Effects of extreme temperature on the risk of preterm birth in China: A population-based multi-center cohort study

Ren, Meng; Wang, Qiong; Zhao, Wei; Ren, Zhoupeng; Zhang, Huanhuan; Jalaludin, Bin; Benmarhnia, Tarik; Di, Jiangli; Hu, Huanqing; Wang, Ying; Ji, John S.; Wan, Liang; Huang, Cunrui

doi:10.1016/j.lanwpc.2022.100496

Cited by 15 publications

(18 citation statements)

References 43 publications

(83 reference statements)

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“…In this national study of heat waves and PTB outcomes across diverse climate zones in China, we found that pregnant women were at a 1.6% (95% CI, 0.3%-3.0%) to 3.7% (95% CI, 0.5%-6.9%) higher risk for PTB when exposed to compound heat waves during the last week before delivery and a 2.7% (95% CI, 0.5%-5.0%) to 4.2% (95% CI, 1.1%-7.5%) higher risk when exposed to daytime-only heat waves, compared with those who were unexposed. Our findings in China are consistent with and expand on the results of previous studies . A recent meta-analysis found 1.16-fold higher odds of PTB during heat waves.…”

Section: Discussionsupporting

confidence: 92%

“…Our findings in China are consistent with and expand on the results of previous studies. [1][2][3][4][5]8,16 A recent meta-analysis 8 found 1.16-fold higher odds of PTB during heat waves. Seven of 8 prior single city or state studies in the US, Australia, A heat wave was defined as a period equal to or more than 2, 3, or 4 consecutive days above the daily temperature threshold.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to maternal SES, studies have also suggested socioeconomic regional variations in heat-related PTB . Meanwhile, research findings about urban-rural disparities in heat-related PTB are limited and inconsistent, with little such evidence available in China.…”

Section: Introductionmentioning

confidence: 99%

“…10,12 In addition to maternal SES, studies have also suggested socioeconomic regional variations in heat-related PTB. [13][14][15][16] Meanwhile, research findings about urban-rural disparities in heat-related PTB are limited and inconsistent, 9,14 with little such evidence available in China. It is important to assess urban-rural and socioeconomic region-specific associations between heat waves and PTB, because the findings could provide critical evidence for developing heat adaptation policies to guide clinical practice, to undertake community health education, and to prevent PTB.…”

Section: Introductionmentioning

confidence: 99%

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Association of Daytime-Only, Nighttime-Only, and Compound Heat Waves With Preterm Birth by Urban-Rural Area and Regional Socioeconomic Status in China

