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Tiwari I, Syer J, Spitzer D, Hodgins S, Tamrakar SR, Dhimal M, Yamamoto SS. Linking weather and health outcomes: Examining the potential influences of weather factors and particulate matter pollution on adverse pregnancy outcomes in the Kavre district, Nepal. ENVIRONMENTAL RESEARCH 2024; 256:119212. [PMID: 38797462 DOI: 10.1016/j.envres.2024.119212] [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: 02/08/2024] [Revised: 03/30/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Adverse pregnancy outcomes (APOs) include stillbirth, preterm birth, and low birthweight (LBW). Studies exploring the impact of weather factors and air pollution on APOs are scarce in Nepal. We examined the impacts of prenatal exposure to temperature, precipitation, and air pollution (PM2.5) on APOs among women living in Kavre, Nepal. METHODS We conducted a hospital and rural health centers-based historical cohort study that included health facility birth records (n = 1716) from the Nepali fiscal year 2017/18 through 2019/20. We linked health records to temperature, precipitation, and PM2.5 data for Kavre for the six months preceding each birth. A random intercept model was used to analyze birthweight, while a composite APO variable, was analyzed using multivariable logistic regression in relation to environmental exposures. RESULTS The proportion of LBW (<2500 gm), preterm birth (babies born alive before 37 weeks of gestation), and stillbirth was 13%, 4.3%, and 1.5%, respectively, in this study. Overall, around 16% of the study participants had one or more APOs. Total precipitation (β: 0.17, 95% CI 0.01 to 0.33, p = 0.03) had a positive effect on birthweight in the wetter season. Negative effects for mean maximum (β: 33.37, 95% CI -56.68 to -10.06, p = 0.005), mean (β: 32.35, 95% CI -54.44 to -10.27, p = 0.004), and mean minimum temperature (β: 29.28, 95% CI -49.58 to -8.98, p = 0.005) on birthweight was also observed in the wetter season. CONCLUSION A positive effect of temperature (mean maximum, mean, and mean minimum) and total precipitation on birthweight was found in the wetter season. This study emphasizes the need for future research using larger cohorts to elucidate these complex relationships in Nepal.
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Affiliation(s)
- Ishwar Tiwari
- School of Public Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, T6G 1C9, Canada.
| | - Joey Syer
- School of Public Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, T6G 1C9, Canada
| | - Denise Spitzer
- School of Public Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, T6G 1C9, Canada
| | - Stephen Hodgins
- School of Public Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, T6G 1C9, Canada
| | - Suman R Tamrakar
- Department of Obstetrics and Gynecology, Dhulikhel Hospital, Kavre, Nepal
| | - Meghnath Dhimal
- Nepal Health Research Council, Ram Shah Path, Kathmandu, Nepal
| | - Shelby S Yamamoto
- School of Public Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, T6G 1C9, Canada
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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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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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LaPointe S, Mendola P, Lin S, Tian L, Bonell A, Adamba C, Palermo T. Impact of cash transfers on the association between prenatal exposures to high temperatures and low birthweight: Retrospective analysis from the LEAP 1000 study. BJOG 2024; 131:641-650. [PMID: 38238994 DOI: 10.1111/1471-0528.17761] [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: 07/14/2023] [Revised: 12/06/2023] [Accepted: 01/01/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To explore the associations between prenatal temperature exposures and low birthweight (LBW) and modification by cash transfer (CT) receipt. DESIGN Retrospective cohort study. SETTING Five rural districts in Northern Ghana. POPULATION OR SAMPLE A total of 3016 infants born to women interviewed as part of the Livelihood Empowerment Against Poverty (LEAP 1000) impact evaluation between 2015 and 2017. METHODS Birthweight was collected using household surveys administered to LEAP 1000 eligible women. We used a UNICEF-developed multiple imputation approach to address missingness of birthweight and applied an empirical heaping correction to the multiply imputed birthweight data. Survey data were linked to the European Centre for Medium-Range Weather Forecasts Reanalysis 5-hourly temperature averaged to weeks for 2011-2017 using community centroids. Using distributed-lag nonlinear models, we explored the lag-specific associations between weekly average temperatures greater than 30°C and LBW, and stratified by LEAP 1000 treatment. MAIN OUTCOME MEASURES Low birthweight (<2.5 kg). RESULTS Twelve percent (n = 365) of infants were LBW; the mean ± SD birthweight was 3.02 ± 0.37 kg. Overall, increasing temperatures were associated with increased odds of LBW, with the greatest odds observed in the 3 weeks before birth (odds ratio 1.005-1.025). These positive associations were even larger among comparison infants and null among treatment infants. CONCLUSIONS Our study found increased odds of LBW with high weekly average temperatures throughout pregnancy and the preconception period and demonstrate mitigated effects by the LEAP 1000 CT program. More evidence on the potential of CTs to serve as adaptation interventions in low- and middle-income countries is needed to protect pregnant persons and their infants from the impacts of climate change.
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Affiliation(s)
- Sarah LaPointe
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Pauline Mendola
- Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Shao Lin
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, New York, USA
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, USA
| | - Lili Tian
- Department of Biostatistics, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Ana Bonell
- Medical Research Council Unit, London School of Hygiene and Tropical Medicine, Banjul, The Gambia
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Clement Adamba
- School of Education and Leadership, University of Ghana, Accra, Ghana
| | - Tia Palermo
- Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, New York, USA
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Rekha S, Nalini SJ, Bhuvana S, Kanmani S, Hirst JE, Venugopal V. Heat stress and adverse pregnancy outcome: Prospective cohort study. BJOG 2024; 131:612-622. [PMID: 37814395 DOI: 10.1111/1471-0528.17680] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To explore the relationship between occupational heat exposure, physiological heat strain indicators and adverse outcomes in pregnant women. DESIGN Prospective cohort. SETTING Workplaces in Tamil Nadu, India. SAMPLE A cohort of 800 pregnant women engaged in moderate to heavy physical work in 2017-2019 and 2021-2022. METHODS Participants were recruited at between 8 and 14 weeks of gestation. Occupational heat exposure and heat strain indicators were captured each trimester. 'Heat exposed' was defined as heat stress exceeding the threshold limit value (TLV) for safe manual work (with maximum wet-bulb globe temperatures of 27.5°C for a heavy workload and 28.0°C for a moderate workload). Physiological heat strain indicators (HSIs) such as core body temperature (CBT) and urine specific gravity (USG) were measured before and after each shift. Heat-related health symptoms were captured using the modified HOTHAPS questionnaire. MAIN OUTCOME MEASURES The main outcome measures included (1) a composite measure of any adverse pregnancy outcome (APO) during pregnancy (including miscarriage, preterm birth, low birthweight, stillbirth, intrauterine growth restriction and birth defects), (2) a composite measure of adverse outcomes at birth (3) and miscarriage. RESULTS Of the 800 participants, 47.3% had high occupational heat exposure. A rise in CBT was recorded in 17.4% of exposed workers, and 29.6% of workers experienced moderate dehydration (USG ≥ 1.020). Heat-exposed women had a doubled risk of miscarriage (adjusted odds ratio, aOR 2.4; 95% confidence interval, 95% CI 1.0-5.7). High occupational heat exposure was associated with an increased risk of any adverse pregnancy and foetal outcome (aOR 2.3; 95% CI 1.4-3.8) and adverse outcome at birth (aOR 2.0; 95% CI 1.2-3.3). CONCLUSIONS High occupational heat exposure is associated with HSIs and adverse pregnancy outcomes in India.
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Affiliation(s)
- Shanmugam Rekha
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Tamil Nadu, Chennai, India
| | - Sirala Jagadeesh Nalini
- Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research, Tamil Nadu, Chennai, India
| | - Srinivasan Bhuvana
- Department of Obstetrics and Gynaecology, Sri Ramachandra Medical Centre, Tamil Nadu, Chennai, India
| | - Sellappa Kanmani
- Centre for Environmental Studies, Anna University, Tamil Nadu, Chennai, India
| | - Jane Elizabeth Hirst
- Nuffield Department of Women's Reproductive Health and George Institute for Global Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, Imperial College London, London, UK
| | - Vidhya Venugopal
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Tamil Nadu, Chennai, India
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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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Zangen NR, Shoham Vardi I, Weintraub AY, Yaniv Salem S. New definitions, old complications: The association between duration of transition from latent to active labor and adverse obstetrical outcomes. Int J Gynaecol Obstet 2024. [PMID: 38287710 DOI: 10.1002/ijgo.15397] [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: 11/18/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVE To explore the relationship between the duration of transition from latent to active labor and various obstetric, maternal, fetal, and neonatal outcomes. METHODS A retrospective cohort study was conducted on term, singleton deliveries at Soroka University Medical Center from 2013 to 2018. Data were extracted from electronic medical records. The exposure variable was defined as prolonged transition, which was itself defined as the upper 10th centile of dilation duration from 4 to 6 cm. Clinical and demographic characteristics were compared using χ2 test. Multivariate logistic regression was used to estimate the contribution of a prolonged transition with each adverse outcome adjusting for potential confounders. RESULTS In all, 12 104 deliveries met the inclusion criteria. The mean ± standard deviation of duration of dilation from 4 to 6 cm was 03:07:58 ± 03:03:42 (hours:minutes:seconds). Progress curves varied significantly among patients with different obstetrical and demographic characteristics. Prolonged transition was significantly linked to an increased risk of cesarean delivery (adjusted odds raito 2.607, 95% confidence interval 2.171-3.130, area under the curve 0.689) and higher rates of maternal and neonatal morbidity. CONCLUSIONS Patients experiencing transition phases exceeding the 90th centile faced an elevated risk of cesarean delivery and postpartum complications. Future studies should focus on interventions during the transition phase to improve pregnancy outcomes and enhance patient safety.
