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Bonell A, Ioannou LG, Hirst JE, Flouris A. Understanding the physiological and biological response to ambient heat exposure in pregnancy: protocol for a systematic review and meta-analysis. BMJ Open 2024; 14:e085314. [PMID: 38969375 PMCID: PMC11227802 DOI: 10.1136/bmjopen-2024-085314] [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: 02/12/2024] [Accepted: 06/21/2024] [Indexed: 07/07/2024] Open
Abstract
INTRODUCTION Climate change increases not only the frequency, intensity and duration of extreme heat events but also annual temperatures globally, resulting in many negative health effects, including harmful effects on pregnancy and pregnancy outcomes. As temperatures continue to increase precipitously, there is a growing need to understand the underlying biological pathways of this association. This systematic review will focus on maternal, placental and fetal changes that occur in pregnancy due to environmental heat stress exposure, in order to identify the evidence-based pathways that play a role in this association. METHODS AND ANALYSIS We will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will search PubMed and Ovid Embase databases from inception using tested and validated search algorithms. Inclusion of any studies that involve pregnant women and have measured environmental heat stress exposure and either maternal, placental or fetal physiological or biochemical changes and are available in English. Modelling studies or those with only animals will be excluded. The risk of bias will be assessed using the Office of Health Assessment and Translation tool. Abstract screening, data extraction and risk of bias assessment will be conducted by two independent reviewers.Environmental parameters will be reported for each study and where possible these will be combined to calculate a heat stress indicator to allow comparison of exposure between studies. A narrative synthesis will be presented following standard guidelines. Where outcome measures have at least two levels of exposure, we will conduct a dose-response meta-analysis should there be at least three studies with the same outcome. A random effects meta-analysis will be conducted where at least three studies give the same outcome. ETHICS AND DISSEMINATION This systematic review and meta-analysis does not require ethical approval. Dissemination will be through peer-reviewed journal publication and presentation at international conferences/interest groups. PROSPERO REGISTRATION NUMBER CRD42024511153.
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Affiliation(s)
- Ana Bonell
- Medical Research Council Unit The Gambia, London School of Hygiene & Tropical Medicine, London, UK
| | - Leonidas G Ioannou
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Volos, Greece
| | - Jane Elizabeth Hirst
- The George Institute for Global Health, Imperial College London, London, UK
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Andreas Flouris
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Volos, Greece
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Wang L, Zhang C, Di J, Wang Q, Ren M, Huang A, Chen S, Zhao W, Hu H, Wang A, Di Q, Ji JS, Liang W, Huang C. Increased risk of preterm birth due to heat exposure during pregnancy: Exploring the mechanism of fetal physiology. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 931:172730. [PMID: 38663596 DOI: 10.1016/j.scitotenv.2024.172730] [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: 12/22/2023] [Revised: 04/07/2024] [Accepted: 04/22/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Heat exposure during pregnancy can increase the risk of preterm birth (PTB) through a range of potential mechanisms including pregnancy complications, hormone secretion and infections. However, current research mainly focuses on the effect of heat exposure on pathophysiological pathways of pregnant women, but ignore that maternal heat exposure can also cause physiological changes to the fetus, which will affect the risk of PTB. OBJECTIVE In this study, we aimed to explore the mediating role of fetal heart rate (FHR) in the relationship between maternal heat exposure and PTB incidence. METHODS We assigned heat exposure to a multi-center birth cohort in China during 2015-2018, which included all 162,407 singleton live births with several times FHR measurements during the second and third trimesters. We examined the associations between heat exposure, FHR and PTB in the entire pregnancy, each trimester and the last gestational month. The inverse odds ratio-weighted approach applied to the Cox regression was used to identify the mediation effect of heat exposure on PTB and its clinical subtypes via FHR. FINDINGS Exposure to heat significantly increased the risk of PTB during the third trimester and the entire pregnancy, hazard ratios and 95 % CIs were 1.266 (1.161, 1.379) and 1.328 (1.218, 1.447). Heat exposure during the third trimester and entire pregnancy increased FHR in the third trimester by 0.24 bpm and 0.14 bpm. The proportion of heat exposure mediated by FHR elevation on PTB and its subtype ranged from 3.68 % to 24.06 %, with the significant mediation effect found for both medically indicated PTB and spontaneous PTB. CONCLUSIONS This study suggests that heat exposure during pregnancy has an important impact on fetal health, and FHR, as a surrogate marker of fetal physiology, may mediate the increased risk of PTB caused by extreme heat. Monitoring and managing physiological changes in the fetus would constitute a promising avenue to reduce adverse birth outcomes associated with maternal heat exposure.
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Affiliation(s)
- Liyun Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chunying Zhang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiangli Di
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qiong Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Meng Ren
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Aiqun Huang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sidi Chen
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wei Zhao
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huanqing Hu
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ailing Wang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Qian Di
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - John S Ji
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute of Healthy China, Tsinghua University, Beijing, China
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute of Healthy China, Tsinghua University, Beijing, China.
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Xiao H, Li Y, Liu X, Wen Q, Yao C, Zhang Y, Xie W, Wu W, Wu L, Ma X, Li Y, Ji A, Cai T. High ambient temperature may increase the risk of anemia in pregnancy: Identifying susceptible exposure windows. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 926:172059. [PMID: 38556012 DOI: 10.1016/j.scitotenv.2024.172059] [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: 11/08/2023] [Revised: 03/16/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
Anemia in pregnancy (AIP) is associated with multiple severe maternal and perinatal adverse outcomes. However, there is a lack of evidence on the association between environmental factors and AIP. Aim to explore the association between ambient temperature and the risk of AIP, and identify susceptible exposure windows, we conducted a matched case-control study from 2013 to 2016 in Xi'an, China, which included 710 women with AIP and 1420 women without AIP. The conditional logistic regression model was used to evaluate the association between ambient temperature and AIP at different gestational weeks and gestational months. The association between extreme temperature and AIP was evaluated using the distributed lag nonlinear model (DLNM). We conducted stratified analyses of age, parity, and season of conception, and estimated the interaction between ambient temperature and air pollutants on AIP. Ambient temperature was significantly positively associated with the risk of AIP, and the susceptible exposure windows were 2-25 gestational weeks and 1-6 gestational months, respectively. The strongest effect was observed in the week 8 and month 2, for each 1 °C increase in weekly and monthly mean temperature, the odds ratio (OR) for AIP was 1.038 (95 % confidence interval (CI): 1.022, 1.055) and 1.040 (95 % CI: 1.020, 1.060), respectively. Extreme heat may increase the risk of AIP. Stratified analyses showed that there was no significant difference among different age, parity, and season of conception groups. No significant interaction effect of ambient temperature with air pollution on AIP was found. In summary, high ambient temperature may increase the risk of AIP, and the first and second trimesters may be susceptible exposure windows. Understanding the effect of temperature on pregnant women will be beneficial to reduce the occurrence of AIP.
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Affiliation(s)
- Hua Xiao
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Yunlong Li
- Department of Hematology, Chongqing Hospital of Jiangsu Province Hospital (Qijiang People Hospital), Chongqing 401420, China
| | - Xiaoling Liu
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Qin Wen
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), 400037, China
| | - Chunyan Yao
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Yao Zhang
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Weijia Xie
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Wenhui Wu
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Long Wu
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Xiangyu Ma
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Yafei Li
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Ailing Ji
- Department of Digital Health, Chongqing College of Architecture and Technology, Chongqing 401331, China.
| | - Tongjian Cai
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China.
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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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Nyadanu SD, Dunne J, Tessema GA, Mullins B, Kumi-Boateng B, Bell ML, Duko B, Pereira G. Maternal exposure to ambient air temperature and adverse birth outcomes: An umbrella review of systematic reviews and meta-analyses. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 917:170236. [PMID: 38272077 DOI: 10.1016/j.scitotenv.2024.170236] [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: 07/27/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Multiple systematic reviews on prenatal ambient temperature and adverse birth outcomes exist, but the overall epidemiological evidence and the appropriate metric for thermal stress remain unclear. An umbrella review was performed to summarise and appraise the evidence with recommendations. METHODS Systematic reviews and meta-analyses on the associations between ambient temperature and adverse birth outcomes (preterm birth, stillbirth, birth weight, low birth weight, and small for gestational age) up to December 20, 2023, were synthesised according to a published protocol. Databases PubMed, CINAHL, Scopus, MEDLINE/Ovid, EMBASE/Ovid, Web of Science Core Collection, systematic reviews repositories, electronic grey literature, and references were searched. Risk of bias was assessed using Joanna Briggs Institute's critical appraisal tool. RESULTS Eleven systematic reviews, including two meta-analyses, were included. This comprised 90 distinct observational studies that employed multiple temperature assessment metrics with a very high overlap of primary studies. Primary studies were mostly from the United States while both Africa and South Asia contributed only three studies. A majority (7 out of 11) of the systematic reviews were rated as moderate risk of bias. All systematic reviews indicated that maternal exposures to both extremely high and low temperatures, particularly during late gestation are associated with increased risks of preterm birth, stillbirth, and reduced fetal growth. However, due to great differences in the exposure assessments, high heterogeneity, imprecision, and methodological limitations of the included systematic reviews, the overall epidemiological evidence was classified as probable evidence of causation. No study assessed biothermal metrics for thermal stress. CONCLUSIONS Despite the notable methodological differences, prenatal exposure to extreme ambient temperatures, particularly during late pregnancy, was associated with adverse birth outcomes. Adhering to the appropriate systematic review guidelines for environmental health research, incorporating biothermal metrics into exposure assessment, evidence from broader geodemographic settings, and interventions are recommended in future studies.
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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, P. O. Box 424, Aflao, Ghana.
| | - Jennifer Dunne
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia 6102, Australia
| | - Gizachew A 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
| | - Bernard Kumi-Boateng
- Department of Geomatic Engineering, University of Mines and Technology, P. O. Box 237, Tarkwa, Ghana
| | - Michelle L Bell
- School of the Environment, Yale University, New Haven, CT 06511, USA
| | - Bereket Duko
- 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; WHO Collaborating Centre for Climate Change and Health Impact Assessment, Faculty of Health Science, Curtin University, WA, Australia
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Maralani PJ, Pai V, Ertl-Wagner BB. Safety of Magnetic Resonance Imaging in Pregnancy. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:34-40. [PMID: 37747489 DOI: 10.1007/s00117-023-01207-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Abstract
Magnetic resonance imaging is being increasingly used to diagnose and follow up a variety of medical conditions in pregnancy, both for maternal and fetal indications. However, limited data regarding its safe use in pregnancy may be a source of anxiety and avoidance for both patients and their healthcare providers. In this review, we critically discuss the main safety concerns of Magnetic Resonance Imaging (MRI) in pregnancy including energy deposition, acoustic noise, and use of contrast agents, supported by data from animal and human studies. Use of maternal sedatives and concerns related to occupational exposure in pregnant personnel are also addressed. Exposure to gadolinium-based contrast agents and sedation for MRI during pregnancy should be avoided whenever feasible.
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Affiliation(s)
- Pejman Jabehdar Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Bayview Avenue, Room AG270C, 2075, Toronto, Ontario, Canada.
| | - Vivek Pai
- Department of Medical Imaging, University of Toronto, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
| | - Birgit B Ertl-Wagner
- Department of Medical Imaging, University of Toronto, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
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Li K, Hikage T, Masuda H, Ijima E, Nagai A, Taguchi K. Parameter variation effects on millimeter wave dosimetry based on precise skin thickness in real rats. Sci Rep 2023; 13:17397. [PMID: 37833400 PMCID: PMC10575911 DOI: 10.1038/s41598-023-44572-y] [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: 02/27/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023] Open
Abstract
This study presents a parametric analysis of the steady-state temperature elevation in rat skin models due to millimeter wave exposure at frequencies from 6-100 GHz. The statistical data of the thickness of skin layers, namely epidermis, dermis, dermal white adipose tissue, and panniculus carnosus, were measured for the first time using the excised tissues of real male Sprague-Dawley rats. Based on the precise structure obtained from the histological analysis of rat skin, we solve the bioheat transfer equation to investigate the effects of changes in parameters, such as body parts and thermal constants, on the absorbed power density and temperature elevation of biological tissues. Owing to the notably thin dermal white adipose tissue layer, the surface temperature elevation in the rat head and dorsal skin at 6-100 GHz is 52.6-32.3% and 83.3-58.8% of the average values of different human skin models, respectively. Our results also reveal that the surface temperature elevation of rat skin may correlate with the tissue thickness and deep blood perfusion rates.
