Critical windows of susceptibility for the effects of prenatal exposure to heat and heat variability on gestational growth

Carlson, Jeffrey M.; Zanobetti, Antonella; Cuba, Stephanie Ettinger de; Poblacion, Ana; Fabian, M. Patricia; Carnes, Fei; Rhee, Jongeun; Lane, Kevin; Sandel, Megan; Janulewicz, Patricia

doi:10.1016/j.envres.2022.114607

Cited by 7 publications

(19 citation statements)

References 55 publications

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“…We observed that the association between ambient temperature and PTB was more evident in pregnant women ≥35 years of age and with a low education level. An increased risk of PTB among older women (≥35 years) is induced by medically indicated PTB, considering that advanced maternal age is a contributing factor for medical conditions, such as preeclampsia and fetal growth restriction, whereby the impact of exposure to high temperature is potentially suggested in the literature [ 6 , 31 ]. On the other hand, given that advanced maternal age (≥35 years) was suggested as an independent risk factor for spontaneous preterm labor, mechanisms for spontaneous PTB, such as infection, stress, uterine overdistension, decidual senescence, cervical disease, vascular disorders, and breakdown of maternal-fetal tolerance, should not be excluded [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Disparities in the association between ambient temperature and preterm birth according to individual and regional characteristics: a nationwide time-stratified case-crossover study

Min,

Lee,

et al. 2024

Environ Health

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Background Several studies have reported that climate change elevates heat exposure in pregnant women and high temperatures during pregnancy are associated with preterm births (PTBs). Although the association might be disproportionate, related evidence remains sparse. We evaluated the disproportionate risk of PTB associated with ambient temperature during pregnancy by individual and regional characteristics in South Korea. Methods We collected data on birth certificates and daily mean temperatures during the period from 2011 to 2019. A time-stratified case-crossover design was used to investigate the association between temperature and PTB and stratified analyses were conducted to examine the effect modification of individual and regional characteristics. Results A total of 160,067 singleton PTBs were recorded in Korea from 2011 to 2019. A 5℃ increase in the mean temperature during the last four weeks before delivery was associated with an increased risk of PTB with an odds ratio (OR) of 1.03 (95% confidence interval [CI]: 1.02, 1.05), and the association was more evident in mothers aged ≥35 years (OR: 1.06 [95% CI: 1.03, 1.10]) and with low education levels (OR: 1.04 [95% CI: 1.02, 1.05]). Additionally, the estimated risk was evident in districts with lower medical resources and more prominent disparities were shown by individual and regional characteristics in rural areas than in urban areas. Conclusions This study provides evidence that the risk of PTB related to ambient temperature is disproportionate by individual and regional characteristics and suggests the need for public health policies to alleviate the disparities, especially in rural areas.

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Section: Discussionmentioning

confidence: 99%

Disparities in the association between ambient temperature and preterm birth according to individual and regional characteristics: a nationwide time-stratified case-crossover study

Min,

Lee,

et al. 2024

Environ Health

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“…2,5 A burgeoning body of evidence suggests that prenatal exposures to temperature extremes are associated with adverse pregnancy and birth outcomes. [6][7][8][9][10][11][12][13][14] The mechanisms by which heat impacts fetal health are not yet fully understood but are hypothesised to include inflammation, oxidative stress and placental insufficiency. 15,16 Moreover, thermoregulatory responses of pregnant individuals may lead to dehydration and diverted blood flow and, consequently, to reduced nutrient transport to the developing fetus.…”

Section: Introductionmentioning

confidence: 99%

“…A burgeoning body of evidence suggests that prenatal exposures to temperature extremes are associated with adverse pregnancy and birth outcomes 6–14 . The mechanisms by which heat impacts fetal health are not yet fully understood but are hypothesised to include inflammation, oxidative stress and placental insufficiency 15,16 .…”

Section: Introductionmentioning

confidence: 99%

Impact of cash transfers on the association between prenatal exposures to high temperatures and low birthweight: Retrospective analysis from the LEAP 1000 study

