An expert review of environmental heat exposure and stillbirth in the face of climate change: Clinical implications and priority issues
An expert review of environmental heat exposure and stillbirth in the face of climate change: Clinical implications and priority issues
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DOI：
10.1111/1471-0528.17622
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发表时间：
2023-07
期刊：
影响因子：
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通讯作者：
A. Bonell;Chérie E. Part;U. Okomo;Rebecca Cole;S. Hajat;S. Kovats;A. Sferruzzi-Perri;J. Hirst
中科院分区：
文献类型：
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作者：
A. Bonell;Chérie E. Part;U. Okomo;Rebecca Cole;S. Hajat;S. Kovats;A. Sferruzzi-Perri;J. Hirst
怀孕期间暴露在高温下会增加死产的风险。降低死产率方面的进展已经停滞不前，人们越来越多地暴露在高温和气候事件中，这可能会进一步破坏卫生战略。这篇叙述性综述总结了母体热暴露对死产风险影响的当前临床和流行病学证据。在20项研究中，有19项发现高温与死产风险之间存在关联。最近基于低收入到中等收入国家和热带环境的研究增加了现有文献的内容，表明所有人口都处于危险之中。此外，短期高温暴露和全孕期高温暴露都会增加死产的风险。目前还没有确定一个确切的影响阈值，因为大多数研究将暴露在该人群正常温度的第90摄氏度以上。因此，热暴露与死产之间的联系已被发现，从低至>；12.64°C到>；46.4°C。根据人类和动物的研究，母亲热暴露可能导致死产的病理生理途径包括胎盘和胚胎或胎儿的影响。尽管仍然存在证据空白，还需要进一步的研究来更详细地描述这些机制，但初步证据表明，表观遗传变化、印记基因的改变、先天性异常、胎盘血流减少、大小和功能都起到了作用。最后，我们从公共卫生的角度探讨这个话题；我们讨论和评估当前关于将社区极端高温的风险降至最低的公共卫生指南。在热浪计划中，针对怀孕的指导有限，还没有建立以证据为基础的干预措施来防止不良妊娠结局。我们强调在实地取得进展的优先研究问题，并特别指出迫切需要可持续的循证干预措施。
Exposure to extreme heat in pregnancy increases the risk of stillbirth. Progress in reducing stillbirth rates has stalled, and populations are increasingly exposed to high temperatures and climate events that may further undermine health strategies. This narrative review summarises the current clinical and epidemiological evidence of the impact of maternal heat exposure on stillbirth risk. Out of 20 studies, 19 found an association between heat and stillbirth risk. Recent studies based in low‐ to middle‐income countries and tropical settings add to the existing literature to demonstrate that all populations are at risk. Additionally, both short‐term heat exposure and whole‐pregnancy heat exposure increase the risk of stillbirth. A definitive threshold of effect has not been identified, as most studies define exposure as above the 90th centile of the usual temperature for that population. Therefore, the association between heat and stillbirth has been found with exposures from as low as >12.64°C up to >46.4°C. The pathophysiological pathways by which maternal heat exposure may lead to stillbirth, based on human and animal studies, include both placental and embryonic or fetal impacts. Although evidence gaps remain and further research is needed to characterise these mechanistic pathways in more detail, preliminary evidence suggests epigenetic changes, alteration in imprinted genes, congenital abnormalities, reduction in placental blood flow, size and function all play a part. Finally, we explore this topic from a public health perspective; we discuss and evaluate the current public health guidance on minimising the risk of extreme heat in the community. There is limited pregnancy‐specific guidance within heatwave planning, and no evidence‐based interventions have been established to prevent poor pregnancy outcomes. We highlight priority research questions to move forward in the field and specifically note the urgent need for evidence‐based interventions that are sustainable.