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Affiliation(s)
- Noa R Zangen
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
| | - Ilana Shoham Vardi
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
| | - Shimrit Yaniv Salem
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
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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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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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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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11
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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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12
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Ruan T, Yue Y, Lu W, Zhou R, Xiong T, Jiang Y, Ying J, Tang J, Shi J, Wang H, Xiao G, Li J, Qu Y, Mu D. Association between low ambient temperature during pregnancy and adverse birth outcomes: A systematic review and meta-analysis. Chin Med J (Engl) 2023; 136:2307-2315. [PMID: 36805588 PMCID: PMC10538931 DOI: 10.1097/cm9.0000000000002361] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Extreme temperature events, including extreme cold, are becoming more frequent worldwide, which might be harmful to pregnant women and cause adverse birth outcomes. We aimed to investigate the association between exposure to low ambient temperature in pregnant women and adverse birth outcomes, such as preterm birth, low birth weight, and stillbirth, and to summarize the evidence herein. METHODS Relevant studies were searched in PubMed, Cochrane, and Embase electronic databases until November 2021. Studies involving low ambient temperature, preterm birth, birth weight, and stillbirth were included. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses were followed to conduct this study risk of bias and methods for data synthesis. RESULTS A total of 34 studies were included. First, pregnant women exposed to low ambient temperature had an increased risk of preterm birth (risk ratio [RR] 1.08; 95% confidence interval [CI] 1.04-1.13). Subgroup analyses revealed that exposure during late pregnancy was more likely to induce preterm birth. In addition, only pregnant women exposed to <1st percentile of the mean temperature suffered increased risk of preterm birth. Moreover, pregnant women living in medium or hot areas were more prone to have preterm births than those in cold areas when exposed to low ambient temperatures. Asians and Blacks were more susceptible to low ambient temperatures than Caucasians. Second, pregnant women exposed to low ambient temperature had an increased risk of low birth weight (RR 1.07; 95% CI 1.03-1.12). Third, pregnant women had an increased risk of stillbirth while exposed to low ambient temperature during the entire pregnancy (RR 4.63; 95% CI 3.99-5.38). CONCLUSIONS Exposure to low ambient temperature during pregnancy increases the risk of adverse birth outcomes. Pregnant women should avoid exposure to extremely low ambient temperature (<1st percentile of the mean temperature), especially in their late pregnancy. This study could provide clues for preventing adverse outcomes from meteorological factors. REGISTRATION No. CRD42021259776 at PROSPERO ( https://www.crd.york.ac.uk/PROSPERO/ ).
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Affiliation(s)
- Tiechao Ruan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yan Yue
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan 610041, China
| | - Wenting Lu
- Department of General Practice, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Ruixi Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan 610041, China
| | - Tao Xiong
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yin Jiang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan 610041, China
| | - Junjie Ying
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jun Tang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jing Shi
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan 610041, China
| | - Hua Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan 610041, China
| | - Guoguang Xiao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jinhui Li
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan 610041, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan 610041, China
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13
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Cowell W, Ard N, Herrera T, Medley EA, Trasande L. Ambient temperature, heat stress and fetal growth: A review of placenta-mediated mechanisms. Mol Cell Endocrinol 2023; 576:112000. [PMID: 37460007 DOI: 10.1016/j.mce.2023.112000] [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] [Received: 05/15/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/24/2023]
Abstract
Pregnancy is increasingly considered a period of vulnerability for extreme heat exposure. Multiple lines of evidence support that heat stress is associated with placental insufficiency, poor fetal growth and decreased birth weight. In this narrative review, we first summarize evidence linking ambient temperature or experimentally-induced heat stress with fetal and placental growth outcomes in humans, ruminants and murine species. We then synthesize the literature on putative underlying biological pathways with a focus on the placenta. Reviewed mechanisms include: reduced uterine-placental blood flow, impaired supply of metabolic substrates to the fetus, activation of the maternal stress-response system, and disruption of other endocrine and immune system endpoints. Taken together, this body of evidence supports that exposure to extreme ambient heat likely has adverse consequences for placental development and function. However, research investigating placenta-mediated pathophysiological mechanisms in humans remains extremely limited.
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Affiliation(s)
- Whitney Cowell
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA; Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Natasha Ard
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Teresa Herrera
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Eleanor A Medley
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Leonardo Trasande
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA; Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
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14
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Ahmad WA, Nirel R, Golan R, Kloog I, Rotem R, Negev M, Koren G, Levine H. Association between ambient particulate matter and preterm birth stratified by temperature: A population-based pregnancy cohort study. Int J Hyg Environ Health 2023; 254:114269. [PMID: 37832218 DOI: 10.1016/j.ijheh.2023.114269] [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: 04/07/2023] [Revised: 09/16/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023]
Abstract
A growing body of literature reports associations between exposure to particulate matter with aerodynamic diameters ≤2.5 μm (PM2.5) and 2.5-10 μm (PM10-2.5) during pregnancy and preterm birth (PTB). However, the role of ambient temperature in PM-PTB associations was rarely investigated. In Israel, we used Maccabi Healthcare Services data to establish a population-based cohort of 381,265 singleton births reaching 24-42 weeks' gestation and birth weight of 500-5000 g (2004-2015). Daily PM and ambient temperature predictions from a satellite-based spatiotemporal model, at a 1 × 1 km spatial resolution, were linked to the date of birth and maternal residence. Mixed effects Cox regression models, adjusted for covariates, with a random intercept at the mother level were used to assess associations between mean exposure during pregnancy and PTB. We found that exposure to PM2.5 was positively associated with PTB when the average exposure during pregnancy was either low (first quintile) or high (fifth quintile), compared to exposure in the 2nd-4th quintiles, with hazard ratios (HRs) 1.18 (95% confidence interval [CI], 1.13-1.24) and 1.07 (95% CI, 1.02-1.12), respectively. The results revealed effect modification of temperature. For mothers exposed to low (below median) average temperature during pregnancy, HRs of PTB were 0.93 (95% CI, 0.87-1.00) and 1.21 (95% CI, 1.14-1.29) for the first and fifth PM2.5 quintiles, respectively, when compared to the 2nd-4th quintiles. However, a reverse trend was indicated for high-temperature pregnancies, where the corresponding HRs were 1.48 (95% CI, 1.39-1.58) and 0.92, (95% CI, 0.96-0.98). In conclusion, consideration of climatic factors can provide new insights into the risk of PTB as a result of exposure to PM2.5 during pregnancy.
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Affiliation(s)
- Wiessam Abu Ahmad
- Hebrew University-Hadassah School of Public Health, Hebrew University of Jerusalem, Israel.
| | - Ronit Nirel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rachel Golan
- Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Itai Kloog
- Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ran Rotem
- Harvard T.H. Chan School of Public Health, Boston, MA, USA; Institute of Research and Innovation, Maccabitech, Tel-Aviv, Israel
| | - Maya Negev
- University of Haifa, School of Public Health, Haifa, Israel
| | - Gideon Koren
- Institute of Research and Innovation, Maccabitech, Tel-Aviv, Israel; Tel Aviv University, Tel-Aviv, Israel
| | - Hagai Levine
- Hebrew University-Hadassah School of Public Health, Hebrew University of Jerusalem, Israel
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15
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Fan X, Hu J. Early arrivals: association of maternal obstetric factors with preterm births and their survival in India. Public Health 2023; 222:e18. [PMID: 36334951 DOI: 10.1016/j.puhe.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 09/21/2022] [Indexed: 11/11/2022]
Affiliation(s)
- X Fan
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne VIC 3004, Australia.