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Affiliation(s)
- Kun Li
- Advanced Wireless and Communication Research Center, The University of Electro-Communications, 182-8585, Tokyo, Japan.
| | - Takashi Hikage
- Faculty of Information Science and Technology, Hokkaido University, 060-0808, Hokkaido, Japan
| | - Hiroshi Masuda
- Department of Environmental Medicine, Kurume University School of Medicine, Fukuoka, 830-0011, Japan
| | - Etsuko Ijima
- Department of Environmental Medicine, Kurume University School of Medicine, Fukuoka, 830-0011, Japan
| | - Akiko Nagai
- Department of Anatomy, Aichi-Gakuin University School of Dentistry, Nagoya, 464-8650, Japan
| | - Kenji Taguchi
- Department of Electrical and Electronic Engineering, Kitami Institute of Technology, Kitami, 090-8507, Japan
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Cordelli E, Ardoino L, Benassi B, Consales C, Eleuteri P, Marino C, Sciortino M, Villani P, Brinkworth MH, Chen G, McNamee JP, Wood AW, Belackova L, Verbeek J, Pacchierotti F. Effects of Radiofrequency Electromagnetic Field (RF-EMF) exposure on pregnancy and birth outcomes: A systematic review of experimental studies on non-human mammals. ENVIRONMENT INTERNATIONAL 2023; 180:108178. [PMID: 37729852 DOI: 10.1016/j.envint.2023.108178] [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: 02/13/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND The World Health Organization is coordinating an international project aimed at systematically reviewing the evidence regarding the association between radiofrequency electromagnetic field (RF-EMF) exposure and adverse health effects. Within the project, 6 topics have been prioritized by an expert group, which include reproductive health outcomes. OBJECTIVES According to the protocol published in 2021, a systematic review and meta-analyses on the adverse effects of RF-EMF exposure during pregnancy in offspring of experimental animals were conducted. METHODS Three electronic databases (PubMed, Scopus and EMF Portal) were last searched on September 8 or 17, 2022. Based on predefined selection criteria, the obtained references were screened by two independent reviewers. Studies were included if they met the following criteria: 1) original, sham controlled experimental study on non-human mammals exposed in utero, published in peer-reviewed journals, 2) the experimental RF-EMF exposure was within the frequency range 100 kHz-300 GHz, 3) the effects of RF-EMF exposure on fecundity (litter size, embryonic/fetal losses), on the offspring health at birth (decrease of weight or length, congenital malformations, changes of sex ratio) or on delayed effects (neurocognitive alterations, female infertility or early-onset cancer) were studied. Study characteristics and outcome data were extracted by two reviewers. Risk of bias (RoB) was assessed using the Office of Health Assessment and Translation (OHAT) guidelines. Study results were pooled in a random effects meta-analysis comparing average exposure to no-exposure and in a dose-response meta-analysis using all exposure doses, after exclusion of studies that were rated at "high concern" for RoB. Subgroup analyses were conducted for species, Specific Absorption Rate (SAR) and temperature increase. The certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS Eighty-eight papers could be included in this review. Effects on fecundity. The meta-analysis of studies on litter size, conducted at a whole-body average SAR of 4.92 W/kg, did not show an effect of RF-EMF exposure (MD 0.05; 95% CI -0.21 to 0.30). The meta-analysis of studies on resorbed and dead fetuses, conducted at a whole-body average SAR of 20.26 W/kg, showed a significant increase of the incidence in RF-EMF exposed animals (OR 1.84; 95% CI 1.27 to 2.66). The results were similar in the dose-response analysis. Effects on the offspring health at birth. The meta-analysis of studies on fetal weight, conducted at a whole-body average SAR of 9.83 W/kg, showed a small decrease in RF-EMF exposed animals (SMD 0.31; 95% CI 0.15 to 0.48). The meta-analysis of studies on fetal length, conducted at a whole-body average SAR of 4.55 W/kg, showed a moderate decrease in length at birth (SMD 0.45; 95% CI 0.07 to 0.83). The meta-analysis of studies on the percentage of fetuses with malformations, conducted at a whole-body average SAR of 6.75 W/kg, showed a moderate increase in RF-EMF exposed animals (SMD -0.45; 95% CI -0.68 to -0.23). The meta-analysis of studies on the incidence of litters with malformed fetuses, conducted at a whole-body average SAR of 16.63 W/kg, showed a statistically significant detrimental RF-EMF effect (OR 3.22; 95% CI 1.9 to 5.46). The results were similar in the dose-response analyses. Delayed effects on the offspring health. RF-EMF exposure was not associated with detrimental effects on brain weight (SMD 0.10; 95% CI -0.09 to 0.29) and on learning and memory functions (SMD -0.54; 95% CI -1.24 to 0.17). RF-EMF exposure was associated with a large detrimental effect on motor activity functions (SMD 0.79; 95% CI 0.21 to 1.38) and a moderate detrimental effect on motor and sensory functions (SMD -0.66; 95% CI -1.18 to -0.14). RF-EMF exposure was not associated with a decrease of the size of litters conceived by F2 female offspring (SMD 0.08; 95% CI -0.39 to 0.55). Notably, meta-analyses of neurobehavioural effects were based on few studies, which suffered of lack of independent replication deriving from only few laboratories. DISCUSSION There was high certainty in the evidence for a lack of association of RF-EMF exposure with litter size. We attributed a moderate certainty to the evidence of a small detrimental effect on fetal weight. We also attributed a moderate certainty to the evidence of a lack of delayed effects on the offspring brain weight. For most of the other endpoints assessed by the meta-analyses, detrimental RF-EMF effects were shown, however the evidence was attributed a low or very low certainty. The body of evidence had limitations that did not allow an assessment of whether RF-EMF may affect pregnancy outcomes at exposure levels below those eliciting a well-known adverse heating impact. In conclusion, in utero RF-EMF exposure does not have a detrimental effect on fecundity and likely affects offspring health at birth, based on the meta-analysis of studies in experimental mammals on litter size and fetal weight, respectively. Regarding possible delayed effects of in utero exposure, RF-EMF probably does not affect offspring brain weight and may not decrease female offspring fertility; on the other hand, RF-EMF may have a detrimental impact on neurobehavioural functions, varying in magnitude for different endpoints, but these last findings are very uncertain. Further research is needed on the effects at birth and delayed effects with sample sizes adequate for detecting a small effect. Future studies should use standardized endpoints for testing prenatal developmental toxicity and developmental neurotoxicity (OECD TG 414 and 426), improve the description of the exposure system design and exposure conditions, conduct appropriate dosimetry characterization, blind endpoint analysis and include several exposure levels to better enable the assessment of a dose-response relationship. PROTOCOL REGISTRATION AND PUBLICATION The protocol was published in Pacchierotti et al., 2021 and registered in PROSPERO CRD42021227746 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227746).
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Affiliation(s)
- Eugenia Cordelli
- Division Health Protection Technologies, Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Rome, Italy.
| | - Lucia Ardoino
- Division Health Protection Technologies, Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Rome, Italy
| | - Barbara Benassi
- Division Health Protection Technologies, Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Rome, Italy
| | - Claudia Consales
- Division Health Protection Technologies, Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Rome, Italy
| | - Patrizia Eleuteri
- Division Health Protection Technologies, Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Rome, Italy
| | - Carmela Marino
- Division Health Protection Technologies, Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Rome, Italy
| | | | - Paola Villani
- Division Health Protection Technologies, Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Rome, Italy
| | - Martin H Brinkworth
- School of Chemistry and Bioscience, Faculty of Life Sciences, University of Bradford, Bradford, UK
| | - Guangdi Chen
- Bioelectromagnetics Laboratory, Zhejiang University School of Medicine, Hangzhou, China
| | - James P McNamee
- Non-Ionizing Radiation Health Sciences Division, Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada
| | - Andrew W Wood
- Department of Health Sciences and Biostatistics, Swinburne University of Technology, Hawthorn, Australia
| | - Lea Belackova
- University Medical Centers Amsterdam, Coronel Institute of Occupational Health, Cochrane Work, Amsterdam, The Netherlands
| | - Jos Verbeek
- University Medical Centers Amsterdam, Coronel Institute of Occupational Health, Cochrane Work, Amsterdam, The Netherlands
| | - Francesca Pacchierotti
- Division Health Protection Technologies, Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Rome, Italy.
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Nyadanu SD, Tessema GA, Mullins B, Kumi-Boateng B, Ofosu AA, Pereira G. Prenatal exposure to long-term heat stress and stillbirth in Ghana: A within-space time-series analysis. ENVIRONMENTAL RESEARCH 2023; 222:115385. [PMID: 36736550 DOI: 10.1016/j.envres.2023.115385] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 01/22/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Few studies examined the association between prenatal long-term ambient temperature exposure and stillbirth and fewer still from developing countries. Rather than ambient temperature, we used a human thermophysiological index, Universal Thermal Climate Index (UTCI) to investigate the role of long-term heat stress exposure on stillbirth in Ghana. METHODS District-level monthly UTCI was linked with 90,532 stillbirths of 5,961,328 births across all 260 local districts between 1st January 2012 and 31st December 2020. A within-space time-series design was applied with distributed lag nonlinear models and conditional quasi-Poisson regression. RESULTS The mean (28.5 ± 2.1 °C) and median UTCI (28.8 °C) indicated moderate heat stress. The Relative Risks (RRs) and 95% Confidence Intervals (CIs) for exposure to lower-moderate heat (1st to 25th percentiles of UTCI) and strong heat (99th percentile) stresses showed lower risks, relative to the median UTCI. The higher-moderate heat stress exposures (75th and 90th percentiles) showed greater risks which increased with the duration of heat stress exposures and were stronger in the 90th percentile. The risk ranged from 2% (RR = 1.02, 95% CI 0.99, 1.05) to 18% (RR = 1.18, 95% CI 1.02, 1.36) for the 90th percentile, relative to the median UTCI. Assuming causality, 19 (95% CI 3, 37) and 27 (95% CI 3, 54) excess stillbirths per 10,000 births were attributable to long-term exposure to the 90th percentile relative to median UTCI for the past six and nine months, respectively. Districts with low population density, low gross domestic product, and low air pollution which collectively defined rural districts were at higher risk as compared to those in the high level (urban districts). DISCUSSION Maternal exposure to long-term heat stress was associated with a greater risk of stillbirth. Climate change-resilient interventional measures to reduce maternal exposure to heat stress, particularly in rural areas may help lower the risk of stillbirth.
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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 A 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; enAble Institute, Curtin University, Perth Kent Street, Bentley, Western Australia, 6102, Australia
| | - Ben Mullins
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia
| | - Bernard Kumi-Boateng
- Department of Geomatic Engineering, University of Mines and Technology, P. O. Box 237, Tarkwa, Ghana
| | | | - 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; WHO Collaborating Centre for Environmental Health Impact Assessment. Faculty of Health Science, Curtin University, WA, Australia
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10
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Wang Z, Luo X, Luo Z, Tan Y, He G, Li P, Yang X. Transcriptome sequencing reveals neurotoxicity in embryonic neural stem/progenitor cells under heat stress. Toxicol In Vitro 2023; 86:105486. [DOI: 10.1016/j.tiv.2022.105486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/19/2022] [Accepted: 10/16/2022] [Indexed: 12/05/2022]
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11
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Bonell A, Sonko B, Badjie J, Samateh T, Saidy T, Sosseh F, Sallah Y, Bajo K, Murray KA, Hirst J, Vicedo-Cabrera A, Prentice AM, Maxwell NS, Haines A. Environmental heat stress on maternal physiology and fetal blood flow in pregnant subsistence farmers in The Gambia, west Africa: an observational cohort study. Lancet Planet Health 2022; 6:e968-e976. [PMID: 36495891 PMCID: PMC9756110 DOI: 10.1016/s2542-5196(22)00242-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Anthropogenic climate change has caused extreme temperatures worldwide, with data showing that sub-Saharan Africa is especially vulnerable to these changes. In sub-Saharan Africa, women comprise 50% of the agricultural workforce, often working throughout pregnancy despite heat exposure increasing the risk of adverse birth outcomes. In this study, we aimed to improve understanding of the pathophysiological mechanisms responsible for the adverse health outcomes resulting from environmental heat stress in pregnant subsistence farmers. We also aimed to provide data to establish whether environmental heat stress also has physiological effects on the fetus. METHODS We conducted an observational cohort study in West Kiang, The Gambia, at the field station for the Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine (named the MRC Keneba field station). Pregnant women who were aged 16 years or older and who were at <36 weeks' gestation of any gravida or parity were invited to participate in the study. Participants were eligible if they were involved in agricultural or related manual daily tasks of living. Participants were ineligible if they refused to provide consent, had multiple pregnancies (eg, if they had twins), were acutely unwell, or were diagnosed with pre-eclampsia or eclampsia. Heat stress was measured by wet bulb globe temperature (WBGT) and by using the universal thermal climate index (UTCI), and maternal heat strain was directly measured by modified physiological strain index calculated from heart rate and skin temperature. Outcome measures of fetal heart rate (FHR) and fetal strain (defined as a FHR >160 beats per min [bpm] or <115 bpm, or increase in umbilical artery resistance index) were measured at rest and during the working period. Multivariable repeated measure models (linear regression for FHR, and logistic regression for fetal strain) were used to evaluate the association of heat stress and heat strain with acute fetal strain. FINDINGS Between Aug 26, 2019, and March 27, 2020, 92 eligible participants were recruited to the study. Extreme heat exposure was frequent, with average exposures of WBGT of 27·2°C (SD 3·6°C) and UTCI equivalent temperature of 34·0°C (SD 3·7°C). The total effect of UTCI on fetal strain resulted in an odds ratio (OR) of 1·17 (95% CI 1·09-1·29; p<0·0001), with an adjusted direct effect of OR of 1·12 (1·03-1·21; p=0·010) with each 1°C increase in UTCI. The adjusted OR of maternal heat strain on fetal strain was 1·20 (1·01-1·43; p=0·038), using the UTCI model, with each unit increase. INTERPRETATION Data from our study show that decreasing maternal exposure to heat stress and heat strain is likely to reduce fetal strain, with the potential to reduce adverse birth outcomes. Further work that explores the association between heat stress and pregnancy outcomes in a variety of settings and populations is urgently needed to develop effective interventions. FUNDING The Wellcome Trust.
