Elevated outdoor temperatures and risk of stillbirth
Elevated outdoor temperatures and risk of stillbirth
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DOI：
10.1093/ije/dyw077
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发表时间：
2017-02-01
影响因子：
7.7
通讯作者：
Kosatsky, Tom
中科院分区：
文献类型：
--
作者：
Auger, Nathalie;Fraser, William D.;Kosatsky, Tom
背景：死产的原因尚不清楚，包括室外温度升高是否会增加风险。我们评估了温带地区温暖月份环境温度升高与死产风险的关系。方法：我们对加拿大魁北克大陆1981年至2011年4月至9月期间的5047例死产进行了病例交叉研究。使用经相对湿度调整的每日最高温度数据，我们通过比较胎儿死亡前的温度和相邻几天的温度，估计了死产的相关性。根据孕龄(足月、早产)和死因(母亲、胎盘/脐带/胎膜、出生窒息、先天异常等)，主要结局为死产。结果：死亡前一周室外温度升高与早产风险的相关性更强。死亡前一天气温28摄氏度的足月死产的几率是20摄氏度的1.16倍(95%可信区间，CI 1.02-1.33)。室外温度升高与因不明原因和母体原因导致的死产有关，但与其他原因无关。与20℃相比，28℃下死产的概率是不明原因死产的1.19倍(95%可信区间1.02~1.40)，孕产妇并发症的几率高1.46倍(95%可信区间1.03~2.07)。结论：室外温度升高可能是足月死产的危险因素，包括不明原因死产或孕产妇并发症。
Background: The causes of stillbirth are poorly understood, including whether elevated outdoor temperatures increase risk. We assessed the relationship between elevated ambient temperatures and risk of stillbirth by gestational age and cause of death during warm months in a temperate region.Methods: We performed a case-crossover study of 5047 stillbirths in continental Quebec, Canada, between the months of April through September from 1981 to 2011. Using data on maximum daily temperatures adjusted for relative humidity, we estimated associations with stillbirth, comparing temperatures before fetal death with temperatures on adjacent days. The main outcomes were stillbirth according to age of gestation (term, preterm), and cause of death (undetermined, maternal, placenta/cord/membranes, birth asphyxia, congenital anomaly, other).Results: Elevated outdoor temperatures the week before the death were more strongly associated with risk of term than preterm stillbirth. Odds of term stillbirth for temperature 28 degrees C the day before death were 1.16 times greater relative to 20 degrees C (95% confidence interval, CI 1.02-1.33). Elevated outdoor temperature was associated with stillbirth due to undetermined and maternal causes, but not other causes. Compared with 20 degrees C, the odds of stillbirth at 28 degrees C were 1.19 times greater for undetermined causes (95% CI 1.02-1.40) and 1.46 times greater for maternal complications (95% CI 1.03-2.07).Conclusions: Elevated outdoor temperatures may be a risk factor for term stillbirth, including stillbirth due to undetermined causes or maternal complications.