| | - J Hu
- Department of Clinical Nutrition, The General Hospital of Western Theater Command, Chengdu 610083, China
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16
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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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17
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Wu Y, Yuan J, Yuan Y, Kong C, Jing W, Liu J, Ye H, Liu M. Effects of ambient temperature and relative humidity on preterm birth during early pregnancy and before parturition in China from 2010 to 2018: a population-based large-sample cohort study. Front Public Health 2023; 11:1101283. [PMID: 37408740 PMCID: PMC10319007 DOI: 10.3389/fpubh.2023.1101283] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/26/2023] [Indexed: 07/07/2023] Open
Abstract
Background The progression of global warming and increase in instances of extreme weather have received considerable attention. We conducted a cohort study on women of childbearing age in Yunnan Province, examined the association between ambient temperature and humidity on preterm birth and evaluated the effects of extreme weather during early pregnancy and before parturition on preterm birth. Methods We conducted a population-based cohort study on women of childbearing age 18-49 years who participated in National Free Preconception Health Examination Project (NFPHEP) in Yunnan Province from January 1, 2010, to December 31, 2018. Meteorological data, namely daily average temperature (°C) and daily average relative humidity (%), were obtained from China National Meteorological Information Center. Four exposure windows were explored: 1 week of pregnancy, 4 weeks of pregnancy, 4 weeks before delivery, and 1 week before delivery. We used a Cox proportional hazards model and adjusted the potential risk factors for preterm birth to obtain the effects of exposure to temperature and humidity on preterm birth among the stages of pregnancy. Results At 1 week of pregnancy and at 4 weeks of pregnancy, the association between temperature and preterm birth was U-shaped. The correlation between relative humidity and the risk of preterm birth was n-type at 1 week of pregnancy. The correlation between preterm birth and temperature and relative humidity at 4 weeks before delivery and at 1 week before delivery is J-shaped. Low temperature and low humidity were protective factors against preterm birth, whereas high temperature and high humidity were risk factors for preterm birth.The effects of high temperature and extremely high temperature were the strongest at 4 weeks before delivery, with HRs of 1.417 (95% CI: 1.362-1.474) and 1.627 (95% CI: 1.537-1.722), respectively. The effects of extremely low humidity and low humidity were strongest at 1 week before delivery, with HRs of 0.681 (95% CI: 0.609-0.761) and 0.696 (95% CI: 0.627-0.771), respectively. Conclusion Temperature and relative humidity affect preterm birth differently for each pregnancy stage. The effects of meteorological factors on pregnancy outcomes such as premature birth should not be ignored.
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Affiliation(s)
- Yu Wu
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Jie Yuan
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Yanling Yuan
- Yunnan Population and Family Planning Research Institute, Yunnan, China
| | - Cai Kong
- Yunnan Population and Family Planning Research Institute, Yunnan, China
| | - Wenzhan Jing
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Hanfeng Ye
- Yunnan Population and Family Planning Research Institute, Yunnan, China
| | - Min Liu
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
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18
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Wu Y, Ye H, Yuan Y, Kong C, Jing W, Liu J, Liu M. Association between season of conception, month of conception with preterm birth in China: a population-based retrospective cohort study. Reprod Health 2023; 20:88. [PMID: 37312160 DOI: 10.1186/s12978-023-01636-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/05/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Seasonal patterns of preterm birth were identified in previous studies, but the effect of conception season on preterm birth has not been extensively studied. Based on the notion that the etiological roots of preterm birth lie in the beginning of pregnancy, we did a population-based retrospective cohort study in Southwest China to examine the effects of season of conception and month of conception on preterm birth. METHODS We did a population-based retrospective cohort study in women (aged 18-49) who participated in the NFPHEP from 2010 to 2018, and had a singleton livebirth in southwest China. According to the time of the last menstruation reported by the participants, month of conception and season of conception were then ascertained. We used multivariate log-binomial model to adjust the potential risk factors for preterm birth and obtained adjusted risk ratio (aRR) and 95% confidence intervals (95%CI) for conception season, conception month and preterm birth. RESULTS Among 194 028 participants, 15 034 women had preterm birth. Compared with pregnancies that were conceived in the summer, pregnancies that were conceived in the spring, autumn and winter had the higher risk of preterm birth (Spring: aRR = 1.10, 95% CI: 1.04-1.15; Autumn: aRR = 1.14, 95% CI: 1.09-1.20; Winter: aRR = 1.28, 95% CI: 1.22-1.34) and also had a higher risk of early preterm birth (Spring: aRR = 1.09, 95% CI: 1.01-1.18; Autumn: aRR = 1.09, 95% CI: 1.01-1.19; Winter: aRR = 1.16, 95% CI: 1.08-1.25). Pregnancies in December, and January had a higher risk of preterm birth and early preterm birth than pregnancies that were conceived in July. CONCLUSIONS Our study found that preterm birth was significantly related to season of conception. Preterm and early preterm birth rates were the highest among pregnancies that were conceived in winter, and the lowest among pregnancies in summer.
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Affiliation(s)
- Yu Wu
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Hanfeng Ye
- Yunnan Population and Family Planning Research Institute, No. 146, Qingnian Road, Wuhua District, Kunming, 650021, Yunnan, China
| | - Yanling Yuan
- Yunnan Population and Family Planning Research Institute, No. 146, Qingnian Road, Wuhua District, Kunming, 650021, Yunnan, China
| | - Cai Kong
- Yunnan Population and Family Planning Research Institute, No. 146, Qingnian Road, Wuhua District, Kunming, 650021, Yunnan, China
| | - Wenzhan Jing
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Jue Liu
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Min Liu
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China.
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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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Jani P, Mishra U, Buchmayer J, Walker K, Gözen D, Maheshwari R, D'Çruz D, Lowe K, Wright A, Marceau J, Culcer M, Priyadarshi A, Kirby A, Moore JE, Oei JL, Shah V, Vaidya U, Khashana A, Godambe S, Cheah FC, Zhou W, Xiaojing H, Satardien M. Thermoregulation and golden hour practices in extremely preterm infants: an international survey. Pediatr Res 2023; 93:1701-1709. [PMID: 36075989 PMCID: PMC9453708 DOI: 10.1038/s41390-022-02297-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Are thermoregulation and golden hour practices in extremely preterm (EP) infants comparable across the world? This study aims to describe these practices for EP infants based on the neonatal intensive care unit's (NICUs) geographic region, country's income status and the lowest gestational age (GA) of infants resuscitated. METHODS The Director of each NICU was requested to complete the e-questionnaire between February 2019 and August 2021. RESULTS We received 848 responses, from all geographic regions and resource settings. Variations in most thermoregulation and golden hour practices were observed. Using a polyethylene plastic wrap, commencing humidity within 60 min of admission, and having local protocols were the most consistent practices (>75%). The odds for the following practices differed in NICUs resuscitating infants from 22 to 23 weeks GA compared to those resuscitating from 24 to 25 weeks: respiratory support during resuscitation and transport, use of polyethylene plastic wrap and servo-control mode, commencing ambient humidity >80% and presence of local protocols. CONCLUSION Evidence-based practices on thermoregulation and golden hour stabilisation differed based on the unit's region, country's income status and the lowest GA of infants resuscitated. Future efforts should address reducing variation in practice and aligning practices with international guidelines. IMPACT A wide variation in thermoregulation and golden hour practices exists depending on the income status, geographic region and lowest gestation age of infants resuscitated. Using a polyethylene plastic wrap, commencing humidity within 60 min of admission and having local protocols were the most consistent practices. This study provides a comprehensive description of thermoregulation and golden hour practices to allow a global comparison in the delivery of best evidence-based practice. The findings of this survey highlight a need for reducing variation in practice and aligning practices with international guidelines for a comparable health care delivery.
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Affiliation(s)
- Pranav Jani
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia.
- The University of Sydney, Sydney, NSW, Australia.
| | - Umesh Mishra
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Julia Buchmayer
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Karen Walker
- The University of Sydney, Sydney, NSW, Australia
- Department of Newborn Care, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Council of International Neonatal Nurses, Boston, MA, USA
- The George Institute for Global Health, Sydney, NSW, Australia
- Sydney Institute for Women, Children & their Families, Sydney, NSW, Australia
| | - Duygu Gözen
- Pediatric Nursing Department, Florence Nightingale Faculty of Nursing, İstanbul University - Cerrahpaşa, İstanbul, Turkey
| | - Rajesh Maheshwari
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Daphne D'Çruz
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
| | - Krista Lowe
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
| | - Audrey Wright
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
| | - James Marceau
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
| | - Mihaela Culcer
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Archana Priyadarshi
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Adrienne Kirby
- The National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - James E Moore
- Connecticut Children's, Division of Neonatal-Perinatal Medicine, Connecticut Children's Medical Center, Hartford, CT, USA
- UCONN School of Medicine Farmington, Farmington, CT, USA
| | - Ju Lee Oei
- The Royal Hospital for Women, Randwick, NSW, Australia
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Vibhuti Shah
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, Mount Sinai Hospital, Toronto, ON, Canada
| | - Umesh Vaidya
- Department of Pediatrics, King Edward Memorial Hospital, Pune, India
| | | | - Sunit Godambe
- Divisional Director for Clinical Governance, Women Children and Clinical Support, Imperial College Healthcare NHS Trust, London, UK
| | - Fook Choe Cheah
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bangi, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Wenhao Zhou
- Department of Neonatology and Vice President, Children's Hospital of Fudan University, Shanghai, China
| | - Hu Xiaojing
- Nursing Department, Children's Hospital of Fudan University, Shanghai, China
| | - Muneerah Satardien
- Department of Paediatrics and Child Health, Tygerberg Hospital Cape Town, Cape Town, South Africa
- University of Stellenbosch South Africa, Stellenbosch, South Africa
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21
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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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22
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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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23
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Bonell A, Vannevel V, Sonko B, Mohammed N, Vicedo-Cabrera AM, Haines A, Maxwell NS, Hirst J, Prentice AM. A feasibility study of the use of UmbiFlow™ to assess the impact of heat stress on fetoplacental blood flow in field studies. Int J Gynaecol Obstet 2023; 160:430-436. [PMID: 36165637 PMCID: PMC10092781 DOI: 10.1002/ijgo.14480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/09/2022] [Accepted: 09/26/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the use of UmbiFlow™ in field settings to assess the impact of heat stress on umbilical artery resistance index (RI). METHODS This feasibility study was conducted in West Kiang, The Gambia, West Africa; a rural area with increasing exposure to extreme heat. We recruited women with singleton fetuses who performed manual tasks (such as farming) during pregnancy to an observational cohort study. The umbilical artery RI was measured at rest, and during and at the end of a typical working shift in women at 28 weeks or more of pregnancy. Adverse pregnancy outcomes (APO) were classified as stillbirth, preterm birth, low birth weight, or small for gestational age, and all other outcomes as normal. RESULTS A total of 40 participants were included; 23 normal births and 17 APO. Umbilical artery RI demonstrated a nonlinear relationship to heat stress, with indication of a potential threshold value for placental insufficiency at 32°C by universal thermal climate index and 30°C by wet bulb globe temperature. CONCLUSIONS The Umbiflow device proved to be an effective field method for assessing placental function. Dynamic changes in RI may begin to explain the association between extreme heat and APO with an identified threshold of effect.