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Affiliation(s)
- Ana Bonell
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia; Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Bakary Sonko
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Jainaba Badjie
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Tida Samateh
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Tida Saidy
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Fatou Sosseh
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Yahya Sallah
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Kebba Bajo
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Kris A Murray
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia; Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK; MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Jane Hirst
- Nuffield Department of Women's and Reproductive Health and the George Institute for Global Health, University of Oxford, Oxford, UK
| | - Ana Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Andrew M Prentice
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Neil S Maxwell
- Environmental Extremes Laboratory, University of Brighton, Eastbourne, UK
| | - Andy Haines
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
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12
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Nyadanu SD, Tessema GA, Mullins B, Pereira G. Maternal acute thermophysiological stress and stillbirth in Western Australia, 2000-2015: A space-time-stratified case-crossover analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 836:155750. [PMID: 35526628 DOI: 10.1016/j.scitotenv.2022.155750] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/02/2022] [Accepted: 05/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The extreme thermal environment driven by climate change disrupts thermoregulation in pregnant women and may threaten the survival of the developing fetus. OBJECTIVES To investigate the acute effect of maternal exposure to thermophysiological stress (measured with Universal Thermal Climate Index, UTCI) on the risk of stillbirth and modification of this effect by sociodemographic disparities. METHODS We conducted a space-time-stratified case-crossover analysis of daily UTCI and 2835 singleton stillbirths between 1st January 2000 and 31st December 2015 across multiple small areas in Western Australia. Distributed lag non-linear models were combined with conditional quasi-Poisson regression to investigate the effects of the UTCI exposure from the preceding 6 days to the day of stillbirth. We also explored effect modification by fetal and maternal sociodemographic factors. RESULTS The median UTCI was 13.9 °C (representing no thermal stress) while the 1st and 99th percentiles were 0.7 °C (slight cold stress) and 31.7 °C (moderate heat stress), respectively. Relative to median UTCI, we found positive associations between acute maternal cold and heat stresses and higher risks of stillbirth, increasing with the intensity and duration of the thermal stress episodes. The cumulative risk from the preceding 6 days to the day of stillbirth was stronger in the 99th percentile (RR = 1.19, 95% CI: 1.17, 1.21) than the 1st percentile (RR = 1.14, 95% CI: 1.12, 1.15), relative to the median UTCI. The risks were disproportionately higher in term and male stillborn fetuses, smoking, unmarried, ≤19 years old, non-Caucasian, and low socioeconomic status mothers. DISCUSSION Acute maternal exposure to both cold and heat stresses may contribute to the risk of stillbirth and be exacerbated by sociodemographic disparities. The findings suggest public health attention, especially for the identified higher-risk groups. Future studies should consider the use of a human thermophysiological index, rather than surrogates such as ambient temperature.
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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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13
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Khodadadi N, Dastoorpoor M, Khanjani N, Ghasemi A. Universal Thermal Climate Index (UTCI) and adverse pregnancy outcomes in Ahvaz, Iran. Reprod Health 2022; 19:33. [PMID: 35109854 PMCID: PMC8811963 DOI: 10.1186/s12978-022-01344-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/03/2022] [Indexed: 12/19/2022] Open
Abstract
Background Climate change may jeopardize the health of mothers and their offspring. There are few studies on the association between increasing temperature and pregnancy outcomes. The aim of this study was to investigate the relation between Universal Thermal Climate Index (UTCI) and adverse pregnancy outcomes including stillbirth, low birth weight (LBW), preterm labor (PTL), spontaneous abortion (SA), preeclampsia and hypertension in Ahvaz, Iran. Methods Distributed Lag Non-linear Models (DLNM) combined with quasi-Poisson regression were used to research the effect of UTCI on adverse pregnancy outcomes. The effect of time trend, air pollutants (NO2, SO2 and PM10), and weekdays were adjusted. Results The results showed that the low values of UTCI index (11.6 °C, in lags 0–6, 0–13) caused significant increase in the risk of preterm labor. However, hot thermal stress (high UTCI) significantly increased the risk of stillbirth in lag 0–13. We did not observe any significant relation between UTCI and other pregnancy outcomes in this study. Conclusions It seems like both hot and cold weathers can be associated with adverse pregnancy outcomes. Scientists have found that climate change has adverse effects on human health. Because pregnant women are one of the most vulnerable groups, these negative impacts may affect their fetuses, which make up the next generation. In this study, we examined the effect of temperature on some pregnancy outcomes, including low birth weight, preterm labor, spontaneous abortion, preeclampsia and gestational hypertension in Ahvaz city, which is one of the hottest cities in the world. One way to assess temperature impact on humans is by using temperature indicators. In this study we used the Universal Thermal Climate Index (UTCI) for this purpose. The data at different time intervals were collected and evaluated with specific models. Our results showed that low values of UTCI, which is equivalent to cold weather, significantly increase the risk of preterm labor. But, high levels of UTCI, which means hot weather, significantly increase the risk of stillbirth. In conclusion; both hot and cold weather can be associated with adverse pregnancy outcomes in Ahvaz city. Therefore, pregnant women should protect themselves from exposure to hot and cold weather.
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Affiliation(s)
- Narges Khodadadi
- Department of Epidemiology and Biostatistics, Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Dastoorpoor
- Department of Epidemiology and Biostatistics, Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Narges Khanjani
- Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Afsaneh Ghasemi
- Department of Public Health, School of Public Health, Fasa University of Medical Sciences, Fasa, Iran.
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14
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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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15
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Graham JM. Update on the gestational effects of maternal hyperthermia. Birth Defects Res 2021; 112:943-952. [PMID: 32686349 DOI: 10.1002/bdr2.1696] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVES I plan to review the types of defects caused by gestational hyperthermia. Hyperthermia-induced malformations in animals and humans involve many organs and structures, particularly the central nervous system, as well as other defects. The type of defect is related to the timing of the hyperthermic insult, and the underlying mechanisms include cell death, membrane disruption, vascular disruption, and placental infarction. METHODS Review of recent epidemiologic studies (2005-2020) has confirmed an association between gestational hyperthermia and birth defects. RESULTS There are strong associations between neural tube defects and maternal fever, and other studies have demonstrated associations between first trimester hyperthermia and an increased risk for cardiovascular defects, oral clefts, isolated congenital ear defects, cataracts, hypospadias, renal anomalies, possibly anorectal malformations, and congenital anomalies in general, suggesting that this association between maternal hyperthermia and birth defects in humans is causal. The first prospective evaluation of maternal fever was reported in 1998, and this study confirmed findings from previous case-control studies and case series regarding the magnitude and duration of elevated maternal body temperature in relation to an increased risk for neural tube defects as well as a specific pattern of malformation. CONCLUSIONS The consistency of findings across these different study designs supports the causal nature of the relationship between maternal fever and specific birth defects. This review summarizes the recent human evidence documenting the gestational effects of maternal hyperthermia.
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Affiliation(s)
- John M Graham
- Clinical Genetics and Dysmorphology, Cedars-Sinai Medical Center and Harbor-UCLA Medical Center, Professor Emeritus of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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16
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Dastoorpoor M, Khanjani N, Khodadadi N. Association between Physiological Equivalent Temperature (PET) with adverse pregnancy outcomes in Ahvaz, southwest of Iran. BMC Pregnancy Childbirth 2021; 21:415. [PMID: 34088277 PMCID: PMC8178880 DOI: 10.1186/s12884-021-03876-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 05/13/2021] [Indexed: 12/16/2022] Open
Abstract
Background There are few epidemiological studies on the relation between temperature changes and adverse pregnancy outcomes. The purpose of this study was to determine the relation between Physiological Equivalent Temperature (PET) with adverse pregnancy outcomes including stillbirth, low birth weight (LBW), preterm labor (PTL), spontaneous abortion (SA), preeclampsia and hypertension in Ahvaz, Iran. Methods Distributed Lag Non-linear Models (DLNM) combined with quasi-Poisson regression were used to investigate the effect of PET on adverse pregnancy outcomes. In this study the effect of time trend, air pollutants (NO2, SO2 and PM10), and weekdays were adjusted. Results High PET (45.4 C°, lag = 0) caused a significant increase in risk of stillbirth. Also, high levels of PET (45.4, 43.6, 42.5 C°, lag = 0–6) and low levels of PET (9.9, 16.9 C°, lags = 0, 0–13, 0–21) significantly increased the risk of LBW. But, low levels of PET (6.4, 9.9, 16.9 C°, lags = 0–6, 0–13) reduced the risk of gestational hypertension. Conclusion The results of this study showed that hot and cold thermal stress may be associated with increased risk of stillbirth, and LBW in Ahvaz.
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Affiliation(s)
- Maryam Dastoorpoor
- Department of Epidemiology and Biostatistics, Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Narges Khanjani
- Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Narges Khodadadi
- Department of Epidemiology and Biostatistics, Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Jabehdar Maralani P, Kapadia A, Liu G, Moretti F, Ghandehari H, Clarke SE, Wiebe S, Garel J, Ertl-Wagner B, Hurrell C, Schieda N. Canadian Association of Radiologists Recommendations for the Safe Use of MRI During Pregnancy. Can Assoc Radiol J 2021; 73:56-67. [PMID: 34000852 DOI: 10.1177/08465371211015657] [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] [Indexed: 12/18/2022] Open
Abstract
The use of magnetic resonance imaging (MRI) during pregnancy is associated with concerns among patients and health professionals with regards to fetal safety. In this work, the Canadian Association of Radiologists (CAR) Working Group on MRI in Pregnancy presents recommendations for the use of MRI in pregnancy, derived from literature review as well as expert panel opinions and discussions. The working group, which consists of academic subspecialty radiologists and obstetrician-gynaecologists, aimed to provide updated, evidence-based recommendations addressing safety domains related to energy deposition, acoustic noise, and gadolinium-based contrast agent use based on magnetic field strength (1.5T and 3T) and trimester scanned, in addition to the effects of sedative use and occupational exposure.
