero on long-term health and social outcomes: a systematic review. BMC Pregnancy Childbirth 2024; 24:344. [PMID: 38704541 PMCID: PMC11069224 DOI: 10.1186/s12884-024-06512-0] [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: 10/26/2023] [Accepted: 04/11/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Climate change, particularly global warming, is amongst the greatest threats to human health. While short-term effects of heat exposure in pregnancy, such as preterm birth, are well documented, long-term effects have received less attention. This review aims to systematically assess evidence on the long-term impacts on the foetus of heat exposure in utero. METHODS A search was conducted in August 2019 and updated in April 2023 in MEDLINE(PubMed). We included studies on the relationship of environmental heat exposure during pregnancy and any long-term outcomes. Risk of bias was assessed using tools developed by the Joanna-Briggs Institute, and the evidence was appraised using the GRADE approach. Synthesis without Meta-Analysis (SWiM) guidelines were used. RESULTS Eighteen thousand six hundred twenty one records were screened, with 29 studies included across six outcome groups. Studies were mostly conducted in high-income countries (n = 16/25), in cooler climates. All studies were observational, with 17 cohort, 5 case-control and 8 cross-sectional studies. The timeline of the data is from 1913 to 2019, and individuals ranged in age from neonates to adults, and the elderly. Increasing heat exposure during pregnancy was associated with decreased earnings and lower educational attainment (n = 4/6), as well as worsened cardiovascular (n = 3/6), respiratory (n = 3/3), psychiatric (n = 7/12) and anthropometric (n = 2/2) outcomes, possibly culminating in increased overall mortality (n = 2/3). The effect on female infants was greater than on males in 8 of 9 studies differentiating by sex. The quality of evidence was low in respiratory and longevity outcome groups to very low in all others. CONCLUSIONS Increasing heat exposure was associated with a multitude of detrimental outcomes across diverse body systems. The biological pathways involved are yet to be elucidated, but could include epigenetic and developmental perturbations, through interactions with the placenta and inflammation. This highlights the need for further research into the long-term effects of heat exposure, biological pathways, and possible adaptation strategies in studies, particularly in neglected regions. Heat exposure in-utero has the potential to compound existing health and social inequalities. Poor study design of the included studies constrains the conclusions of this review, with heterogenous exposure measures and outcomes rendering comparisons across contexts/studies difficult. TRIAL REGISTRATION PROSPERO CRD 42019140136.
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Affiliation(s)
- Nicholas Brink
- Climate and Health Directorate, Wits RHI, University of the Witwatersrand, Johannesburg, South Africa.
| | - Darshnika P Lakhoo
- Climate and Health Directorate, Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Ijeoma Solarin
- Climate and Health Directorate, Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Gloria Maimela
- Climate and Health Directorate, Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Shane Norris
- MRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew F Chersich
- Climate and Health Directorate, Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
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Matsuura H. Biodemography as human-centered climate change research. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2023; 68:113-114. [PMID: 37995327 DOI: 10.1080/19485565.2023.2287341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
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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: 173] [Impact Index Per Article: 43.3] [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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Patel JC, Khurana P, Sharma YK, Kumar B, Sugadev R. Google trend analysis of climatic zone based Indian severe seasonal sensitive population. BMC Public Health 2020; 20:306. [PMID: 32164654 PMCID: PMC7069044 DOI: 10.1186/s12889-020-8399-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 02/24/2020] [Indexed: 01/07/2023] Open
Abstract
Background Our earlier Google Trend (GT) Analytics study reported that the worldwide human population severely subject to four seasonal (sensitive) comorbid lifestyle diseases (SCLD) such as asthma, obesity, hypertension and fibrosis. The human population subject to seasonal variability in these four diseases activity referred as “severe seasonal sensitive population”. In India, the estimated burden of these four seasonal diseases is more than 350 million as on the year 2018. It is a growing crisis for India with a projected disease burden of 500 million in the year 2025. This study was aimed to decipher the genuine SCLD seasonal trends in the entire Indian population using GT and validate these trends in Indian climatic zones. Methods GT is used to study the temporal trends in web search using weekly Relative Search Volume (RSV) for the period 2004 to 2017. The relative search volume (RSV) of the four-severe seasonal comorbid diseases namely Asthma, Hypertension, Obesity and Fibrosis were collected with and without obesity as the reference. The RSV were collected using the GT selection options as (i) Whole India (ii) Jammu and Kashmir (Cold zone) (iii) Rajasthan (Hot and Dry zone) (iii) West Bengal (Hot and Humid zone) and (iv) Uttar Pradesh state (Composite zone). The time series analysis was carried out to find seasonal patterns, comorbidity, trends and periodicity in the entire India and four of its states (zones). Results Our analysis of entire India (2004–2017) revealed high significant seasonal patterns and comorbidity in all the four diseases of SCLD. The positive tau values indicated strong positive seasonal trends in the SCLD throughout the period (Table). The auto correlation analysis revealed that these diseases were subjected to 3, 4 and 6 months period seasonal variations. Similar seasonal patterns and trends were also observed in all the four Indian temperature zones. Overall study indicated that SCLD seasonal search patterns and trends are highly conserved in India even in drastic Indian climatic zones. Conclusions The clinical outcome arise out of these observations could be of immense significance in handling the major chronic life style diseases asthma, hypertension, obesity and fibrosis. The possible strong comorbid relationship among asthma, hypertension, obesity and fibrosis may be useful to segregate Indian seasonal sensitive population. In disease activity-based chronotherapy, the search interest of segment of the population with access to Internet may be used as an indicator for public health sectors in the early detection of SCLD from a specific country or a region. As this disease population could be highly subject to the adverse effect of seasons in addition to life style and other environmental factors. Our study necessitates that these Indian populations need special attention from the Indian health care sectors.