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Affiliation(s)
- Ana Bonell
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Valerie Vannevel
- Maternal and Infant Healthcare Strategies Unit, SAMRC, Pretoria, South Africa
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
- Research Centre for Maternal, Fetal, Newborn & Child Healthcare strategies, University of Pretoria, Pretoria, South Africa
| | - Bakary Sonko
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Nuredin Mohammed
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Ana M Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Andy Haines
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Public Health, Environment and Society, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil S Maxwell
- Environmental Extremes Laboratory, University of Brighton, Eastbourne, UK
| | - Jane Hirst
- Nuffield Department of Women's and Reproductive Health and the George Institute for Global Health, University of Oxford, Oxford, UK
| | - Andrew M Prentice
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
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24
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Rothschild J, Haase E. The mental health of women and climate change: Direct neuropsychiatric impacts and associated psychological concerns. Int J Gynaecol Obstet 2023; 160:405-413. [PMID: 36165632 DOI: 10.1002/ijgo.14479] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/11/2022] [Accepted: 09/26/2022] [Indexed: 01/20/2023]
Abstract
Climate change brings exposures to heat, air pollution, poorer quality food, and infectious disease that have significant direct effects on women and their mental health. These environmental impacts are multifaceted in their consequences and raise risks of depression, suicide, violent victimization, post-traumatic stress disorder, and various other neuropsychiatric symptoms. Women also suffer increased climate psychological risks from higher rates of stillbirth, preterm birth, and developmental problems in their children. Here we review what is known about the overlap of women's individual mental health and climate change, and highlight areas where more research is needed.
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Affiliation(s)
- Julia Rothschild
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Elizabeth Haase
- Department of Psychiatry, Carson Tahoe Regional Medical Center, Carson City, Nevada, USA.,University of Nevada School of Medicine at Reno, Reno, Nevada, USA
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25
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Shankar K, Ali SA, Ruebel ML, Jessani S, Borengasser SJ, Gilley SP, Jambal P, Yazza DN, Weaver N, Kemp JF, Westcott JL, Hendricks AE, Saleem S, Goldenberg RL, Hambidge KM, Krebs NF. Maternal nutritional status modifies heat-associated growth restriction in women with chronic malnutrition. PNAS NEXUS 2023; 2:pgac309. [PMID: 36744021 PMCID: PMC9896899 DOI: 10.1093/pnasnexus/pgac309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 01/05/2023] [Indexed: 01/29/2023]
Abstract
Rapid changes in the global climate are deepening existing health disparities from resource scarcity and malnutrition. Rising ambient temperatures represent an imminent risk to pregnant women and infants. Both maternal malnutrition and heat stress during pregnancy contribute to poor fetal growth, the leading cause of diminished child development in low-resource settings. However, studies explicitly examining interactions between these two important environmental factors are lacking. We leveraged maternal and neonatal anthropometry data from a randomized controlled trial focused on improving preconception maternal nutrition (Women First Preconception Nutrition trial) conducted in Thatta, Pakistan, where both nutritional deficits and heat stress are prevalent. Multiple linear regression of ambient temperature and neonatal anthropometry at birth (n = 459) showed a negative association between daily maximal temperatures in the first trimester and Z-scores of birth length and head circumference. Placental mRNA-sequencing and protein analysis showed transcriptomic changes in protein translation, ribosomal proteins, and mTORC1 signaling components in term placenta exposed to excessive heat in the first trimester. Targeted metabolomic analysis indicated ambient temperature associated alterations in maternal circulation with decreases in choline concentrations. Notably, negative impacts of heat on birth length were in part mitigated in women randomized to comprehensive maternal nutritional supplementation before pregnancy suggesting potential interactions between heat stress and nutritional status of the mother. Collectively, the findings bridge critical gaps in our current understanding of how maternal nutrition may provide resilience against adverse effects of heat stress in pregnancy.
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Affiliation(s)
- Kartik Shankar
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | | | - Meghan L Ruebel
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
- USDA-ARS, Southeast Area, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA
| | | | - Sarah J Borengasser
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Stephanie P Gilley
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Puujee Jambal
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Deaunabah N Yazza
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Nicholas Weaver
- Department of Mathematical and Statistical Sciences, University of Colorado Denver, CO 80204, USA
| | - Jennifer F Kemp
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Jamie L Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Audrey E Hendricks
- Department of Mathematical and Statistical Sciences, University of Colorado Denver, CO 80204, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - K Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
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26
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de Bont J, Stafoggia M, Nakstad B, Hajat S, Kovats S, Part C, Chersich M, Luchters S, Filippi V, Stephansson O, Ljungman P, Roos N. Associations between ambient temperature and risk of preterm birth in Sweden: A comparison of analytical approaches. ENVIRONMENTAL RESEARCH 2022; 213:113586. [PMID: 35671796 DOI: 10.1016/j.envres.2022.113586] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/24/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Evidence indicates that high temperatures are a risk factor for preterm birth. Increasing heat exposures due to climate change are therefore a concern for pregnant women. However, the large heterogeneity of study designs and statistical methods across previous studies complicate interpretation and comparisons. We investigated associations of short-term exposure to high ambient temperature with preterm birth in Sweden, applying three complementary analytical approaches. METHODS We included 560,615 singleton live births between 2014 and 2019, identified in the Swedish Pregnancy Register. We estimated weekly mean temperatures at 1-km2 spatial resolution using a spatiotemporal machine learning methodology, and assigned them at the residential addresses of the study participants. The main outcomes of the study were gestational age in weeks and subcategories of preterm birth (<37 weeks): extremely preterm birth (<28 weeks), very preterm birth (from week 28 to <32), and moderately preterm birth (from week 32 to<37). Case-crossover, quantile regression and time-to-event analyses were applied to estimate the effects of short-term exposure to increased ambient temperature during the week before birth on preterm births. Furthermore, distributed lag nonlinear models (DLNM) were applied to identify susceptibility windows of exposures throughout pregnancy in relation to preterm birth. RESULTS A total of 1924 births were extremely preterm (0.4%), 2636 very preterm (0.5%), and 23,664 moderately preterm (4.2%). Consistent across all three analytical approaches (case-crossover, quantile regression and time-to-event analyses), higher ambient temperature (95th vs 50th percentile) demonstrated increased risk of extremely preterm birth, but associations did not reach statistical significance. In DLNM models, we observed no evidence to suggest an increased effect of high temperature on preterm birth risk. Even so, a suggested trend was observed in both the quantile regression and time-to-event analyses of a higher risk of extremely preterm birth with higher temperature during the last week before birth. CONCLUSIONS In Sweden, with high quality data on exposure and outcome, a temperate climate and good quality ante-natal health care, we did not find an association between high ambient temperatures and preterm births. Results were consistent across three complementary analytical approaches.
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Affiliation(s)
- Jeroen de Bont
- Institute of Environmental Medicine, Karolinska Institutet, Sweden.
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Sweden; Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Italy
| | - Britt Nakstad
- Division Paediatric Adolescent Medicine, Inst Clinical Medicine, University of Oslo, Oslo, Norway; Department Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Shakoor Hajat
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, UK
| | - Sari Kovats
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, UK
| | - Chérie Part
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, UK
| | - Matthew Chersich
- Wits Reproductive Health and HIV Institute, Faculty of Health Science, University of the Witwatersrand, South Africa
| | - Stanley Luchters
- Centre for Sexual Health and HIV/AIDS Research, CeSHHAR, Harare, Zimbabwe; Department of Public Health and Primary Care, Ghent University, Belgium; Liverpool School of Tropical Medicine, UK
| | - Veronique Filippi
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Sweden; Department of Cardiology, Danderyd University Hospital, Sweden
| | - Nathalie Roos
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Sweden
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27
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Libonati R, Geirinhas JL, Silva PS, Monteiro Dos Santos D, Rodrigues JA, Russo A, Peres LF, Narcizo L, Gomes MER, Rodrigues AP, DaCamara CC, Pereira JMC, Trigo RM. Drought-heatwave nexus in Brazil and related impacts on health and fires: A comprehensive review. Ann N Y Acad Sci 2022; 1517:44-62. [PMID: 36052446 DOI: 10.1111/nyas.14887] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Climate change is drastically altering the frequency, duration, and severity of compound drought-heatwave (CDHW) episodes, which present a new challenge in environmental and socioeconomic sectors. These threats are of particular importance in low-income regions with growing populations, fragile infrastructure, and threatened ecosystems. This review synthesizes emerging progress in the understanding of CDHW patterns in Brazil while providing insights about the impacts on fire occurrence and public health. Evidence is mounting that heatwaves are becoming increasingly linked with droughts in northeastern and southeastern Brazil, the Amazonia, and the Pantanal. In those regions, recent studies have begun to build a better understanding of the physical mechanisms behind CDHW events, such as the soil moisture-atmosphere coupling, promoted by exceptional atmospheric blocking conditions. Results hint at a synergy between CDHW events and high fire activity in the country over the last decades, with the most recent example being the catastrophic 2020 fires in the Pantanal. Moreover, we show that HWs were responsible for increasing mortality and preterm births during record-breaking droughts in southeastern Brazil. This work paves the way for a more in-depth understanding on CDHW events and their impacts, which is crucial to enhance the adaptive capacity of different Brazilian sectors.