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Affiliation(s)
| | - Anish Kapadia
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - Grace Liu
- Department of Obstetrics and Gynecology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Felipe Moretti
- Department of Obstetrics and Gynecology, 12365University of Ottawa, Ottawa, Ontario, Canada
| | - Hournaz Ghandehari
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - Sharon E Clarke
- Department of Diagnostic Radiology, 3688Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sheldon Wiebe
- Department of Medical Imaging, 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Juliette Garel
- Département de radiologie, radio-oncologie et médecine nucléaire, Université de Montréal, Montréal, Québec, Canada
| | - Birgit Ertl-Wagner
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - Casey Hurrell
- Research and Policy Development - Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Nicola Schieda
- Department of Radiology, 12365University of Ottawa, Ottawa, Ontario, Canada
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18
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Finnell RH, Caiaffa CD, Kim SE, Lei Y, Steele J, Cao X, Tukeman G, Lin YL, Cabrera RM, Wlodarczyk BJ. Gene Environment Interactions in the Etiology of Neural Tube Defects. Front Genet 2021; 12:659612. [PMID: 34040637 PMCID: PMC8143787 DOI: 10.3389/fgene.2021.659612] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/31/2021] [Indexed: 12/24/2022] Open
Abstract
Human structural congenital malformations are the leading cause of infant mortality in the United States. Estimates from the United States Center for Disease Control and Prevention (CDC) determine that close to 3% of all United States newborns present with birth defects; the worldwide estimate approaches 6% of infants presenting with congenital anomalies. The scientific community has recognized for decades that the majority of birth defects have undetermined etiologies, although we propose that environmental agents interacting with inherited susceptibility genes are the major contributing factors. Neural tube defects (NTDs) are among the most prevalent human birth defects and as such, these malformations will be the primary focus of this review. NTDs result from failures in embryonic central nervous system development and are classified by their anatomical locations. Defects in the posterior portion of the neural tube are referred to as meningomyeloceles (spina bifida), while the more anterior defects are differentiated as anencephaly, encephalocele, or iniencephaly. Craniorachischisis involves a failure of the neural folds to elevate and thus disrupt the entire length of the neural tube. Worldwide NTDs have a prevalence of approximately 18.6 per 10,000 live births. It is widely believed that genetic factors are responsible for some 70% of NTDs, while the intrauterine environment tips the balance toward neurulation failure in at risk individuals. Despite aggressive educational campaigns to inform the public about folic acid supplementation and the benefits of providing mandatory folic acid food fortification in the United States, NTDs still affect up to 2,300 United States births annually and some 166,000 spina bifida patients currently live in the United States, more than half of whom are now adults. Within the context of this review, we will consider the role of maternal nutritional status (deficiency states involving B vitamins and one carbon analytes) and the potential modifiers of NTD risk beyond folic acid. There are several well-established human teratogens that contribute to the population burden of NTDs, including: industrial waste and pollutants [e.g., arsenic, pesticides, and polycyclic aromatic hydrocarbons (PAHs)], pharmaceuticals (e.g., anti-epileptic medications), and maternal hyperthermia during the first trimester. Animal models for these teratogens are described with attention focused on valproic acid (VPA; Depakote). Genetic interrogation of model systems involving VPA will be used as a model approach to discerning susceptibility factors that define the gene-environment interactions contributing to the etiology of NTDs.
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Affiliation(s)
- Richard H. Finnell
- Department of Molecular and Human Genetics and Medicine, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
- Department of Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - Carlo Donato Caiaffa
- Department of Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - Sung-Eun Kim
- Department of Pediatrics, The University of Texas at Austin Dell Medical School, Austin, TX, United States
| | - Yunping Lei
- Department of Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - John Steele
- Department of Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - Xuanye Cao
- Department of Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - Gabriel Tukeman
- Department of Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - Ying Linda Lin
- Department of Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - Robert M. Cabrera
- Department of Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - Bogdan J. Wlodarczyk
- Department of Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
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19
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Granja MG, Oliveira ACDR, de Figueiredo CS, Gomes AP, Ferreira EC, Giestal-de-Araujo E, de Castro-Faria-Neto HC. SARS-CoV-2 Infection in Pregnant Women: Neuroimmune-Endocrine Changes at the Maternal-Fetal Interface. Neuroimmunomodulation 2021; 28:1-21. [PMID: 33910207 PMCID: PMC8247841 DOI: 10.1159/000515556] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/23/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) has devastating effects on the population worldwide. Given this scenario, the extent of the impact of the disease on more vulnerable individuals, such as pregnant women, is of great concern. Although pregnancy may be a risk factor in respiratory virus infections, there are no considerable differences regarding COVID-19 severity observed between pregnant and nonpregnant women. In these circumstances, an emergent concern is the possibility of neurodevelopmental and neuropsychiatric harm for the offspring of infected mothers. Currently, there is no stronger evidence indicating vertical transmission of SARS-CoV-2; however, the exacerbated inflammatory response observed in the disease could lead to several impairments in the offspring's brain. Furthermore, in the face of historical knowledge on possible long-term consequences for the progeny's brain after infection by viruses, we must consider that this might be another deleterious facet of COVID-19. In light of neuroimmune interactions at the maternal-fetal interface, we review here the possible harmful outcomes to the offspring brains of mothers infected by SARS-CoV-2.
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Affiliation(s)
- Marcelo Gomes Granja
- Molecular and Cellular Biology Program, Federal University of State of Rio de Janeiro − UNIRIO, Rio de Janeiro, Rajasthan, Brazil
- Immunopharmacology Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation − Fiocruz, Rio de Janeiro, Rajasthan, Brazil
| | | | | | - Alex Portes Gomes
- Medical Science Program, Neurology and Neuroscience, Fluminense Federal University − UFF, Niterói, Rajasthan, Brazil
| | - Erica Camila Ferreira
- Immunopharmacology Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation − Fiocruz, Rio de Janeiro, Rajasthan, Brazil
| | - Elizabeth Giestal-de-Araujo
- Neuroscience Program, Fluminense Federal University − UFF, Niterói, Rajasthan, Brazil
- National Institute of Technology-Neuroimmunomodulation − INCT-NIM, Rio de Janeiro, Rajasthan, Brazil
| | - Hugo Caire de Castro-Faria-Neto
- Immunopharmacology Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation − Fiocruz, Rio de Janeiro, Rajasthan, Brazil
- National Institute of Technology-Neuroimmunomodulation − INCT-NIM, Rio de Janeiro, Rajasthan, Brazil
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20
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Barger MK. Current Resources for Evidence-Based Practice, March/April 2021. J Midwifery Womens Health 2021; 66:274-281. [PMID: 33788383 DOI: 10.1111/jmwh.13229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Mary K Barger
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
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21
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Olivier K, Reinders LA, Clarke MW, Crew RC, Pereira G, Maloney SK, Wyrwoll CS. Maternal, Placental, and Fetal Responses to Intermittent Heat Exposure During Late Gestation in Mice. Reprod Sci 2021; 28:416-425. [PMID: 32804351 DOI: 10.1007/s43032-020-00291-7] [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: 03/12/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022]
Abstract
Physiological adaptations during heat exposure are critical in pregnancy. Maternal thermoregulation has to accommodate the increased metabolic load of the developing fetus. Here, we assess the consequences of intermittent heat exposure, as occurs in heat waves, for maternal adaptations during pregnancy, and chronic feto-placental outcomes. Following timed mating, C57BL/6J mice were allocated to either standard animal housing temperature conditions (SH) or housing at a temperature within the thermoneutral zone (TNZ). A subset of the TNZ group was exposed to 37 °C for 8 h a day from E15.5 to E17.5 to simulate a heat wave (HW). Maternal weight gain, food intake, rectal temperature, and nesting behaviors were measured across gestation. Fetal and placental tissues were collected at E18.5. With heat exposure, maternal rectal temperature increased while food intake and nest complexity decreased. Maternal daily weight gain initially decreased due to heat exposure, but on the last day of exposure, it was comparable to the other experimental groups. These maternal responses during heat exposure impacted on the fetus, with restrictions in placental and fetal development evident just before birth. Thus, the vascular portion of the placenta, and the relative fetal head size, was smaller. Furthermore, SH and TNZ animals demonstrated distinct differences in food intake and nesting behavior during pregnancy, reinforcing the need for caution in extrapolating from animal models to humans when housing occurs outside of thermoneutral zone conditions. This study highlights the direct effects of temperature conditions on health in pregnancy and provides a foundation for future studies to investigate fetal health consequences that are associated with intermittent heat exposure.
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Affiliation(s)
- Karike Olivier
- School of Human Sciences, The University of Western Australia, Perth, 6009, Australia
| | - Lauren A Reinders
- School of Human Sciences, The University of Western Australia, Perth, 6009, Australia
| | - Michael W Clarke
- Centre for Microscopy, Characterisation and Analysis, The University of Western Australia, Perth, 6009, Australia
| | - Rachael C Crew
- School of Human Sciences, The University of Western Australia, Perth, 6009, Australia
| | - Gavin Pereira
- School of Public Health, Curtin University, Bentley, 6102, Australia
| | - Shane K Maloney
- School of Human Sciences, The University of Western Australia, Perth, 6009, Australia
| | - Caitlin S Wyrwoll
- School of Human Sciences, The University of Western Australia, Perth, 6009, Australia.
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22
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Maskal JM, Duttlinger AW, Kpodo KR, McConn BR, Byrd CJ, Richert BT, Marchant-Forde JN, Lay DC, Perry SD, Lucy MC, Safranski TJ, Johnson JS. Evaluation and mitigation of the effects of in utero heat stress on piglet growth performance, postabsorptive metabolism, and stress response following weaning and transport. J Anim Sci 2020; 98:5896567. [PMID: 32835367 DOI: 10.1093/jas/skaa265] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/14/2020] [Indexed: 01/03/2023] Open
Abstract
In utero heat stress (IUHS) increases the energy requirements of pigs during postnatal life, and this may compound weaning and transport stress. The study objective was to evaluate and mitigate the negative effects of IUHS following weaning and transport through the provision of a nutrient-dense (ND) nursery diet formulated to meet the greater energy requirements of IUHS pigs during the first 14 d postweaning and transport. Twenty-four pregnant gilts were exposed to thermoneutral (TN; n = 12; 17.5 ± 2.1 °C) or heat stress (HS; n = 12; cycling 26 to 36 °C) conditions for the first half of gestation (day 6 to 59) and then TN conditions (20.9 ± 2.3 °C) until farrowing. Nine TN gilts and 12 HS gilts produced litters. At weaning (16.2 ± 0.4 d), mixed-sex piglets (N = 160; 4.78 ± 0.15 kg body weight [BW]) were transported (loading + transport + unloading) for 11 h 40 min. Following transport, piglets were blocked into pens (n = 4 pigs/pen) by in utero and dietary treatments: in utero thermoneutral (IUTN) + control (C) diet (n = 10 pens), IUTN + ND (n = 10 pens), IUHS + C (n = 10 pens), and IUHS + ND (n = 10 pens). Treatment diets were fed from day 1 to 14 postweaning and transport (period 1), and the C diet was fed to all pigs from day 14 to 35 postweaning and transport (period 2). Production measures were taken in 7 d intervals to calculate average daily gain (ADG), average daily feed intake (ADFI), average daily net energy intake (ADEI), gain:feed, and gain:net energy intake. Blood samples were collected prior to transport, following transport, and on days 2, 7, 14, 28, and 35 postweaning and transport to analyze cortisol, glucose, insulin, and nonesterified fatty acids. Behavior was assessed through video-recording on days 3, 5, 8, 11, and 13 postweaning and transport. In period 1, ADG was reduced (P = 0.04; 20.0 g/d) in IUHS vs. IUTN pigs. Pigs fed ND diets had reduced ADFI (P = 0.02; 9.3%) compared with C diet-fed pigs during period 1, which resulted in similar ADEI (P = 0.23; 1,115 ± 35 kcal/d). During transport, cortisol was decreased (P = 0.03; 25.8%) in IUHS vs. IUTN pigs. On day 2, glucose was decreased (P = 0.01; 13.8%) in IUHS vs. IUTN pigs. No in utero treatment-related behavior differences were observed but lying was reduced (P = 0.03; 6.5%) and standing was increased (P = 0.04; 14.1%) in ND vs. C pigs overall. In summary, IUHS reduced growth performance in pigs following weaning and transport, and providing an ND diet did not rescue the lost performance.
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Affiliation(s)
- Jacob M Maskal
- Department of Animal Sciences, Purdue University, West Lafayette, IN
| | - Alan W Duttlinger
- Department of Animal Sciences, Purdue University, West Lafayette, IN
| | - Kouassi R Kpodo
- Department of Animal Sciences, Purdue University, West Lafayette, IN
| | - Betty R McConn
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | | | - Brian T Richert
- Department of Animal Sciences, Purdue University, West Lafayette, IN
| | | | - Donald C Lay
- Livestock Behavior Research Unit, USDA-ARS, West Lafayette, IN
| | - Shelbi D Perry
- Division of Animal Sciences, University of Missouri, Columbia, MO
| | - Matthew C Lucy
- Division of Animal Sciences, University of Missouri, Columbia, MO
| | - Tim J Safranski
- Division of Animal Sciences, University of Missouri, Columbia, MO
| | - Jay S Johnson
- Livestock Behavior Research Unit, USDA-ARS, West Lafayette, IN
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23
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Abstract
MRI is a powerful diagnostic tool with excellent soft tissue contrast that uses nonionizing radiation. These advantages make MRI an appealing modality for imaging the pregnant patient; however, specific risks inherent to the magnetic resonance environment must be considered. MRI may be performed without and/or with intravenous contrast, which adds further fetal considerations. The risks of MRI with and without intravenous contrast are reviewed as they pertain to the pregnant or lactating patient and to the fetus and nursing infant. Relevant issues for gadolinium-based contrast agents and ultrasmall paramagnetic iron oxide particles are reviewed.