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Affiliation(s)
- Jai Chand Patel
- Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Lucknow Road, Timarpur, Delhi, India
| | - Pankaj Khurana
- Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Lucknow Road, Timarpur, Delhi, India
| | - Yogendra Kumar Sharma
- Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Lucknow Road, Timarpur, Delhi, India
| | - Bhuvnesh Kumar
- Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Lucknow Road, Timarpur, Delhi, India
| | - Ragumani Sugadev
- Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Lucknow Road, Timarpur, Delhi, India.
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Al Ssabbagh M, Geldsetzer P, Bärnighausen T, Deckert A. The relationship between adult height and diabetes in India: A countrywide cross-sectional study. J Diabetes 2020; 12:158-168. [PMID: 31420914 DOI: 10.1111/1753-0407.12977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/31/2019] [Accepted: 08/11/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND One major aspect of the epidemiological transition happening in India is the increased diabetes prevalence. Poor environmental conditions in early childhood potentially can increase the risk of developing diabetes in adulthood. Adults' height as an indirect indicator might reflect such conditions. In this paper, we investigate the relationship between adult height as a proxy for early childhood conditions and the risk of developing diabetes in India. METHODS This cross-sectional study used national representative data of the latest National Family Health Survey (2015-2016), comprising 512 616 women aged 20 to 49 and 87 281 men aged 20 to 54. We applied the multivariable fractional polynomials approach in logistic regression models to allow for nonlinear relationships between height and diabetes, separated by sex. Additionally, we fitted logistic regression models with height categories. Fixed effects linear probability models were used to control for potential confounding. RESULTS The study revealed a linear relationship between increasing height and increasing diabetes risk among men. Among women, the shortest were at the highest risk (not significant). CONCLUSIONS Among Indian men, being taller increases the risk of developing diabetes, which contradicts findings from other countries. In contrast, the shortest women seem to be at the greatest risk. Hence, public health interventions in India might be well advised to focus more on the nutrition status of young girls.
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Affiliation(s)
- Majd Al Ssabbagh
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Till Bärnighausen
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Africa Health Research Institute, Mtubatuba, South Africa
| | - Andreas Deckert
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
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Undernutrition in childhood resulted in bad dietary behaviors and the increased risk of hypertension in a middle-aged Chinese population. J Dev Orig Health Dis 2018; 9:544-551. [PMID: 29855394 DOI: 10.1017/s204017441800034x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study was designed to explore the association between undernutrition in the growth period and cardiovascular risk factors in a middle-aged Chinese population. A total of 1756 subjects, aged 45-60 years, were invited to participate in the Hefei Nutrition and Health Study and divided into three groups according to their self-reported animal food intake in the growth period. Group 1, Group 2 and Group 3 were defined as undernutrition, nutritional improvement and the good nutrition group, respectively. In the three groups, the subjects in Groups 1 and 2 had more oil and salt intake (P<0.001), and less eggs and milk intake (P<0.001), when compared with the subjects in Group 3. After adjusting for age, education, smoking status and other confounding factors, it was found that male participants who experienced nutritional improvement before age 18 had higher risk of hypertension [odds ratio (OR)=1.68; 95% confidence intervals (CI): 1.05, 2.69] than those with good nutrition, and female participants with undernutrition (OR=1.52; 95% CI: 1.01, 2.29) and nutritional improvement (OR=1.68; 95% CI: 1.04, 2.69) before age 18 had a higher risk of hypertension than those with good nutrition. For diabetes, obesity, hypercholesterolemia and hypertriglyceridemia, our results did not found difference among the three groups both in male and female. Our findings indicated that nutritional deficiency in childhood was associated with bad dietary behaviors and a significantly increased risk of hypertension in middle age. Therefore, early adequate nutrition is very important for the prevention of non-communicable diseases later.
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Alshamsan R, Lee JT, Rana S, Areabi H, Millett C. Comparative health system performance in six middle-income countries: cross-sectional analysis using World Health Organization study of global ageing and health. J R Soc Med 2017; 110:365-375. [PMID: 28895493 DOI: 10.1177/0141076817724599] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objective To assess and compare health system performance across six middle-income countries that are strengthening their health systems in pursuit of universal health coverage. Design Cross-sectional analysis from the World Health Organization Study on global AGEing and adult health, collected between 2007 and 2010. Setting Six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa. Participants Nationally representative sample of adults aged 50 years and older. Main outcome measures We present achievement against key indicators of health system performance across effectiveness, cost, access, patient-centredness and equity domains. Results We found areas of poor performance in prevention and management of chronic conditions, such as hypertension control and cancer screening coverage. We also found that cost remains a barrier to healthcare access in spite of insurance schemes. Finally, we found evidence of disparities across many indicators, particularly in the effectiveness and patient centredness domains. Conclusions These findings identify important focus areas for action and shared learning as these countries move towards achieving universal health coverage.
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Affiliation(s)
- Riyadh Alshamsan
- 1 College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11632, Saudi Arabia.,2 Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London SW7 2AZ, UK
| | - John Tayu Lee
- 2 Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London SW7 2AZ, UK.,3 Saw Swee Hock School of Public Health, University of Singapore, Singapore 117549
| | - Sangeeta Rana
- 4 Field Epidemiology Service South East and London, Public Health England, London SE1 6LH, UK.,5 Imperial College Healthcare NHS Trust, London SW7 2AZ, UK
| | - Hasan Areabi
- 1 College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11632, Saudi Arabia
| | - Christopher Millett
- 2 Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London SW7 2AZ, UK
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