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Affiliation(s)
- Renata Libonati
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto Dom Luiz, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal.,Forest Research Centre, School of Agriculture, University of Lisbon, Lisbon, Portugal
| | - João L Geirinhas
- Instituto Dom Luiz, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Patrícia S Silva
- Instituto Dom Luiz, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | | | - Julia A Rodrigues
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Russo
- Instituto Dom Luiz, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Leonardo F Peres
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luiza Narcizo
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Monique E R Gomes
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andreza P Rodrigues
- Escola de Enfermagem Anna Nery, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos C DaCamara
- Instituto Dom Luiz, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - José Miguel C Pereira
- Forest Research Centre, School of Agriculture, University of Lisbon, Lisbon, Portugal.,TERRA Associate Laboratory, Tapada da Ajuda, Portugal
| | - Ricardo M Trigo
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto Dom Luiz, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
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28
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Malaspina D. Editorial for Special Issue: From cytokines to climate and C-sections and from micronutrients to the microbiome: Neurodevelopment and the risk for psychosis. Schizophr Res 2022; 247:1-6. [PMID: 35396142 DOI: 10.1016/j.schres.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Dolores Malaspina
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry, Neuroscience, Genetic and Genomic Sciences, New York, N.Y. , U.S.A..
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29
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Mehrabadi S, Miri M, Najafi ML, Ghalenovi M, Adli A, Pajohanfar NS, Ambrós A, Dovlatabadi A, Estiri EH, Abroudi M, Alonso L, Bazghandi MS, Dadvand P. Green space exposure during pregnancy and umbilical cord blood levels of liver enzymes. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:68432-68440. [PMID: 35545744 DOI: 10.1007/s11356-022-20568-5] [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: 12/23/2021] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
Evidence has suggested better pregnancy outcomes due to exposure to greenspace; however, the studies on such an association with the level of liver enzymes in the cord blood are still nonexistent. Hence, this study investigated the relationship between exposure to greenspace during the entire pregnancy and gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels in cord blood samples. We selected 150 pregnant women from our pregnancy cohort in Sabzevar, Iran (2018). Greenspace exposure was characterized based on (i) residential distance to green space, (ii) time spent in public/private green spaces, (iii) residential surrounding greenspace, (iv) visual access to greenspace, and (v) number of indoor natural pot plants at home. We developed linear regression models to investigate the adjusted associations of greenspace exposure with enzyme levels. Each one interquartile range (IQR) increase in the residential surrounding greenspace (100 m buffer) was related to a reduction of -12.58 (U/L) (95% CI -22.86, -2.29), -3.35 (U/L) (95% CI -5.50, -1.20), and -0.57 (U/L) (95% CI -1.12, -0.02) in the levels of GGT, AST, and ALT, respectively. Moreover, a similar association was observed for the time the participants spent in green spaces. A decrease in the residential distance to large green spaces was related with lower cord blood levels of AST, ALT, and GGT. Having a window with greenspace view at home was significantly related to lower AST level. The results for the indoor plant pots were not conclusive. Our findings suggested an inverse relationship between greenspace exposure during pregnancy and cord blood levels of liver enzymes. Further studies in other settings and populations are needed to confirm our findings.
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Affiliation(s)
- Saide Mehrabadi
- Department of Midwifery, School of Nursing, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mohammad Miri
- Non-Communicable Diseases Research Center, Department of Environmental Health, School of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran.
| | - Moslem Lari Najafi
- Pharmaceutical Sciences and Cosmetic Products Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mina Ghalenovi
- Department of Midwifery, School of Nursing, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Abolfazl Adli
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Nasim Sadat Pajohanfar
- Department of Midwifery, School of Nursing, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Albert Ambrós
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Afishin Dovlatabadi
- Non-Communicable Diseases Research Center, Department of Environmental Health, School of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Elahe Hasannejad Estiri
- Non-Communicable Diseases Research Center, Department of Environmental Health, School of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mina Abroudi
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Lucia Alonso
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Malihe Sadat Bazghandi
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Payam Dadvand
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Nyadanu SD, Tessema GA, Mullins B, Pereira G. Prenatal acute thermophysiological stress and spontaneous preterm birth in Western Australia, 2000-2015: A space-time-stratified case-crossover analysis. Int J Hyg Environ Health 2022; 245:114029. [PMID: 36049361 DOI: 10.1016/j.ijheh.2022.114029] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/03/2022] [Accepted: 08/20/2022] [Indexed: 10/15/2022]
Abstract
Epidemiologic evidence on acute heat and cold stress and preterm birth (PTB) is inconsistent and based on ambient temperature rather than a thermophysiological index. The aim of this study was to use a spatiotemporal thermophysiological index (Universal Thermal Climate Index, UTCI) to investigate prenatal acute heat and cold stress exposures and spontaneous PTB. We conducted a space-time-stratified case-crossover analysis of 15,576 singleton live births with spontaneous PTB between January 1, 2000 and December 31, 2015 in Western Australia. The association between UTCI and spontaneous PTB was examined with distributed lag nonlinear models and conditional quasi-Poisson regression. Relative to the median UTCI, there was negligible evidence for associations at the lower range of exposures (1st to 25th percentiles). We found positive associations in the 95th and 99th percentiles, which increased with increasing days of heat stress in the first week of delivery. The relative risk (RR) and 95% confidence interval (CI) for the immediate (delivery day) and cumulative short-term (up to six preceding days) exposures to heat stress (99th percentile, 31.2 °C) relative to no thermal stress (median UTCI, 13.8 °C) were 1.01 (95% CI: 1.01, 1.02) and 1.05 (95% CI: 1.04, 1.06), respectively. Elevated effect estimates for heat stress were observed for the transition season, the year 2005-2009, male infants, women who smoked, unmarried, ≤ 19 years old, non-Caucasians, and high socioeconomic status. Effect estimates for cold stress (1st percentile, 0.7 °C) were highest in the transition season, during 2005-2009, and for married, non-Caucasian, and high socioeconomic status women. Acute heat stress was associated with an elevated risk of spontaneous PTB with sociodemographic vulnerability. Cold stress was associated with risk in a few vulnerable subgroups. Awareness and mitigation strategies such as hydration, reducing outdoor activities, affordable heating and cooling systems, and climate change governance may be beneficial. Further studies with the UTCI are required.
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Affiliation(s)
- Sylvester Dodzi Nyadanu
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia; Education, Culture, and Health Opportunities (ECHO) Ghana, ECHO Research Group International, Aflao, Ghana.
| | - Gizachew Assefa Tessema
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia; School of Public Health, University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - Ben Mullins
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia; EnAble Institute, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia; Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, 0473, Oslo, Norway
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Galarneau JM, Beach J, Cherry N. Pregnancy Outcome in Women Exposed to Metal Fume in Welding: A Canadian Cohort Study. Ann Work Expo Health 2022; 66:1099-1110. [PMID: 35488367 PMCID: PMC9664228 DOI: 10.1093/annweh/wxac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Welding is a physically demanding job that entails exposure to metal fume and particles. There is little information on the effect of welding exposures on the outcome of a pregnancy conceived during a period when a woman was employed as a welder. METHODS Women welders recruited to the Workers Health in Apprenticeship Trades-Metal and Electrical (WHAT-ME) study were followed-up every 6 months for up to 5 years (January 2011-August 2018), and every pregnancy recorded. At the first 6-month follow-up, a detailed questionnaire was completed for the most recent day in welding, and this information was collected again at each follow-up and also from questionnaires completed during pregnancy. The date of conception was estimated for each pregnancy and the job at that date identified. Exposures to ergonomic factors, work schedule and perceptions of noise, heat and cold were extracted for the job at conception. Exposures to metals (aluminum, chromium, manganese, and nickel) and particles in welding fume were estimated from previously validated exposure algorithms reflecting the welding process, base metal and consumables of the job at the conception date. The effects of exposures were estimated in multilevel multivariable models allowing for confounding. RESULTS There were 242 pregnancies conceived by a welder working in her trade, 87 were before the first follow-up, 3 were after first follow-up but detailed information was not collected, 22 of those potentially included in the assessment group were in-trade but not welding leaving 122 pregnancies in 90 welders for analysis. Of these 91 resulted in a live birth and 31 in a fetal loss (27 miscarriages and 4 stillbirths). Mean birth weight for live births was 3365 g and gestation 39.4 weeks. Final models showed that risk of fetal loss increased with manipulating heavy objects [odds ratio (OR) = 5.13, 95% confidence interval (CI) 2.04-12.92], whole-body vibration (OR = 5.86, 95% CI 1.81-18.92), a higher rating for noise exposure intensity (OR = 1.52, 95% CI 1.24-1.85), and decreased with use of local exhaust ventilation (OR = 0.20, 95% CI 0.03-1.18). Gestation decreased with perceived heat intensity (β = -0.15, 95% CI -0.29 to -0.02) and number of previous pregnancies (β = -0.35, 95% CI -0.65 to -0.05). Birth weight was lower in those reporting whole-body vibration (β = -596 g, 95% CI -924 to -267) and increased with the welder's body mass index (β = 36 g, 95% CI 12-61). Estimates of exposure to metals and particles were unrelated to gestation or birth weight. In a bivariate analysis, allowing for the same welder reporting >1 pregnancy, estimated airborne aluminum exposure (and to a lesser degree exposure to nickel and particles) was related to greater risk of fetal loss (OR = 1.52, 95% CI 1.04-2.24) but neither aluminum nor the other estimated elements of welding fume added to the final model. CONCLUSIONS In this group of women actively engaged in welding during the time surrounding conception, the outcome of pregnancy was strongly related to work exposures, particularly vibration (reported in grinding tasks), manipulation of heavy objects, and perceived intensity of noise and heat. The study was unable to show an independent effect of exposure to metal fume constituents.