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Affiliation(s)
- Jason T Little
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Candice A Bookwalter
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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24
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Kwon JH, Kim HK, Ha TW, Im JS, Song BH, Hong KS, Oh JS, Han J, Lee MR. Hyperthermia Disturbs and Delays Spontaneous Differentiation of Human Embryoid Bodies. Biomedicines 2020; 8:biomedicines8060176. [PMID: 32604871 PMCID: PMC7345654 DOI: 10.3390/biomedicines8060176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 12/18/2022] Open
Abstract
Various types of stress stimuli have been shown to threaten the normal development of embryos during embryogenesis. Prolonged heat exposure is the most common stressor that poses a threat to embryo development. Despite the extensive investigation of heat stress control mechanisms in the cytosol, the endoplasmic reticulum (ER) heat stress response remains unclear. In this study, we used human embryonic stem cells (hESCs) to examine the effect of heat stress on early embryonic development, specifically alterations in the ER stress response. In a hyperthermic (42 °C) culture, ER stress response genes involved in hESC differentiation were induced within 1 h of exposure, which resulted in disturbed and delayed differentiation. In addition, hyperthermia increased the expression levels of activating transcription factor 4 (ATF4) and C/EBP homologous protein (CHOP) genes, which are associated with the protein kinase RNA-like endoplasmic reticulum kinase (PERK) signaling pathway. Furthermore, we demonstrated that tauroursodeoxycholic acid, a chemical chaperone, mitigated the delayed differentiation under hyperthermia. Our study identified novel gene markers in response to hyperthermia-induced ER stress on hESCs, thereby providing further insight into the mechanisms that regulate human embryogenesis.
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Affiliation(s)
- Ji Hyun Kwon
- Soonchunhyang Institute of Medi-bio Science (SIMS), Soon Chun Hyang University, Cheonan 31151, Korea; (J.H.K.); (H.K.K.); (T.W.H.); (J.S.I.); (B.H.S.)
| | - Hyun Kyu Kim
- Soonchunhyang Institute of Medi-bio Science (SIMS), Soon Chun Hyang University, Cheonan 31151, Korea; (J.H.K.); (H.K.K.); (T.W.H.); (J.S.I.); (B.H.S.)
| | - Tae Won Ha
- Soonchunhyang Institute of Medi-bio Science (SIMS), Soon Chun Hyang University, Cheonan 31151, Korea; (J.H.K.); (H.K.K.); (T.W.H.); (J.S.I.); (B.H.S.)
| | - Jeong Suk Im
- Soonchunhyang Institute of Medi-bio Science (SIMS), Soon Chun Hyang University, Cheonan 31151, Korea; (J.H.K.); (H.K.K.); (T.W.H.); (J.S.I.); (B.H.S.)
| | - Byung Hoo Song
- Soonchunhyang Institute of Medi-bio Science (SIMS), Soon Chun Hyang University, Cheonan 31151, Korea; (J.H.K.); (H.K.K.); (T.W.H.); (J.S.I.); (B.H.S.)
| | - Ki Sung Hong
- Department of Medicine, Konkuk University School of Medicine and Mirae Cell Bio Co. LTD., Seoul 05029, Korea;
| | - Jae Sang Oh
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan 31151, Korea
- Correspondence: (J.S.O.); (J.H.); (M.R.L.); Tel.: +82-41-413-5027 (J.H.); +82-10-2918-3903 (J.S.O); +82-41-413-5013 (M.R.L.)
| | - Jaeseok Han
- Soonchunhyang Institute of Medi-bio Science (SIMS), Soon Chun Hyang University, Cheonan 31151, Korea; (J.H.K.); (H.K.K.); (T.W.H.); (J.S.I.); (B.H.S.)
- Correspondence: (J.S.O.); (J.H.); (M.R.L.); Tel.: +82-41-413-5027 (J.H.); +82-10-2918-3903 (J.S.O); +82-41-413-5013 (M.R.L.)
| | - Man Ryul Lee
- Soonchunhyang Institute of Medi-bio Science (SIMS), Soon Chun Hyang University, Cheonan 31151, Korea; (J.H.K.); (H.K.K.); (T.W.H.); (J.S.I.); (B.H.S.)
- Correspondence: (J.S.O.); (J.H.); (M.R.L.); Tel.: +82-41-413-5027 (J.H.); +82-10-2918-3903 (J.S.O); +82-41-413-5013 (M.R.L.)
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25
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In utero heat stress alters postnatal phenotypes in swine. Theriogenology 2020; 154:110-119. [PMID: 32540511 DOI: 10.1016/j.theriogenology.2020.05.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/05/2020] [Accepted: 05/10/2020] [Indexed: 12/12/2022]
Abstract
The prenatal environment influences offspring health and development, and this is readily apparent when considering the well-described effects of maternal nutrition and stress on the postnatal metabolism, neural function, and stress response of progeny. Moreover, in laboratory species, sheep, and humans, the effects of in utero heat stress on offspring development have been described in detail for >50 years. Despite our extensive knowledge of the postnatal phenotypes elicited by in utero stressors, the carryover effects of in utero heat stress in pigs have only recently begun to be elucidated. The effects of climate change on increasing global temperatures, combined with greater metabolic heat production in modern swine, has increased heat stress susceptibility in pigs. Greater heat stress susceptibility can negatively affect swine welfare and performance and may impact future generations of pigs through in utero heat stress. Pigs exposed to in utero heat stress develop a variety of postnatal phenotypes that prevent profitable production, and compromise health, and welfare in commercial production systems. Specifically, in utero heat stress alters the postnatal stress response, core body temperature, response to an immune challenge, and is teratogenic. In addition, in utero heat stress changes postnatal body composition through reduced lean and increased adipose tissue accretion rates, respectively. Furthermore, in utero heat stress reduces piglet birth weight, body weight gain, and reproductive efficiency. Although the economic impact of in utero heat stress in pigs has yet to be determined, it likely rivals the postnatal consequences of heat stress and is a threat to the global sustainability of swine production.
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26
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Lum M, Tsiouris AJ. MRI safety considerations during pregnancy. Clin Imaging 2020; 62:69-75. [PMID: 32109683 DOI: 10.1016/j.clinimag.2020.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/11/2020] [Accepted: 02/18/2020] [Indexed: 12/12/2022]
Abstract
The use of magnetic resonance imaging (MRI) during pregnancy is on the rise due its ability to provide detailed cross-sectional anatomy without ionizing radiation. Despite the favorable radiation profile, theoretically concerns regarding the safety of MRI and gadolinium-based contrast agent (GBCA) administration have been raised. Currently there are no studies that have shown any attributable harms of MRI during any trimester of pregnancy although prospective and longitudinal studies are lacking. GBCA administration may be associated with a slightly higher rate of neonatal death, although this is based on a single, large cohort study. Understanding the available evidence regarding MRI safety during pregnancy in the context of current society guidelines will help the radiologist serve as a valuable resource to patients and referring providers.
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Affiliation(s)
- Mark Lum
- Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065, United States of America.
| | - A John Tsiouris
- Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065, United States of America
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27
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Issaoui M, Balandraud X, Grédiac M, Blaysat B, Ouchchane L, Delabaere A, Sauvant-Rochat MP, Lemery D. Temperature Rise Caused by Shear Wave Elastography, Pulse Doppler and B-Mode in Biological Tissue: An Infrared Thermographic Approach. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:325-335. [PMID: 31735465 DOI: 10.1016/j.ultrasmedbio.2019.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 10/05/2019] [Accepted: 10/11/2019] [Indexed: 06/10/2023]
Abstract
The aim of this study was to determine the interest in and relevance of the use of infrared thermography, which is a non-invasive full-field surface temperature measurement technique, to characterize the heterogeneous heating caused by ultrasound in biological tissue. Thermal effects of shear wave elastography, pulse Doppler and B-mode were evidenced in porcine tissue. Experiments were performed using a high-frequency echography Aixplorer system (Supersonic Imagine, Aix-en-Provence, France). For all three modes, ultrasound was applied continuously for 360 s while the temperature at the sample surface was recorded with a Cedip Jade III-MWIR infrared camera (Flir, Torcy, France). Temperature changes were detected for the three modes. In particular, "heat tunnels" crossing the sample were visualized from the early stages of the experiment. Heat conduction from the transducer was also involved in the global warming of the sample. The study widens the prospects for studies on tolerability, potentially in addition to classic approaches such as those using thermocouples.
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Affiliation(s)
- Maha Issaoui
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France.
| | - Xavier Balandraud
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Michel Grédiac
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Benoit Blaysat
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Lemlih Ouchchane
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Département de Santé Publique, Unité de Biostatistique et Informatique Médicale, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Amelie Delabaere
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie-Pierre Sauvant-Rochat
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Département de Santé Publique et Environnement, Université Clermont-Auvergne, UFR Pharmacie, Clermont-Ferrand, France
| | - Didier Lemery
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
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28
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Cerrizuela S, Vega-Lopez GA, Aybar MJ. The role of teratogens in neural crest development. Birth Defects Res 2020; 112:584-632. [PMID: 31926062 DOI: 10.1002/bdr2.1644] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/11/2019] [Accepted: 12/22/2019] [Indexed: 12/13/2022]
Abstract
The neural crest (NC), discovered by Wilhelm His 150 years ago, gives rise to a multipotent migratory embryonic cell population that generates a remarkably diverse and important array of cell types during the development of the vertebrate embryo. These cells originate in the neural plate border (NPB), which is the ectoderm between the neural plate and the epidermis. They give rise to the neurons and glia of the peripheral nervous system, melanocytes, chondrocytes, smooth muscle cells, odontoblasts and neuroendocrine cells, among others. Neurocristopathies are a class of congenital diseases resulting from the abnormal induction, specification, migration, differentiation or death of NC cells (NCCs) during embryonic development and have an important medical and societal impact. In general, congenital defects affect an appreciable percentage of newborns worldwide. Some of these defects are caused by teratogens, which are agents that negatively impact the formation of tissues and organs during development. In this review, we will discuss the teratogens linked to the development of many birth defects, with a strong focus on those that specifically affect the development of the NC, thereby producing neurocristopathies. Although increasing attention is being paid to the effect of teratogens on embryonic development in general, there is a strong need to critically evaluate the specific role of these agents in NC development. Therefore, increased understanding of the role of these factors in NC development will contribute to the planning of strategies aimed at the prevention and treatment of human neurocristopathies, whose etiology was previously not considered.
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Affiliation(s)
- Santiago Cerrizuela
- Área Biología Experimental, Instituto Superior de Investigaciones Biológicas (INSIBIO, CONICET-UNT), Tucumán, Argentina.,Instituto de Biología "Dr. Francisco D. Barbieri", Facultad de Bioquímica, Química y Farmacia, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Guillermo A Vega-Lopez
- Área Biología Experimental, Instituto Superior de Investigaciones Biológicas (INSIBIO, CONICET-UNT), Tucumán, Argentina.,Instituto de Biología "Dr. Francisco D. Barbieri", Facultad de Bioquímica, Química y Farmacia, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Manuel J Aybar
- Área Biología Experimental, Instituto Superior de Investigaciones Biológicas (INSIBIO, CONICET-UNT), Tucumán, Argentina.,Instituto de Biología "Dr. Francisco D. Barbieri", Facultad de Bioquímica, Química y Farmacia, Universidad Nacional de Tucumán, Tucumán, Argentina
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29
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Wang R, Yang Y, Xiao M, Guo B, Liu W, Wang H. Neonatal Inhibition of Connexin 36 Ameliorates Fetal Brain Injury Induced by Maternal Noninfectious Fever in Mice. Dev Neurosci 2019; 41:94-101. [PMID: 31112950 DOI: 10.1159/000499735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/19/2019] [Indexed: 11/19/2022] Open
Abstract
Prenatal fever could result in brain function impairments in the offspring. The present study investigated the effect of interleukin-6 (IL-6)-induced maternal fever on the offspring and the involvement of connexin 36 in this process. Pregnant C57BL/6J mice were injected with IL-6 on gestational day 15. The levels of iNOS and COX-2 were measured as an index of neuroinflammation in the brain of newborn pups. Offspring were treated with the connexin 36 (Cx36) inhibitor mefloquine at postnatal day (P)1-P3 or at P40-P42. Rotarod, grip traction, and foot fault tests were carried out to evaluate the motor behavior of adult offspring. Injection of IL-6 led to an elevation of the core temperature in the pregnant dams. Offspring of these dams showed significantly increased COX-2 and iNOS mRNA expression and protein levels in the whole-brain samples and significantly increased Cx36 in the cerebellum. Moreover, offspring of these dams showed motor deficits at an adult age. Neonatal administration of the Cx36 inhibitor mefloquine could prevent these motor deficits. Maternal fever during pregnancy induced by IL-6 injection could lead to neuroinflammation and motor deficits in the offspring. Neonatal inhibition of Cx36 could ameliorate the motor deficits in the offspring, indicating an involvement of Cx36 in the IL-6-induced maternal fever.
