The role of extreme heat exposure on premature rupture of membranes in Southern California: A study from a large pregnancy cohort
The role of extreme heat exposure on premature rupture of membranes in Southern California: A study from a large pregnancy cohort
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DOI：
10.1016/j.envint.2023.107824
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发表时间：
2023-02
影响因子：
11.8
通讯作者：
Anqi Jiao;Yi Sun;D. Sacks;C. Avila;V. Chiu;J. Molitor;J. Chen;K. Sanders;J. Abatzoglou;Jeff M. Slezak;T. Benmarhnia;D. Getahun;Jun Wu
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作者：
Anqi Jiao;Yi Sun;D. Sacks;C. Avila;V. Chiu;J. Molitor;J. Chen;K. Sanders;J. Abatzoglou;Jeff M. Slezak;T. Benmarhnia;D. Getahun;Jun Wu
研究背景胎膜早破（premature rupture of membranes，PROM）与孕妇及其后代的高死亡率和高发病率有关。流行病学证据表明，热相关的胎膜早破风险是非常有限的。我们调查了急性热浪暴露和自发PRMO.MethodsWe之间的关联进行了这项回顾性队列研究的母亲在凯撒永久南加州谁经历了膜破裂在温暖的季节（5月至9月），从2008年至2018年。使用每日最高热量指数，其中包括最后一个妊娠周的每日最高温度和最低相对湿度，开发了12种具有不同截止值（第75，90，95和98）和持续时间（≥ 2，3和4连续天）的热浪定义。考克斯比例风险模型分别适用于自发性胎膜早破、足月胎膜早破（TPROM）和早产胎膜早破（PPROM），邮政编码作为随机效应，孕周作为时间单位。空气污染的影响（即，PM2.5和NO2）、气候适应措施（即，绿色空间和空调[AC]渗透率），社会人口因素，和吸烟行为进行了examined.ResultsIn总数，我们包括190,767名受试者与16,490（8.6%）自发PROM。我们发现，与不太强烈的热浪相关的胎膜早破风险增加了9-14%。TPROM和PPROM的模式与PROM相似。孕期PM2.5浓度高、年龄小于25岁、文化程度低、家庭收入低、吸烟的母亲发生高温胎膜早破的危险性更大。即使气候适应因素没有统计学意义上的影响修饰符，母亲生活在较低的绿色空间或较低的AC渗透率始终较高的热相关的PROM的风险相比，他们的countermeasurement.ConclusionUsing一个丰富的和高质量的临床数据库，我们发现有害的热暴露自发性PROM早产和足月分娩。一些具有特殊特征的亚组更容易发生与热相关的胎膜早破风险。
BackgroundSignificant mortality and morbidity in pregnant women and their offspring are linked to premature rupture of membranes (PROM). Epidemiological evidence for heat-related PROM risk is extremely limited. We investigated associations between acute heatwave exposure and spontaneous PROM.MethodsWe conducted this retrospective cohort study among mothers in Kaiser Permanente Southern California who experienced membrane ruptures during the warm season (May-September) from 2008 to 2018. Twelve definitions of heatwaves with different cut-off percentiles (75th, 90th, 95th, and 98th) and durations (≥ 2, 3, and 4 consecutive days) were developed using the daily maximum heat index, which incorporates both daily maximum temperature and minimum relative humidity in the last gestational week. Cox proportional hazards models were fitted separately for spontaneous PROM, term PROM (TPROM), and preterm PROM (PPROM) with zip codes as the random effect and gestational week as the temporal unit. Effect modification by air pollution (i.e., PM2.5and NO2), climate adaptation measures (i.e., green space and air conditioning [AC] penetration), sociodemographic factors, and smoking behavior was examined.ResultsIn total, we included 190,767 subjects with 16,490 (8.6%) spontaneous PROMs. We identified a 9–14% increase in PROM risks associated with less intense heatwaves. Similar patterns as PROM were found for TPROM and PPROM. The heat-related PROM risks were greater among mothers exposed to a higher level of PM2.5during pregnancy, under 25 years old, with lower education and household income level, and who smoked. Even though climate adaptation factors were not statistically significant effect modifiers, mothers living with lower green space or lower AC penetration were at consistently higher heat-related PROM risks compared to their counterparts.ConclusionUsing a rich and high-quality clinical database, we detected harmful heat exposure for spontaneous PROM in preterm and term deliveries. Some subgroups with specific characteristics were more susceptible to heat-related PROM risk.