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Affiliation(s)
- Jean-Michel Galarneau
- Division of Preventive Medicine, University of Alberta, Edmonton, Canada,Faculty of Kinesiology, Sports Injury Prevention Research Centre, University of Calgary, Calgary, Canada
| | - Jeremy Beach
- Division of Preventive Medicine, University of Alberta, Edmonton, Canada
| | - Nicola Cherry
- Author to whom correspondence should be addressed. Tel: +1-780-492-7851; e-mail:
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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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An Exploratory Spatiotemporal Analysis of Socio-Environmental Patterns in Severe Maternal Morbidity. Matern Child Health J 2022; 26:1077-1086. [PMID: 35060067 DOI: 10.1007/s10995-021-03330-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Severe Maternal Morbidity (SMM) is a group of pregnancy complications in which a woman nearly dies. Despite its increasing prevalence, little research has evaluated geographic patterns of SMM and the underlying social determinants that influence excess risk. This study examined the spatial clustering of SMM across South Carolina, US, and its associations with place-based social and environmental factors. METHODS Hospitalized deliveries from 2012 to 2017 were analyzed using Kulldorff's spatial scan statistic to locate areas with abnormally high rates of SMM. SMM patients inside and outside risk clusters were compared using Generalized Estimating Equations (GEE) to determine underlying individual and community-level risk factors. RESULTS GEE models revealed that the odds of living in a high-risk SMM21 (SMM including blood transfusions) cluster was 2.49 times higher among Black patients (p < .001) compared to those outside of a high-risk cluster. Women residing in a high-risk SMM20 (SMM excluding blood transfusions) cluster were 1.38 times more likely to experience the most number of extremely hot days and 1.70 times more likely to present with obesity than women in a low-risk SMM cluster (p < .001). CONCLUSIONS This study is the first to characterize the geographic clustering of SMM risk in the US. Our geospatial approach contributes a novel understanding to factors which influence SMM beyond patient-level characteristics and identifies the impact of hot ambient temperature on maternal morbidity. Findings address an important literature gap surrounding place-based risk factors by explaining the contextual social and built environmental factors that drive SMM risk.
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McElroy S, Ilango S, Dimitrova A, Gershunov A, Benmarhnia T. Extreme heat, preterm birth, and stillbirth: A global analysis across 14 lower-middle income countries. ENVIRONMENT INTERNATIONAL 2022; 158:106902. [PMID: 34627013 DOI: 10.1016/j.envint.2021.106902] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/23/2021] [Accepted: 09/22/2021] [Indexed: 06/13/2023]
Abstract
Stillbirths and complications from preterm birth are two of the leading causes of neonatal deaths across the globe. Lower- to middle-income countries (LMICs) are experiencing some of the highest rates of these adverse birth outcomes. Research has suggested that environmental determinants, such as extreme heat, can increase the risk of preterm birth and stillbirth. Under climate change, extreme heat events have become more severe and frequent and are occurring in differential seasonal patterns. Little is known about how extreme heat affects the risk of preterm birth and stillbirth in LMICs. Thus, it is imperative to examine how exposure to extreme heat affects adverse birth outcomes in regions with some of the highest rates of preterm and stillbirths. Most of the evidence linking extreme heat and adverse birth outcomes has been generated from high-income countries (HICs) notably because measuring temperature in LMICs has proven challenging due to the scarcity of ground monitors. The paucity of health data has been an additional obstacle to study this relationship in LMICs. In this study, globally gridded meteorological data was linked with spatially and temporally resolved Demographic and Health Surveys (DHS) data on adverse birth outcomes. A global analysis of 14 LMICs was conducted per a pooled time-stratified case-crossover design with distributed-lag nonlinear models to ascertain the relationship between acute exposure to extreme heat and PTB and stillbirths. We notably found that experiencing higher maximum temperatures and smaller diurnal temperature range during the last week before birth increased the risk of preterm birth and stillbirth. This study is the first global assessment of extreme heat events and adverse birth outcomes and builds the evidence base for LMICs.
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Affiliation(s)
- Sara McElroy
- University of California, San Diego-Herbert Wertheim School of Public Health, United States; San Diego State University, United States; Scripps Institution of Oceanography, United States.
| | - Sindana Ilango
- University of California, San Diego-Herbert Wertheim School of Public Health, United States; San Diego State University, United States; Scripps Institution of Oceanography, United States; University of Washington, United States
| | - Anna Dimitrova
- University of California, San Diego-Herbert Wertheim School of Public Health, United States; San Diego State University, United States; Scripps Institution of Oceanography, United States
| | - Alexander Gershunov
- University of California, San Diego-Herbert Wertheim School of Public Health, United States; San Diego State University, United States; Scripps Institution of Oceanography, United States
| | - Tarik Benmarhnia
- University of California, San Diego-Herbert Wertheim School of Public Health, United States; San Diego State University, United States; Scripps Institution of Oceanography, United States
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Ha S, Martinez V, Chan-Golston AM. Air pollution and preterm birth: A time-stratified case-crossover study in the San Joaquin Valley of California. Paediatr Perinat Epidemiol 2022; 36:80-89. [PMID: 34872160 DOI: 10.1111/ppe.12836] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/23/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Air pollution is linked to preterm birth (PTB), but existing studies are primarily focused on chronic exposures, conducted in areas with moderate pollution, and/or subject to confounding. OBJECTIVES We investigated short-term associations between two pollutants [particulate matter <2.5 microns (PM2.5 ) and ozone] and PTB, and estimated excess PTB cases potentially attributed to these pollutants. METHODS This time-stratified case-crossover study includes 196,970 singleton pregnancies affected by PTB and early term birth from the San Joaquin Valley (SJV), California, USA (2007-2015). Daily ozone and PM2.5 concentrations were estimated by the SJV Air Pollution Control District and geospatially linked to maternal zip code. We used conditional logistic regression models to estimate the odds ratio (OR) and 95% confidence intervals (CI) for the associations between an interquartile range (IQR) increase in pollutants and very preterm (VPTB, 20-34 weeks), moderate preterm (MPTB, 34-36 weeks) and early term births (ETB, 37-38 weeks). We adjusted all models for co-pollutants and meteorological factors. RESULTS During warm seasons (May-October), an IQR increase in ozone was associated with 9-11% increased odds of VPTB from lag 0 (ORlag0 1.09, 95% CI 1.04,1.16) to lag 7 (ORlag7 1.11, 95% CI 1.04,1.16). Findings were consistent for MPTB and ETB. Ozone was potentially responsible for an excess of 3-6 VPTBs, 7-9 PTBs and 24-42 ETBs per 1,000 singleton deliveries. During cold seasons (November-April), increased PM2.5 exposure was associated with 5-6% increased odds of VPTB beginning at lag 3 (ORlag3 1.06, 95% CI 1.02,1.11). PM2.5 was associated with an excess of 1-3 VPTBs, 0-3 MPTBs and 6-18 ETBs per 1,000 singleton deliveries. CONCLUSIONS PM2.5 and ozone are associated with increased risk of VPTB, MPTB and ETB within one week of exposure and are potential contributors to the increasing PTB trend. More research is needed to further understand the role of air pollution on PTB risk.