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Affiliation(s)
- Ruifen Wang
- Cangzhou Central Hospital of Hebei Province, Cangzhou, China,
| | - Yueqing Yang
- Cangzhou Central Hospital of Hebei Province, Cangzhou, China
| | - Min Xiao
- Cangzhou Central Hospital of Hebei Province, Cangzhou, China
| | - Binfang Guo
- Cangzhou Central Hospital of Hebei Province, Cangzhou, China
| | - Weili Liu
- Cangzhou Central Hospital of Hebei Province, Cangzhou, China
| | - Haiyan Wang
- Cangzhou Central Hospital of Hebei Province, Cangzhou, China
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Boni R. Heat stress, a serious threat to reproductive function in animals and humans. Mol Reprod Dev 2019; 86:1307-1323. [PMID: 30767310 DOI: 10.1002/mrd.23123] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/25/2019] [Accepted: 01/27/2019] [Indexed: 12/18/2022]
Abstract
Global warming represents a major stressful environmental condition that compromises the reproductive efficiency of animals and humans via a rise of body temperature above its physiological homeothermic point (heat stress [HS]). The injuries caused by HS on reproductive function involves both male and female components, fertilization mechanisms as well as the early and late stages of embryo-fetal development. This occurrence causes great economic damage in livestock, and, in wild animals creates selective pressure towards the advantages of better-adapted genotypes to the detriment of others. Humans undergo several types of stress, including heat, and these represent putative causes of ongoing progressive decay in procreation; an increasing number of remedies in the form of antioxidant preparations are now being proposed to counteract the effects of stress. This review aims to describe the results of the most recent studies that aimed to highlight these effects and to draw information on the mechanisms acting as the basis of this problem from a comparative analysis.
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Affiliation(s)
- Raffaele Boni
- Department of Sciences, University of Basilicata, Potenza, Italy
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Rosman NP, Vassar R, Doros G, DeRosa J, Froman A, DiMauro A, Santiago S, Abbott J. Association of Prenatal Ultrasonography and Autism Spectrum Disorder. JAMA Pediatr 2018; 172:336-344. [PMID: 29435580 PMCID: PMC5875374 DOI: 10.1001/jamapediatrics.2017.5634] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/07/2017] [Indexed: 12/28/2022]
Abstract
Importance The prevalence of autism spectrum disorder (ASD) has been increasing rapidly, with current estimates of 1 in 68 children affected. Simultaneously, use of prenatal ultrasonography has increased substantially, with limited investigation into its safety and effects on brain development. Animal studies have demonstrated that prenatal ultrasonography can adversely affect neuronal migration. Objective To quantify prenatal ultrasound exposure by the frequency, timing, duration, and strength of ultrasonographic scans in children with later ASD, developmental delay, and typical development. Design, Setting, and Participants This case-control study included 107 patients with ASD, 104 control individuals with developmental delay, and 209 controls with typical development. Participants were identified from medical records based on prenatal care and delivery at Boston Medical Center, a diverse, academic, safety-net medical center, from July 1, 2006, through December 31, 2014, with a gestational age at birth of at least 37 weeks. Data were analyzed from May 1, 2015, through November 30, 2017. Exposures Ultrasonographic exposure was quantified by the number and timing of scans, duration of exposure, mean strength (depth, frame rate, mechanical index, and thermal index), and time of Doppler and 3- and 4-dimensional imaging. Main Outcomes and Measures Among participants with ASD and controls with developmental delay and typical development, ultrasound exposure was quantified and compared per trimester and for the entire pregnancy, with adjustment for infant sex, gestational age at birth, and maternal age. Results A total of 420 participants were included in the study (328 boys [78.1%] and 92 girls [21.9%]; mean age as of January 1, 2016, 6.6 years; 95% CI, 6.5-6.8 years). The ASD group received a mean of 5.9 scans (95% CI, 5.2-6.6), which was not significantly different from the 6.1 scans (95% CI, 5.4-6.8) in the developmental delay group or the 6.3 scans (95% CI, 5.8-6.8) in the typical development group. Compared with the typical development group, the ASD group had shorter duration of ultrasound exposure during the first (290.4 seconds [95% CI, 212.8-368.0 seconds] vs 406.4 seconds [95% CI, 349.5-463.3 seconds]) and second (1687.6 seconds [95% CI, 1493.8-1881.4 seconds] vs 2011.0 seconds [95% CI, 1868.9-2153.1 seconds]) trimesters but no difference in the number of scans. The ASD group had greater mean depth of ultrasonographic penetration than the developmental delay group in the first trimester (12.5 cm [95% CI, 12.0-13.0 cm] vs 11.6 cm [95% CI, 11.1-12.1 cm]). The ASD group had greater mean depth than the typical development group during the first (12.5 cm [95% CI, 12.0-13.0 cm] vs 11.6 cm [95% CI, 11.3-12.0 cm]) and the second (12.9 cm [95% CI, 12.6-13.3 cm] vs 12.5 cm [95% CI, 12.2-12.7 cm]) trimesters. Conclusions and Relevance This study found significantly greater mean depth of ultrasonographic penetration in the ASD group compared with the developmental delay group in the first trimester and compared with the typical development group in the first and second trimesters. Further research is needed to determine whether other variables of ultrasound exposure also have adverse effects on the developing fetus.
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Affiliation(s)
- N. Paul Rosman
- Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
- Division of Pediatric Neurology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
- Departments of Pediatrics and Neurology, Division of Pediatric Neurology, Boston Medical Center, Boston, Massachusetts
| | - Rachel Vassar
- medical student at Boston University School of Medicine, Boston, Massachusetts
- Department of Pediatrics, Benioff Children’s Hospital, University of California, San Francisco
| | - Gheorghe Doros
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - James DeRosa
- graduate student at Boston University School of Public Health, Boston, Massachusetts
| | - Allison Froman
- graduate student at Boston University School of Public Health, Boston, Massachusetts
| | - Audrey DiMauro
- medical student at Boston University School of Medicine, Boston, Massachusetts
- Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts
| | - Sherry Santiago
- Division of Pediatric Neurology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
- Division of Pediatric Neurology, Puerto Rico Children’s Hospital, Bayamón, Puerto Rico
| | - Jodi Abbott
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
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Asamoah B, Kjellstrom T, Östergren PO. Is ambient heat exposure levels associated with miscarriage or stillbirths in hot regions? A cross-sectional study using survey data from the Ghana Maternal Health Survey 2007. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:319-330. [PMID: 28748383 PMCID: PMC5854714 DOI: 10.1007/s00484-017-1402-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 06/13/2017] [Accepted: 06/27/2017] [Indexed: 05/27/2023]
Abstract
It is well established that high ambient heat could cause congenital abnormalities resulting in miscarriage or stillbirth among certain species of mammals. However, this has not been systematically studied in real field settings among humans, despite the potential value of such knowledge for estimating the impact of global warming on the human species. This study sought to test the hypothesis that maternal heat exposure during pregnancy in hot regions is associated with increased prevalence of spontaneous abortions or stillbirths and to develop an analytical strategy to use existing data from maternal health surveys and existing data on historical heat levels at a geographic grid cell level. A subsample of the Ghana Maternal Health Survey 2007 was used in this study. This study sample consisted of 1136 women with pregnancy experiences between 2004 and 2007, out of which 141 women had a pregnancy that terminated in miscarriage or stillbirth. Induced-abortion cases were excluded. The linkage between ambient heat exposure and pregnancy outcome followed the epidemiological time-place-person principle, by linking timing of pregnancy outcome with historical data of local area heat levels for each month, as estimated in an international database. Maternal heat exposure level was estimated using calculated levels of the wet-bulb globe temperature (WBGT), which takes into account temperature, humidity, heat radiation, and air movement over the skin (wind speed). The values we used applied to exposure in the shade or in buildings without cooling (no solar heat radiation) and a standard air movement of 1 m/s. We applied two exposure durations: yearly average and monthly average for second month of pregnancy. In one analysis, we restricted the sample to four regions with time-homogeneous ambient heat. Analysis was made using logistic regression. About 12% of the latest pregnancies ended in either miscarriage (9.6%) or stillbirth (2.8%). The odds ratios indicated 12 to 15% increase (ORcrude 1.15, 95% CI 0.92-1.42, and ORage adjusted 1.12, 95% CI 0.90-1.39) in the odds of having a stillbirth or miscarriage with each additional degree increase in WBGT, although this was just outside two-sided statistical significance. The WBGT range was quite narrow (most annual values in the range 24-26 °C, and most monthly values in the range 23-27 °C), which may have hidden any real impacts of high heat levels. The seemingly positive association observed disappeared after adjusting for gravidity. The analyses of the four selected regions indicated 27 to 42% increase in the odds of experiencing miscarriage or stillbirth with every degree increase in WBGT (crude OR 1.42 95% CI 1.00-2.03). This association remained after adjusting for maternal age pregnancy history, although no longer statistically significant (adjusted OR 1.27, 95% CI 0.89-1.81). Environmental heat exposures may be associated with adverse pregnancy outcomes, but this study was inconclusive, possibly because the heat exposure range was small. Historical records of routine observations in existing databases can be used for epidemiological studies on the health effects of heat, although data from properly and purposively designed studies might be more suitable for further studies.
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Affiliation(s)
- Benedict Asamoah
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmo, Sweden.
| | - Tord Kjellstrom
- Centre for Technological Research and Innovation (CETRI), Limmasol, Cyprus
- Australian National University, Canberra, Australia
| | - Per-Olof Östergren
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmo, Sweden
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Ravanelli N, Casasola W, English T, Edwards KM, Jay O. Heat stress and fetal risk. Environmental limits for exercise and passive heat stress during pregnancy: a systematic review with best evidence synthesis. Br J Sports Med 2018; 53:799-805. [PMID: 29496695 DOI: 10.1136/bjsports-2017-097914] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Pregnant women are advised to avoid heat stress (eg, excessive exercise and/or heat exposure) due to the risk of teratogenicity associated with maternal hyperthermia; defined as a core temperature (Tcore) ≥39.0°C. However, guidelines are ambiguous in terms of critical combinations of climate and activity to avoid and may therefore unnecessarily discourage physical activity during pregnancy. Thus, the primary aim was to assess Tcore elevations with different characteristics defining exercise and passive heat stress (intensity, mode, ambient conditions, duration) during pregnancy relative to the critical maternal Tcore of ≥39.0°C. DESIGN Systematic review with best evidence synthesis. DATA SOURCES EMBASE, MEDLINE, SCOPUS, CINAHL and Web of Science were searched from inception to 12 July 2017. STUDY ELIGIBILITY CRITERIA Studies reporting the Tcore response of pregnant women, at any period of gestation, to exercise or passive heat stress, were included. RESULTS 12 studies satisfied our inclusion criteria (n=347). No woman exceeded a Tcore of 39.0°C. The highest Tcore was 38.9°C, reported during land-based exercise. The highest mean end-trial Tcore was 38.3°C (95% CI 37.7°C to 38.9°C) for land-based exercise, 37.5°C (95% CI 37.3°C to 37.7°C) for water immersion exercise, 36.9°C (95% CI 36.8°C to 37.0°C) for hot water bathing and 37.6°C (95% CI 37.5°C to 37.7°C) for sauna exposure. CONCLUSION The highest individual core temperature reported was 38.9°C. Immediately after exercise (either land based or water immersion), the highest mean core temperature was 38.3°C; 0.7°C below the proposed teratogenic threshold. Pregnant women can safely engage in: (1) exercise for up to 35 min at 80%-90% of their maximum heart rate in 25°C and 45% relative humidity (RH); (2) water immersion (≤33.4°C) exercise for up to 45 min; and (3) sitting in hot baths (40°C) or hot/dry saunas (70°C; 15% RH) for up to 20 min, irrespective of pregnancy stage, without reaching a core temperature exceeding the teratogenic threshold.