et al. 2023

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ImportanceAssociations between heat waves and preterm birth (PTB) have been reported. However, associations of daytime-only, nighttime-only, and compound heat waves with PTB have yet to be explored at a national level. Furthermore, possible heterogeneity across urban-rural communities with different socioeconomic statuses needs to be explored.ObjectiveTo examine the association between daytime-only, nighttime-only, and compound heat waves and PTB in China and to find variations between urban and rural regions.Design, Setting, and ParticipantsThis case-crossover study used nationwide representative birth data between January 1, 2012, and December 31, 2019, from China’s National Maternal Near Miss Surveillance System. This multisite study covered 30 provinces in China and ensured the representation of urban and rural populations across 3 socioeconomic regions. Singleton live births delivered in the warm seasons from April to October during the study period were included. Exclusion criteria consisted of gestational age younger than 20 or older than 45 weeks, maternal ages younger than 13 or older than 50 years, conception dates earlier than 20 weeks before January 1, 2012, and later than 45 weeks before December 31, 2019, and an inconsistent combination of birthweight and gestational age according to growth standard curves of Chinese newborns. Data were analyzed from September 10, 2021, to April 25, 2023.ExposuresEighteen definitions of heat waves by 3 distinct types, including daytime only (only daily maximum temperature exceeds thresholds), nighttime only (only daily minimum temperature exceeds thresholds), and compound (both daily maximum and minimum temperature exceeds thresholds) heat waves, and 6 indexes, including 75th percentile of daily temperature thresholds for 2 or more (75th-D2), 3 or more (75th-D3), or 4 or more (75th-D4) consecutive days and 90th percentile of daily temperature thresholds for 2 or more (90th-D2), 3 or more (90th-D3), and 4 or more (90th-D4) consecutive days.Main Outcomes and MeasuresPreterm births with less than 37 completed weeks of gestation.ResultsAmong the 5 446 088 singleton births in the final analytic sample (maternal mean [SD] age, 28.8 [4.8] years), 310 384 were PTBs (maternal mean [SD] age, 29.5 [5.5] years). Compared with unexposed women, exposure of pregnant women to compound heat waves in the last week before delivery was associated with higher risk for PTB, with the adjusted odds ratios (AORs) ranging from 1.02 (95% CI, 1.00-1.03) to 1.04 (95% CI, 1.01-1.07) in 6 indexes. For daytime-only heat wave exposures, AORs ranged from 1.03 (95% CI, 1.01-1.05) to 1.04 (95% CI, 1.01-1.08) in the 75th-D4, 90th-D2, 90th-D3, and 90th-D4 indexes. Such associations varied by rural (AOR range, 1.05 [95% CI, 1.01-1.09] to 1.09 [95% CI, 1.04-1.14]) and urban (AOR range, 1.00 [95% CI, 0.98-1.02] to 1.01 [95% CI, 0.99-1.04]) regions during exposure to daytime-only heat waves in the 75th-D3 and 90th-D3 indexes.Conclusions and RelevanceIn this case-crossover study, exposure to compound and daytime-only heat waves in the last week before delivery were associated with PTB, particularly for pregnant women in rural regions exposed to daytime-only heat waves. These findings suggest that tailored urban-rural preventive measures may improve maternal health in the context of climate change.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of Daytime-Only, Nighttime-Only, and Compound Heat Waves With Preterm Birth by Urban-Rural Area and Regional Socioeconomic Status in China

et al. 2023

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“…Recent literature has highlighted the impact of environmental exposures on maternal health, encompassing a range of factors such as air pollutants 9 , green spaces 10 , and extreme temperatures 11 . As a response to these hazards, the Zhejiang Environmental and Birth Health Research Alliance (ZEBRA) was established in 2022 under the leadership of the Health Commission of Zhejiang Province.…”

Section: Why Was the Zebra Maternity Cohort Set Up?mentioning

confidence: 99%

Cohort Profile: Zhejiang Environmental and Birth Health Research Alliance (ZEBRA) Maternity Cohort

Sun

Tang

Xiang

et al. 2023

Preprint

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The Zhejiang Environmental and Birth Health Research Alliance (ZEBRA) established a maternity cohort to investigate the relationship between perinatal abnormalities and various risk factors among the Chinese maternal population. The primary aim of ZEBRA is to explore the feasibility of early-stage risk prediction and the forecast of adverse perinatal symptoms and gestational outcomes. The cohort is ambidirectional, with a retrospective arm tracking 6,275 pregnant females enrolled between 2013 and 2016, and a prospective arm recruiting 112,414 participants since the baseline year of 2017. The current ZEBRA maternity cohort database comprises a diverse range of sociodemographic features, physiological characteristics, medical history, therapeutic interventions, and measurements of environmental exposures. Going forward, the cohort will continue to enrol a wider range of participants and collect an even more extensive array of features. ZEBRA is seeking collaborations with both national and international multi-cohort studies to contribute to the field of epidemiology, and provide valuable evidence-based insights for global maternal and child healthcare.

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Interaction effects of night-time temperature and PM2.5 on preterm birth in Huai River Basin, China

Zhang¹,

Zhang²,

Feng³

et al. 2023

Environment International

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Effects of extreme temperature on the risk of preterm birth in China: A population-based multi-center cohort study

Cited by 15 publications

References 43 publications

Association of Daytime-Only, Nighttime-Only, and Compound Heat Waves With Preterm Birth by Urban-Rural Area and Regional Socioeconomic Status in China

Association of Daytime-Only, Nighttime-Only, and Compound Heat Waves With Preterm Birth by Urban-Rural Area and Regional Socioeconomic Status in China

Cohort Profile: Zhejiang Environmental and Birth Health Research Alliance (ZEBRA) Maternity Cohort

Interaction effects of night-time temperature and PM2.5 on preterm birth in Huai River Basin, China

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