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Affiliation(s)
- Sandie Ha
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, California, USA.,Health Sciences Research Institute, University of California, Merced
| | - Valerie Martinez
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, California, USA.,Health Sciences Research Institute, University of California, Merced
| | - Alec M Chan-Golston
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, California, USA
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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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Gong Y, Chai J, Yang M, Sun P, Sun R, Dong W, Li Q, Zhou D, Yu F, Wang Y, Yan X, Zhang J, Zhang Y, Jiang L, Ba Y, Zhou G. Effects of ambient temperature on the risk of preterm birth in offspring of adolescent mothers in rural henan, China. ENVIRONMENTAL RESEARCH 2021; 201:111545. [PMID: 34171374 DOI: 10.1016/j.envres.2021.111545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/20/2021] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND A number of studies have explored the association between ambient temperature and preterm birth (PTB), but rarely among adolescent mothers. OBJECTIVES To estimate the effects of ambient temperature on the risk of PTB and gestational age of newborns delivered by adolescent mothers in rural areas of Henan province. METHODS We obtained 5394 medical records of adolescent mothers with results of pre-pregnancy physical examination and pregnancy outcomes from the National Free Preconception Health Examination Project (NFPHEP) in Henan province. Meteorological information was obtained from the China Meteorological Data Sharing Service System. Individual exposure levels were evaluated with an inverse distance-weighted model. A multiple logistic regression model and multiple linear regression model were used to estimate the effects of ambient temperature on the risk of PTB and gestational age, respectively. Stratified and interaction analyses were also performed. RESULTS Of newborns in this study, 3.45% (186/5394) were PTB. Mean, maximum and minimum temperature during the entire pregnancy, especially the last 1-4 weeks of pregnancy, were positively associated with the risk of PTB and negatively associated with gestational age (P < 0.05). Nevertheless, a masking effect was observed that gestational age was positively associated with ambient temperature during the first trimester of pregnancy, due to the strongly inverse correlation between ambient temperature during the early and late stages of pregnancy. Stratified analyses showed that increasing temperature during the last 1-4 weeks of pregnancy increased the risk of PTB and decreased gestational age in newborns born in the cold season (P < 0.05). Furthermore, interaction analyses showed that birth season modified the effects of temperature on the gestational age (Pinteraction < 0.10). CONCLUSIONS Elevated ambient temperature can decrease gestational age and increase the risk of PTB in offspring of adolescent mothers in rural areas. The birth season may modify the effects of temperature on gestational age.
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Affiliation(s)
- Yongxiang Gong
- Department of Environmental Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, PR China.
| | - Jian Chai
- National Health Commission Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Henan Institute of Reproduction Health Science and Technology, Zhengzhou, Henan, 450002, PR China.
| | - Meng Yang
- Department of Environmental Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, PR China.
| | - Panpan Sun
- National Health Commission Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Henan Institute of Reproduction Health Science and Technology, Zhengzhou, Henan, 450002, PR China.
| | - Renjie Sun
- Department of Environmental Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, PR China.
| | - Wei Dong
- National Health Commission Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Henan Institute of Reproduction Health Science and Technology, Zhengzhou, Henan, 450002, PR China.
| | - Qinyang Li
- Department of Environmental Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, PR China.
| | - Dezhuang Zhou
- National Health Commission Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Henan Institute of Reproduction Health Science and Technology, Zhengzhou, Henan, 450002, PR China.
| | - Fangfang Yu
- Department of Environmental Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, PR China; Yellow River Institute for Ecological Protection & Regional Coordinated Development, Zhengzhou University, Zhengzhou, Henan, 450001, PR China.
| | - Yuhong Wang
- National Health Commission Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Henan Institute of Reproduction Health Science and Technology, Zhengzhou, Henan, 450002, PR China.
| | - Xi Yan
- Department of Neurology, Henan Provincial People's Hospital; Zhengzhou University People's Hospital; Henan University People's Hospital, Zhengzhou, Henan, 450001, PR China.
| | - Junxi Zhang
- National Health Commission Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Henan Institute of Reproduction Health Science and Technology, Zhengzhou, Henan, 450002, PR China.
| | - Yawei Zhang
- Department of Environment Health Science, Yale University School of Public Health, New Haven, CT, USA.
| | - Lifang Jiang
- National Health Commission Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Henan Institute of Reproduction Health Science and Technology, Zhengzhou, Henan, 450002, PR China.
| | - Yue Ba
- Department of Environmental Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, PR China; Yellow River Institute for Ecological Protection & Regional Coordinated Development, Zhengzhou University, Zhengzhou, Henan, 450001, PR China.
| | - Guoyu Zhou
- Department of Environmental Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, PR China; Yellow River Institute for Ecological Protection & Regional Coordinated Development, Zhengzhou University, Zhengzhou, Henan, 450001, PR China.
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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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Dervis S, Dobson KL, Nagpal TS, Geurts C, Haman F, Adamo KB. Heat loss responses at rest and during exercise in pregnancy: A scoping review. J Therm Biol 2021; 99:103011. [PMID: 34420641 DOI: 10.1016/j.jtherbio.2021.103011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/07/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The teratogenic risk associated with maternal hyperthermia (i.e., core temperature ≥39.0 °C) has been a crucial motive in understanding thermoregulatory responses in pregnancy. To date, a substantial number of studies have focused on core temperature responses in a wide range of exercise intensities, duration, and ambient temperatures. Fortunately, none have reported core temperatures exceeding 39.0 °C. Nonetheless, there are limited studies that have provided substantial insight into both dry and evaporative heat loss mechanisms involved in facilitating the maintenance of core temperature (≥39.0 °C) during heat stress in pregnant women. The purpose of this scoping review was to summarize the available literature that has assessed heat loss responses in studies of human pregnancy. METHODS A search strategy was developed combining the terms pregnancy, thermoregulation, and adaptation. A systematic search was performed in the following databases: PubMed, Embase, Scopus, and ProQuest. Studies eligible for inclusion included pregnant women between the ages of 18-40 years old, and at least one measurement of the following: sweating, blood flow, skin temperature, and behavioural responses. Retrieved data were categorized as evaporative (sweating), dry or behavioural heat loss responses and summarized narratively. RESULTS Thirty-three studies were included in this review (twenty-nine measured physiological responses and four measured behavioural responses). Studies suggest that during exercise, evaporative (sweating) and dry (skin blood flow and temperature) heat loss responses increase from early to late pregnancy in addition to greater cardiac output, blood volume and reduced vascular resistance. Behavioural practices related to heat loss responses are also influenced by cultural/religious expectations, personal preferences and sociodemographics. CONCLUSION The findings from this review suggest that pregnancy modifies evaporative (sweating), dry and behavioural heat loss. However, future studies have an opportunity to compare heat loss measurements accounting for gestational weight gain and thermal sensation/comfort scale to associate physiological responses with perceptual responses across pregnancy.
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Affiliation(s)
- Sheila Dervis
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
| | - Kayla Lerher Dobson
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
| | - Taniya Singh Nagpal
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
| | - Carla Geurts
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
| | - François Haman
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
| | - Kristi Bree Adamo
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
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Saville NM, Cortina-Borja M, De Stavola BL, Pomeroy E, Marphatia A, Reid A, Manandhar DS, Wells JCK. Comprehensive analysis of the association of seasonal variability with maternal and neonatal nutrition in lowland Nepal. Public Health Nutr 2021; 25:1-16. [PMID: 34420531 PMCID: PMC9991647 DOI: 10.1017/s1368980021003633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/26/2021] [Accepted: 08/18/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To provide a comprehensive seasonal analysis of pregnant mothers' eating behaviour and maternal/newborn nutritional status in an undernourished population from lowland rural Nepal, where weather patterns, agricultural labour, food availability and disease prevalence vary seasonally. DESIGN Secondary analysis of cluster-randomised Low Birth Weight South Asia Trial data, applying cosinor analysis to predict seasonal patterns. OUTCOMES Maternal mid-upper arm circumference (MUAC), BMI, dietary diversity, meals per day, eating down and food aversion in pregnancy (≥31 weeks' gestation) and neonatal z-scores of length-for-age (LAZ), weight-for-age (WAZ) and head circumference-for-age (HCAZ) and weight-for-length (WLZ). SETTING Rural areas of Dhanusha and Mahottari districts in plains of Nepal. PARTICIPANTS 2831 mothers aged 13-50 and 3330 neonates. RESULTS We found seasonal patterns in newborn anthropometry and pregnant mothers' anthropometry, meal frequency, dietary diversity, food aversion and eating down. Seasonality in intake varied by food group. Offspring anthropometry broadly tracked mothers'. Annual amplitudes in mothers' MUAC and BMI were 0·27 kg/m2 and 0·22 cm, with peaks post-harvest and nadirs in October when food insecurity peaked. Annual LAZ, WAZ and WLZ amplitudes were 0·125, 0·159 and 0·411 z-scores, respectively. Neonates were the shortest but least thin (higher WLZ) in winter (December/January). In the hot season, WLZ was the lowest (May/June) while LAZ was the highest (March and August). HCAZ did not vary significantly. Food aversion and eating down peaked pre-monsoon (April/May). CONCLUSIONS Our analyses revealed complex seasonal patterns in maternal nutrition and neonatal size. Seasonality should be accounted for when designing and evaluating public heath nutrition interventions.