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Affiliation(s)
- Nicholas Ravanelli
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - William Casasola
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,Exeter Medical School, University of Exeter, Exeter, UK
| | - Timothy English
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Kate M Edwards
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Ollie Jay
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.,Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
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Sickness Status and Neural Tube Defects: A Case-Control Study in a North Indian Population. Birth Defects Res 2017; 109:1393-1399. [DOI: 10.1002/bdr2.1126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/11/2017] [Indexed: 12/31/2022]
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Quality and Safety of Obstetric Practices Using New Modalities— Ultrasound, MR, and CT. Clin Obstet Gynecol 2017; 60:546-561. [DOI: 10.1097/grf.0000000000000300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Morimoto R, Hirata A, Laakso I, Ziskin MC, Foster KR. Time constants for temperature elevation in human models exposed to dipole antennas and beams in the frequency range from 1 to 30 GHz. Phys Med Biol 2017; 62:1676-1699. [PMID: 28166058 DOI: 10.1088/1361-6560/aa5251] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study computes the time constants of the temperature elevations in human head and body models exposed to simulated radiation from dipole antennas, electromagnetic beams, and plane waves. The frequency range considered is from 1 to 30 GHz. The specific absorption rate distributions in the human models are first computed using the finite-difference time-domain method for the electromagnetics. The temperature elevation is then calculated by solving the bioheat transfer equation. The computational results show that the thermal time constants (defined as the time required to reach 63% of the steady state temperature elevation) decrease with the elevation in radiation frequency. For frequencies higher than 4 GHz, the computed thermal time constants are smaller than the averaging time prescribed in the ICNIRP guidelines, but larger than the averaging time in the IEEE standard. Significant differences between the different head models are observed at frequencies higher than 10 GHz, which is attributable to the heat diffusion from the power absorbed in the pinna. The time constants for beam exposures become large with the increase in beam diameter. The thermal time constant in the brain is larger than that in the superficial tissues at high frequencies, because the brain temperature elevation is caused by the heat conduction of energy absorbed in the superficial tissue. The thermal time constant is minimized with an ideal beam with a minimum investigated diameter of 10 mm; this minimal time constant is approximately 30 s and is almost independent of the radiation frequency, which is supported by analytic methods. In addition, the relation between the time constant, as defined in this paper, and 'averaging time' as it appears in the exposure limits is discussed, especially for short intense pulses. Similar to the laser guidelines, provisions should be included in the limits to limit the fluence for such pulses.
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Affiliation(s)
- Ryota Morimoto
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Gokiso-cho, Showa-ku, Nagoya 466-8555, Japan
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Auger N, Fraser WD, Sauve R, Bilodeau-Bertrand M, Kosatsky T. Risk of Congenital Heart Defects after Ambient Heat Exposure Early in Pregnancy. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:8-14. [PMID: 27494594 PMCID: PMC5226695 DOI: 10.1289/ehp171] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/17/2016] [Accepted: 06/22/2016] [Indexed: 05/02/2023]
Abstract
BACKGROUND Congenital heart defects may be environmentally related, but the association with elevated ambient temperature has received little attention. OBJECTIVES We studied the relationship between outdoor heat during the first trimester of pregnancy and risk of congenital heart defects. METHODS We carried out a retrospective cohort study of 704,209 fetuses between 2 and 8 weeks postconception from April to September in Quebec, Canada, 1988-2012. We calculated the prevalence of congenital heart defects at birth according to the number of days women were exposed to maximum temperature ≥ 30°C. In log-binomial regression models, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) for the relationship of temperature with seven critical and eight noncritical heart defects, adjusted for pregnancy characteristics. RESULTS Prevalence of congenital heart defects was 979.5 per 100,000 for 10 days or more of temperature ≥ 30°C compared with 878.9 per 100,000 for 0 days of exposure. Temperature was more precisely associated with noncritical than critical defects, which had lower prevalence. Fetuses exposed to 15 days of temperature ≥ 30°C between 2 and 8 weeks postconception had 1.06 times the risk of critical defects (95% CI: 0.67, 1.67) and 1.12 times the risk of noncritical defects (95% CI: 0.98, 1.29) relative to 0 days. Associations were higher for atrial septal defects (PR 1.37, 95% CI: 1.10, 1.70) than for other noncritical defects. For atrial septal defects, associations with elevated temperatures began the 3rd week postconception. CONCLUSIONS Extreme heat exposure during the first trimester may be associated with noncritical heart defects, especially of the atrial septum. Citation: Auger N, Fraser WD, Sauve R, Bilodeau-Bertrand M, Kosatsky T. 2017. Risk of congenital heart defects after ambient heat exposure early in pregnancy. Environ Health Perspect 125:8-14; http://dx.doi.org/10.1289/EHP171.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
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Tirada N, Dreizin D, Khati NJ, Akin EA, Zeman RK. Imaging Pregnant and Lactating Patients. Radiographics 2016; 35:1751-65. [PMID: 26466183 DOI: 10.1148/rg.2015150031] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As use of imaging in the evaluation of pregnant and lactating patients continues to increase, misperceptions of radiation and safety risks have proliferated, which has led to often unwarranted concerns among patients and clinicians. When radiologic examinations are appropriately used, the benefits derived from the information gained usually outweigh the risks. This review describes appropriateness and safety issues, estimated doses for imaging examinations that use iodizing radiation (ie, radiography, computed tomography, nuclear scintigraphy, and fluoroscopically guided interventional radiology), radiation risks to the mother and conceptus during various stages of pregnancy, and use of iodinated or gadolinium-based contrast agents and radiotracers in pregnant and lactating women. Maternal radiation risk must be weighed with the potential consequences of missing a life-threatening diagnosis such as pulmonary embolus. Fetal risks (ie, spontaneous abortion, teratogenesis, or carcinogenesis) vary with gestational age and imaging modality and should be considered in the context of the potential benefit of medically necessary diagnostic imaging. When feasible and medically indicated, modalities that do not use ionizing radiation (eg, magnetic resonance imaging) are preferred in pregnant and lactating patients. Radiologists should strive to minimize risks of radiation to the mother and fetus, counsel patients effectively, and promote a realistic understanding of risks related to imaging during pregnancy and lactation.
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Affiliation(s)
- Nikki Tirada
- From the Department of Radiology, George Washington University Hospital, 900 23rd St NW, Washington, DC 20037 (N.T., N.J.K., E.A.A., R.K.Z.); and Department of Diagnostic Radiology, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, Baltimore, Md (D.D)
| | - David Dreizin
- From the Department of Radiology, George Washington University Hospital, 900 23rd St NW, Washington, DC 20037 (N.T., N.J.K., E.A.A., R.K.Z.); and Department of Diagnostic Radiology, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, Baltimore, Md (D.D)
| | - Nadia J Khati
- From the Department of Radiology, George Washington University Hospital, 900 23rd St NW, Washington, DC 20037 (N.T., N.J.K., E.A.A., R.K.Z.); and Department of Diagnostic Radiology, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, Baltimore, Md (D.D)
| | - Esma A Akin
- From the Department of Radiology, George Washington University Hospital, 900 23rd St NW, Washington, DC 20037 (N.T., N.J.K., E.A.A., R.K.Z.); and Department of Diagnostic Radiology, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, Baltimore, Md (D.D)
| | - Robert K Zeman
- From the Department of Radiology, George Washington University Hospital, 900 23rd St NW, Washington, DC 20037 (N.T., N.J.K., E.A.A., R.K.Z.); and Department of Diagnostic Radiology, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, Baltimore, Md (D.D)
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Grajewski B, Rocheleau CM, Lawson CC, Johnson CY. "Will my work affect my pregnancy?" Resources for anticipating and answering patients' questions. Am J Obstet Gynecol 2016; 214:597-602. [PMID: 26976559 DOI: 10.1016/j.ajog.2016.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Authoritative information on occupational reproductive hazards is scarce and complex because exposure levels vary, multiple exposures may be present, and the reproductive toxicity of many agents remains unknown. For these reasons, women's health providers may find it challenging to effectively address workplace reproductive health issues with their patients who are pregnant, breast-feeding, or considering pregnancy. Reproductive epidemiologists at the Centers for Disease Control and Prevention National Institute for Occupational Safety and Health answered >200 public requests for occupational reproductive health information during 2009 through 2013. The most frequent occupations represented were health care (41%) and laboratory work (18%). The most common requests for exposure information concerned solvents (14%), anesthetic gases (10%), formaldehyde (7%), infectious agents in laboratories (7%) or health care settings (7%), and physical agents (14%), including ionizing radiation (6%). Information for developing workplace policies or guidelines was sought by 12% of the requestors. Occupational exposure effects on breast-feeding were an increasing concern among working women. Based on information developed in response to these requestors, information is provided for discussing workplace exposures with patients, assessing potential workplace reproductive hazards, and helping patients determine the best options for safe work in pregnancy. Appendices provide resources to address specific occupational exposures, employee groups, personal protective equipment, breast-feeding, and workplace regulations regarding work and pregnancy. These tools can help identify those most at risk of occupational reproductive hazards and improve workers' reproductive health. The information can also be used to inform research priorities and assist the development of workplace reproductive health policies.
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Affiliation(s)
- Barbara Grajewski
- Industrywide Studies Branch, National Institute for Occupational Safety and Health, Cincinnati, OH.
| | - Carissa M Rocheleau
- Industrywide Studies Branch, National Institute for Occupational Safety and Health, Cincinnati, OH
| | - Christina C Lawson
- Industrywide Studies Branch, National Institute for Occupational Safety and Health, Cincinnati, OH
| | - Candice Y Johnson
- Industrywide Studies Branch, National Institute for Occupational Safety and Health, Cincinnati, OH; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA
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Leptin reduces apoptosis triggered by high temperature in human placental villous explants: The role of the p53 pathway. Placenta 2016; 42:106-13. [PMID: 27238720 DOI: 10.1016/j.placenta.2016.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/17/2016] [Accepted: 03/20/2016] [Indexed: 11/21/2022]
Abstract
Maternal fever is common during pregnancy and has for many years been suspected to harm the developing fetus. Whether increased maternal temperature produces exaggerated apoptosis in trophoblast cells remains unclear. Since p53 is a critical regulator of apoptosis we hypothesized that increased temperature in placenta produces abnormal expression of proteins in the p53 pathway and finally caspase-3 activation. Moreover, leptin, produced by placenta, is known to promote the proliferation and survival of trophoblastic cells. Thus, we aimed to study the possible role of leptin preventing apoptosis triggered by high temperature, as well as the molecular mechanisms underlying this effect. Fresh placental tissue was collected from normal pregnancies. Explants of placental villi were exposed to 37 °C, 40 °C and 42 °C during 3 h in the presence or absence of 10 nM leptin in DMEM-F12 medium. Western blotting and qRT-PCR was performed to analyze the expression of p53 and downstream effector, P53AIP1, Mdm2, p21, BAX and BCL-2 as well as the activated cleaved form of caspase-3 and the fragment of cytokeratin-18 (CK-18) cleaved at Asp396 (neoepitope M30). Phosphorylation of the Ser 46 residue on p53, the expression of P53AIP1, Mdm2, p21, as well as caspase-3 and CK-18 were significantly increased in explants at 40 °C and 42 °C. Conversely, these effects were significantly attenuated by leptin 10 nM at both 40 °C and 42 °C. The BCL2/BAX ratio was also significantly decreased in explants at 40 °C and 42 °C compared with explants incubated at 37 °C, which was prevented by leptin stimulation. These data illustrate the potential role of leptin for reducing apoptosis in trophoblast explants, including trophoblastic cells, triggered by high temperature, by preventing the activation of p53 signaling.
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Woitek R, Prayer D, Hojreh A, Helbich T. Radiological staging in pregnant patients with cancer. ESMO Open 2016; 1:e000017. [PMID: 27843585 PMCID: PMC5070210 DOI: 10.1136/esmoopen-2015-000017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ramona Woitek
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
| | - Daniela Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Azadeh Hojreh
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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Bouyssi-Kobar M, du Plessis AJ, Robertson RL, Limperopoulos C. Fetal magnetic resonance imaging: exposure times and functional outcomes at preschool age. Pediatr Radiol 2015; 45:1823-30. [PMID: 26155983 DOI: 10.1007/s00247-015-3408-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 04/20/2015] [Accepted: 06/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Fetal magnetic resonance imaging (MRI) has been routinely used as a noninvasive diagnostic tool for more than a decade; however, there is a paucity of follow-up studies examining the effects of prenatal exposure to 1.5-T MRI on developmental outcome. OBJECTIVE The objective of this study was to assess the safety of 1.5-T fetal MRI by evaluating functional outcomes of preschool children who were exposed in utero. MATERIALS AND METHODS In the context of a prospective observational study, healthy pregnant women underwent a 1.5-T MRI study using single-shot fast spin echo (SSFSE) sequences during the second or third trimester of pregnancy. The study was approved by the institutional review board at our institution, and written informed consent was obtained from all study participants. MRI scanning times were recorded, and prenatal/postnatal clinical data were collected prospectively. Functional outcomes were assessed using the Vineland Adaptive Behavior Scale (VABS), a widely used, norm-referenced and psychometrically sound functional assessment. RESULTS We studied 72 healthy pregnant women, who underwent fetal MRI at a mean gestational age of 30.5 ± 3.1 weeks. The cohort of fetuses was composed of 43% females, and 18 fetuses were scanned during the second trimester. All fetuses were born at term with appropriate birth weights (3.54 ± 0.5 kg) for gestational age. Mean age at follow-up testing was 24.5 ± 6.7 months. All children had age-appropriate scores in the communication, daily living, socialization and motor skills subdomains of the VABS (z-scores, P > 0.05). Furthermore, all children passed their newborn otoacoustic emission test and had normal hearing at preschool age. MRI study duration and exposure time to radio frequency waves and SSFSE sequences were not associated with adverse functional outcomes or hearing impairment. CONCLUSION Prenatal exposure to 1.5-T MRI during the second or third trimester of pregnancy in a cohort of healthy fetuses is not associated with disturbances in functional outcomes or hearing impairment at preschool age.