LaPointe,

Mendola,

Lin

et al. 2024

BJOG

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ObjectiveTo explore the associations between prenatal temperature exposures and low birthweight (LBW) and modification by cash transfer (CT) receipt.DesignRetrospective cohort study.SettingFive rural districts in Northern Ghana.Population or sampleA total of 3016 infants born to women interviewed as part of the Livelihood Empowerment Against Poverty (LEAP 1000) impact evaluation between 2015 and 2017.MethodsBirthweight was collected using household surveys administered to LEAP 1000 eligible women. We used a UNICEF‐developed multiple imputation approach to address missingness of birthweight and applied an empirical heaping correction to the multiply imputed birthweight data. Survey data were linked to the European Centre for Medium‐Range Weather Forecasts Reanalysis 5‐hourly temperature averaged to weeks for 2011–2017 using community centroids. Using distributed‐lag nonlinear models, we explored the lag‐specific associations between weekly average temperatures greater than 30°C and LBW, and stratified by LEAP 1000 treatment.Main outcome measuresLow birthweight (<2.5 kg).ResultsTwelve percent (n = 365) of infants were LBW; the mean ± SD birthweight was 3.02 ± 0.37 kg. Overall, increasing temperatures were associated with increased odds of LBW, with the greatest odds observed in the 3 weeks before birth (odds ratio 1.005–1.025). These positive associations were even larger among comparison infants and null among treatment infants.ConclusionsOur study found increased odds of LBW with high weekly average temperatures throughout pregnancy and the preconception period and demonstrate mitigated effects by the LEAP 1000 CT program. More evidence on the potential of CTs to serve as adaptation interventions in low‐ and middle‐income countries is needed to protect pregnant persons and their infants from the impacts of climate change.

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“… 1 Moreover, exposure to ambient and indoor air pollution, 6 , 7 other chemicals, 8 , 9 and, recently, climatic factors are modifiable environmental risk factors of SGA and LGA of increasing interest. 10 , 11 …”

Section: Introductionmentioning

confidence: 99%

“… 11 , 18 However, related research is limited and with inconsistent findings on SGA. 10 , 19 – 21 For LGA, to the best of our knowledge, related epidemiologic evidence is currently lacking in the literature, but this is now receiving greater attention in air pollution epidemiology. 22 – 24 It is important to investigate the association between climate change extremes and LGA risk for actionable intervention given that LGA is also implicated with many health outcomes throughout the life course.…”

Section: Introductionmentioning

confidence: 99%

Critical Windows of Maternal Exposure to Biothermal Stress and Birth Weight for Gestational Age in Western Australia

Nyadanu,

Tessema,

Mullins

et al. 2023

Environ Health Perspect

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Background: There is limited and inconsistent evidence on the risk of ambient temperature on small for gestational age (SGA) and there are no known related studies for large for gestational age (LGA). In addition, previous studies used temperature rather than a biothermal metric. Objectives: Our aim was to examine the associations and critical susceptible windows of maternal exposure to a biothermal metric [Universal Thermal Climate Index (UTCI)] and the hazards of SGA and LGA. Methods: We linked 385,337 singleton term births between 1 January 2000 and 31 December 2015 in Western Australia to daily spatiotemporal UTCI. Distributed lag nonlinear models with Cox regression and multiple models were used to investigate maternal exposure to UTCI from 12 weeks preconception to birth and the adjusted hazard ratios (HRs) of SGA and LGA. Results: Relative to the median exposure, weekly and monthly specific exposures showed potential critical windows of susceptibility for SGA and LGA at extreme exposures, especially during late gestational periods. Monthly exposure showed strong positive associations from the 6th to the 10th gestational months with the highest hazard of 13% for SGA ( ; 95% CI: 1.10, 1.14) and 7% for LGA ( ; 95% CI: 1.03, 1.11) at the 10th month for the 1st UTCI centile. Entire pregnancy exposures showed the strongest hazards of 11% for SGA ( ; 95% CI: 1.04, 1.18) and 3% for LGA ( ; 95% CI: 0.95, 1.11) at the 99th UTCI centile. By trimesters, the highest hazards were found during the second and first trimesters for SGA and LGA, respectively, at the 99th UTCI centile. Based on estimated interaction effects, male births, mothers who were non-Caucasian, smokers, years of age, and rural residents were most vulnerable. Conclusions: Both weekly and monthly specific extreme biothermal stress exposures showed potential critical susceptible windows of SGA and LGA during late gestational periods with disproportionate sociodemographic vulnerabilities. https://doi.org/10.1289/EHP12660

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Critical windows of susceptibility for the effects of prenatal exposure to heat and heat variability on gestational growth

Cited by 7 publications

References 55 publications

Disparities in the association between ambient temperature and preterm birth according to individual and regional characteristics: a nationwide time-stratified case-crossover study

Disparities in the association between ambient temperature and preterm birth according to individual and regional characteristics: a nationwide time-stratified case-crossover study

Impact of cash transfers on the association between prenatal exposures to high temperatures and low birthweight: Retrospective analysis from the LEAP 1000 study

Critical Windows of Maternal Exposure to Biothermal Stress and Birth Weight for Gestational Age in Western Australia

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