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Affiliation(s)
- Naomi M Saville
- Institute for Global Health (IGH), University College London (UCL), London, UK
| | - Mario Cortina-Borja
- Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | - Bianca L De Stavola
- Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | - Emma Pomeroy
- Department of Archaeology, University of Cambridge, Cambridge, UK
| | | | - Alice Reid
- Department of Geography, University of Cambridge, Cambridge, UK
| | | | - Jonathan CK Wells
- Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
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Kim JH, Choi YY, Yoo SI, Kang DR. Association between ambient air pollution and high-risk pregnancy: A 2015-2018 national population-based cohort study in Korea. ENVIRONMENTAL RESEARCH 2021; 197:110965. [PMID: 33722528 DOI: 10.1016/j.envres.2021.110965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Several studies have indicated that prenatal exposure to ambient air pollution is associated with an increased risk of gestational diabetes mellitus, hypertensive disorder during pregnancy, preterm birth, and stillbirth. However, no previous study has focused on the association between the number of pregnancy complications and exposure to ambient air pollution. OBJECTIVES To investigate the association between prenatal exposure to ambient air pollutants and the number of pregnancy complications in high-risk pregnancies. METHODS We collected data on gestational diabetes mellitus, hypertensive disorder during pregnancy, preterm birth, and stillbirth from the National Health Information Databases, provided by the Korean National Health Insurance Service.R To assess individual-level exposure to air pollutants, a spatial prediction model and area-averaging approach were used. RESULTS From 2015 to 2018, data of 789,595 high-risk pregnancies were analyzed. The ratio of gestational diabetes mellitus in the country was the highest, followed by preterm birth, hypertensive disorder during pregnancy, and stillbirth. Approximately 71.7% of pregnant women (566,143) presented with one pregnancy complication in identical pregnancies, 27.5% (216,714) presented with two, and 0.9% (6738) presented with three or more. Multiple logistic regression models with adjustments for age, residence, and income variables indicated that the risk of having two or more pregnancy complications was positively associated with the exposure to higher levels of PM10 (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.09-1.12) and PM2.5 (OR, 1.14; 95% CI, 1.12-1.15). The highest quartile presented higher odds of two or more pregnancy complications compared with the lower three quartiles of PM10, PM2.5, CO, NO2, and SO2 exposures (p < 0.001). CONCLUSION The results indicate that the risk of pregnancy complications is positively associated with the exposure to the high concentrations of PM10, PM2.5, CO, NO2, and SO2.
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Affiliation(s)
- Ju Hee Kim
- Department of Nursing, College of Nursing Science, Kyung Hee University, Seoul, 02447, Republic of Korea.
| | - Yoon Young Choi
- Artificial Intelligence Big Data Medical Center, Wonju College of Medicine, Yonsei University, Wonju, 26426, Republic of Korea
| | - Soo-In Yoo
- Department of Nursing, College of Nursing Science, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Dae Ryong Kang
- Department of Precision Medicine, Wonju College of Medicine, Yonsei University, Wonju, 26426, Republic of Korea.
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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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A Concretizing Research on Making Higher-Education Sustainability Count. SUSTAINABILITY 2021. [DOI: 10.3390/su13052724] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In order to manage the worrying predicament of declining global birth rates, a majority of higher-education institutions have commenced to institute a series of diversified strategies in order to make higher-education sustainability count. The aim of this research is to present the results of a study with the goal of helping educational institutions achieve their sustainability. As a succession of quantitative and qualitative analyses and measurements, there are four valuable and contributive findings in this research. First, total tuition and miscellaneous revenues (TTMR), total university–industry cooperative revenues (TUCIR) and total grants from government (TGG) of higher-education governance (HEG) were able to directly and effectively increase higher-education sustainable value. This definitively indicates that current higher-education students and staff, as well as higher-education experts and professionals, indeed agree that the tuition and miscellaneous fees, university–industry cooperative, and government grant revenues have become the most critical determinants of university environment social governance (UESG). This is because the majority of higher-education institutions do need these revenue resources to advance a succession of environmental protections, social responsibilities, and governance performance for current higher-education institution sustainability development. Second, comprehensive scale of QS rankings (CS-QS) was the most important key determinant to evaluate the university social responsibility development (USRD), which means the majority of higher-education institutions have to pay more attention on the comprehensive scale of QS rankings (CS-QS) in order to make more sustainability count. The third finding is the number of student’s publications (NSP), which was the most crucial key determinant to assay return on investments (ROI), meaning current higher-education students, staff, experts, and professionals consent to higher-education institutions having to establish an evaluated system for student’s publications to stimulate students to publish their diversified studying outcomes in order to make students recognize their growth after taking courses in higher education. The last finding is total tuition and miscellaneous revenues (TTMR) was the most momentous key determinant to control high education governance (HEG), which means current higher-education students, staff, experts, and professionals are concerned with the various governance performances of their tuition and miscellaneous fees. As for the future direction, there are still some evaluated criteria and assessed methods to be comprehensively considered and employed for inducing in-depth conclusions and findings with higher research reliability and validity without time limitations and resource restrictions.
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Cheng P, Peng L, Hao J, Li S, Zhang C, Dou L, Fu W, Yang F, Hao J. Short-term effects of ambient temperature on preterm birth: a time-series analysis in Xuzhou, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:12406-12413. [PMID: 33078353 DOI: 10.1007/s11356-020-11201-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/09/2020] [Indexed: 06/11/2023]
Abstract
To date, research evidence suggests that extreme ambient temperatures may lead to preterm birth. Since the results of studies in subtropical humid monsoon climate are inconclusive, we investigated the association between extreme ambient temperatures and the risk of preterm birth in Xuzhou, China. We analyzed the association between the birth data of 103,876 singleton deliveries (from July 1, 2016 to June 30, 2019) and ambient temperature. We used a quasi-Poisson model with distributed lag nonlinear models (DLNM) to investigate the delay and nonlinear effects of temperature, taking into account the effects of air pollutants and relative humidity. During the study period, the number of hospitalizations for preterm birth was 4623. Taking the median temperature (16.8 °C) as a reference, the highest risk estimate at extreme cold temperature (- 2.8 °C, 1st percentile) was found at lag 0-1 days. Exposure to extreme cold (- 2.8 °C, 1st percentile), or moderate cold (6.8 °C, 25th percentile) were associated with 1.659 (95% confidence interval [CI] 1.177-2.338) and 1.456 (95% CI 1.183-1.790) increased risks of preterm birth, respectively. In the further stratified analysis of the age of pregnant women, we found that there were significant associations between cold temperatures and preterm birth in both groups (older group ≥ 35; younger group < 35). In a subtropical humid monsoon climate, low ambient temperatures may lead to preterm birth, suggesting that women should stay away from low temperatures during pregnancy.
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Affiliation(s)
- Peng Cheng
- Department of Maternal Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Lei Peng
- Xuzhou Maternal and Child Health Family Planning Service Center, 46 Heping Road, Xuzhou, 221000, Jiangsu, China
| | - Jingwen Hao
- Department of Maternal Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Sha Li
- Department of Maternal Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Chao Zhang
- Department of Maternal Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Lianjie Dou
- Department of Maternal Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Weinan Fu
- Department of Maternal Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Fan Yang
- Department of Maternal Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Jiahu Hao
- Department of Maternal Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
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Ranjbaran M, Mohammadi R, Yaseri M, Kamari M, Habibelahi A, Yazdani K. Effect of ambient air pollution and temperature on the risk of stillbirth: a distributed lag nonlinear time series analysis. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2020; 18:1289-1299. [PMID: 33312643 PMCID: PMC7721760 DOI: 10.1007/s40201-020-00547-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 09/21/2020] [Indexed: 05/09/2023]
Abstract
OBJECTIVES This study aimed to determine the effect of ambient air pollution and temperature on stillbirth in Tehran. METHODS In this time-series study, the effect of O3 (ppb), CO (ppm), NO2 (ppb), SO2 (ppb), PM2.5 (μg/m3), and minimum, maximum, and mean daily temperature (°C) on stillbirth was evaluated in Tehran, Iran between March 2015 and March 2018. Using a quasi-Poisson regression model in combination with a Distributed Lag Non-linear Models (DLNM), the Relative Risk (RR) was estimated through comparing the high temperature (99th, 95th, and 75th percentiles) and low temperature (1st, 5th, and 25th percentiles) with the median. The effect of air pollution was estimated for each 1-, 5-, or 10-unit increase in the concentration during lags (days) 0-21. RESULTS Among air pollutants, only a 5-ppm increase in the SO2 concentration in lag 0 increased the risk of stillbirth significantly (RR = 1.062; 1.002-1.125). The largest effect of heat was observed while comparing the 99th percentile of minimum daily temperature (26.9 °C) with the median temperature (13.2 °C), which was not statistically significant (RR = 1.25; 0.95-1.65). As for cold, a non-significant protective effect was observed while comparing the 1st percentile of maximum daily temperature (3.1 °C) with the median temperature (23.2 °C) (RR = 0.92; 0.72-1.19). CONCLUSION Each 5-ppm increase in the mean daily SO2 in lag 0 increased the risk of stillbirth by 6% while other air pollutants had no significant effects on stillbirth. In lags 0 and 1, the heat increased the risk of stillbirth while the cold had protective effects, which were not statistically significant.
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Affiliation(s)
- Mehdi Ranjbaran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- School of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
- Nutritional Health Research Center, Health and Nutritional Department, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Kamari
- Deputy of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Kamran Yazdani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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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: 153] [Impact Index Per Article: 38.3] [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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