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Affiliation(s)
- Marine Bouyssi-Kobar
- Institute for Biomedical Sciences, George Washington University, Washington, DC, USA.,Advanced Pediatric Brain Imaging Research Laboratory, Departments of Diagnostic Imaging and Radiology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Adré J du Plessis
- Fetal and Transitional Medicine, Children's National Health System, Washington, DC, USA
| | - Richard L Robertson
- Department of Radiology, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA
| | - Catherine Limperopoulos
- Advanced Pediatric Brain Imaging Research Laboratory, Departments of Diagnostic Imaging and Radiology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC, 20010, USA. .,Fetal and Transitional Medicine, Children's National Health System, Washington, DC, USA.
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Vicedo-Cabrera AM, Olsson D, Forsberg B. Exposure to seasonal temperatures during the last month of gestation and the risk of preterm birth in Stockholm. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:3962-78. [PMID: 25867199 PMCID: PMC4410227 DOI: 10.3390/ijerph120403962] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/01/2015] [Indexed: 11/23/2022]
Abstract
Recent evidence from studies performed mainly in warm climates suggests an association between exposure to extreme temperatures late in pregnancy and an increased risk of preterm delivery. However, there have been fewer studies on the effect of low temperatures. The aim of this study is to explore the potential association between both heat and cold during late pregnancy and an increased risk of preterm birth in the northern location of Stockholm, Sweden. All singleton spontaneous births that took place in greater Stockholm (1998–2006) were included. Non-linear and delayed effects of mean temperature on the risk of preterm birth were explored through distributed lag non-linear models. Extreme and moderate heat and cold were estimated separately through quasi-Poisson regression analysis in two seasonal periods (heat in warm season, cold in cold season). The risk of preterm birth increased by 4%–5% when the mean temperature reached the 75th percentile (moderate heat) four weeks earlier (reference: the annual median value), with a maximum cumulative risk ratio of 2.50 (95% confidence interval: 1.02–6.15). Inconsistent associations were obtained for cold and extreme heat. Exposure to moderately high temperatures during late pregnancy might be associated with an increase in risk of preterm birth in Stockholm.
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Affiliation(s)
- Ana M Vicedo-Cabrera
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, SE901 87 Umeå, Sweden.
| | - David Olsson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, SE901 87 Umeå, Sweden.
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, SE901 87 Umeå, Sweden.
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Ferrer MS, Miesner M, Anderson DE, Rousseau M, Sardoy MC. Ultrasonographic fetal parameters and neonatal survival in somatic cell nuclear transfer-derived beef calves. Theriogenology 2014; 82:827-33. [PMID: 25107630 DOI: 10.1016/j.theriogenology.2014.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/20/2014] [Accepted: 06/18/2014] [Indexed: 11/27/2022]
Abstract
The objectives of this study were to identify prognostic indicators of calf survival in SCNT-derived beef calves. Ultrasonographic parameters of fetal well-being and development, maternal clinical parameters, and neonatal parameters were evaluated as predictors of calf survival in cows carrying SCNT-derived beef fetuses (n = 38). Calf survival was 61.5% (88.2% female and 40.9% male calves; P = 0.0026). Cow respiratory rate and cow temperature were significantly greater in the nonsurviving (NS) group 1 week prepartum. In surviving (S) calves, fetal heart rate (FHR) decreased during the last 2 weeks of gestation (P < 0.01). However, this final deceleration was not observed in NS calves, resulting in higher FHRs in this group (P < 0.0001). Fetal movement and fluid scores did not differ with calf classification. Mean amniotic fluid depth was smaller in S (5.5 ± 0.7 cm) than NS (8.7 ± 1.4 cm) calves (P = 0.0398). However, mean allantoic fluid depth did not differ (P = 0.6120). There was a significant association between the body weight of calf and the diameter of the fetal aorta (P = 0.0115; r(2) = 0.3762). Surviving calves were lighter at birth (P = 0.0028) and were born later (P = 0.007) than NS calves. Calves born vaginally had a smaller fetal aorta (2.1 ± 0.1 cm vaginal and 2.4 ± 0.1 cm Cesarean) (P = 0.0487) and a lighter birth weight (41.4 ± 4.2 kg vaginal and 60.4 ± 2.1 kg Cesarean) (P = 0.0001) than calves born by Cesarean. Also, calves that underwent spontaneous labor (52.2% S and 0% NS; P = 0.0029) had a lighter birth weight (44.9 ± 3.8 kg) than calves that did not initiate labor (61.6 ± 2.2 kg) (P = 0.0004). Frequent ultrasonographic fetal monitoring allowed identification of differences between S and NS calves. Calves without a final decrease in FHR or with a large aortic diameter were more likely to require a Cesarean because of failure to initiate labor or fetomaternal disproportion. Parameters of fetal well-being and development during the last 3 weeks of gestation were first described in SCNT-derived beef calves.
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Affiliation(s)
- M S Ferrer
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA.
| | - M Miesner
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - D E Anderson
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - M Rousseau
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - M C Sardoy
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
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Fiocchi S, Parazzini M, Liorni I, Samaras T, Ravazzani P. Temperature Increase in the Fetus Exposed to UHF RFID Readers. IEEE Trans Biomed Eng 2014; 61:2011-9. [DOI: 10.1109/tbme.2014.2312023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Serena Fiocchi
- Istituto di Elettronica e di Ingegneria dell'Informazione e delle Telecomunicazioni, CNR Consiglio Nazionale delle Ricerche, Milan, Italy
| | - Marta Parazzini
- Istituto di Elettronica e di Ingegneria dell'Informazione e delle Telecomunicazioni, CNR Consiglio Nazionale delle Ricerche, Milan, Italy
| | - Ilaria Liorni
- Dipartimento di Elettronica, Informazione e Bioingegneria DEIB, Politecnico di Milano, Milan, Italy
| | - Theodoros Samaras
- Department of Physics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paolo Ravazzani
- Istituto di Elettronica e di Ingegneria dell'Informazione e delle Telecomunicazioni, CNR Consiglio Nazionale delle Ricerche, Milan, Italy
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Dreier JW, Andersen AMN, Berg-Beckhoff G. Systematic review and meta-analyses: fever in pregnancy and health impacts in the offspring. Pediatrics 2014; 133:e674-88. [PMID: 24567014 DOI: 10.1542/peds.2013-3205] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Fever during pregnancy has been suspected to harm the developing fetus. However, until now, no systematic analysis of the available evidence has been undertaken to assess the impact of maternal fever on health outcomes in the child. The goal of this study was to systematically review evidence from epidemiologic studies on adverse health outcomes of the offspring in relation to exposure to maternal fever during pregnancy. METHODS Systematic searches in PubMed, Web of Science, and the Cochrane Library were performed by using Medical Subject Headings, Boolean operators, and truncation, and references of references were reviewed. Cohort and case-control studies addressing health outcomes of prenatal fever exposure in humans were eligible for inclusion. Studies with no direct reference to fever, studies in selected populations (eg, preterm births), and studies published before 1990 were excluded. RESULTS The available literature supported an increased risk of adverse offspring health in association with fever during pregnancy. The strongest evidence was available for neural tube defects, congenital heart defects, and oral clefts, in which meta-analyses suggested between a 1.5- and nearly 3-fold increased risk with fever exposure in the first trimester. We did not find strong evidence of a dose-response relationship, but there was some evidence that antipyretic medications may have a protective effect when used in relation to febrile episodes. CONCLUSIONS We found substantial evidence to support the contention that maternal fever during pregnancy may negatively affect offspring health. The harmful effects seemed to cover both short- and longer-term health outcomes; however, for several outcomes, the evidence was insufficient to judge any association.
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Cibull SL, Harris GR, Nell DM. Trends in diagnostic ultrasound acoustic output from data reported to the US Food and Drug Administration for device indications that include fetal applications. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1921-1932. [PMID: 24154895 DOI: 10.7863/ultra.32.11.1921] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES A survey was conducted of acoustic output data received by the US Food and Drug Administration for diagnostic ultrasound devices whose indications for use include fetal applications to assess trends in maximum available acoustic output over time. METHODS Data were collected from 124 regulatory submissions received between 1984 and 2010. Data collection excluded transducers not indicated for diagnostic fetal imaging. The output parameters of ultrasonic power, mean center frequency, and bone thermal index (TIB) were extracted or computed from the submissions for 3 periods: 1984-1989, 1992-1997, and 2005-2010. The data were stratified according to the following imaging modes: M-mode, B/M-mode, pulsed wave Doppler, color flow Doppler, and continuous wave Doppler. RESULTS Ultrasonic power and maximum TIB values have increased roughly an order of magnitude from pre-1991 to post-1991 periods; the center frequency has decreased somewhat (4.2 to 3.4 MHz). The percentage of Doppler-mode transducers has increased substantially over time, with the majority of the diagnostic fetal imaging transducers currently designed to operate in Doppler modes; this increase is particularly important, since Doppler modes generate much higher TIB levels than B/M-modes. Color flow Doppler ultrasound currently operates at the highest mean ultrasonic power level (with a 14-fold increase over time). CONCLUSIONS The observed trends in increased acoustic output for both Doppler and non-Doppler modes underscore the widely recognized importance of adherence to the ALARA (as low as reasonably achievable) principle and prudent use in fetal ultrasound imaging.
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Affiliation(s)
- Sarah L Cibull
- US Food and Drug Administration, 10903 New Hampshire Ave, Room WO62-2104, Silver Spring, MD 20993-0002 USA.
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Fiocchi S, Markakis IA, Liorni I, Parazzini M, Samaras T, Ravazzani P. Estimate of the fetal temperature increase due to UHF RFID exposure. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:1254-7. [PMID: 24109922 DOI: 10.1109/embc.2013.6609735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Exposure from electromagnetic (EM) devices has increased during the last decades due to the rapid development of new technologies. Among them, radiofrequency identification (RFID) applications are used in almost every aspect of everyday life, which could expose people unselectively. This scenario could pose potential risks for certain groups of general population, such as pregnant women, who are more sensitive to thermal effects produced by EM exposure. In this paper, the temperature rise at the steady state in two pregnant women models exposed to UHF RFID has been assessed. Results show that heating of tissues is far from the threshold of biological effects indicated by radiation protection guidelines.
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van Rhoon GC, Samaras T, Yarmolenko PS, Dewhirst MW, Neufeld E, Kuster N. CEM43°C thermal dose thresholds: a potential guide for magnetic resonance radiofrequency exposure levels? Eur Radiol 2013; 23:2215-27. [PMID: 23553588 DOI: 10.1007/s00330-013-2825-y] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 01/30/2013] [Accepted: 02/02/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To define thresholds of safe local temperature increases for MR equipment that exposes patients to radiofrequency fields of high intensities for long duration. These MR systems induce heterogeneous energy absorption patterns inside the body and can create localised hotspots with a risk of overheating. METHODS The MRI + EUREKA research consortium organised a "Thermal Workshop on RF Hotspots". The available literature on thresholds for thermal damage and the validity of the thermal dose (TD) model were discussed. RESULTS/CONCLUSIONS The following global TD threshold guidelines for safe use of MR are proposed: 1. All persons: maximum local temperature of any tissue limited to 39 °C 2. Persons with compromised thermoregulation AND (a) Uncontrolled conditions: maximum local temperature limited to 39 °C (b) Controlled conditions: TD < 2 CEM43°C 3. Persons with uncompromised thermoregulation AND (a) Uncontrolled conditions: TD < 2 CEM43°C (b) Controlled conditions: TD < 9 CEM43°C The following definitions are applied: Controlled conditions A medical doctor or a dedicated trained person can respond instantly to heat-induced physiological stress Compromised thermoregulation All persons with impaired systemic or reduced local thermoregulation KEY POINTS • Standard MRI can cause local heating by radiofrequency absorption. • Monitoring thermal dose (in units of CEM43°C) can control risk during MRI. • 9 CEM43°C seems an acceptable thermal dose threshold for most patients. • For skin, muscle, fat and bone,16 CEM43°C is likely acceptable.
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Affiliation(s)
- Gerard C van Rhoon
- Department of Radiotherapy, Erasmus MC Cancer Center, Rotterdam, The Netherlands.
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