Associations between ambient temperature and risk of preterm birth in Sweden: A comparison of analytical approaches
Associations between ambient temperature and risk of preterm birth in Sweden: A comparison of analytical approaches
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DOI：
10.1016/j.envres.2022.113586
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发表时间：
2022-10-01
影响因子：
8.3
通讯作者：
Roos, Nathalie
中科院分区：
文献类型：
--
作者：
de Bont, Jeroen;Stafoggia, Massimo;Roos, Nathalie
背景：有证据表明，高温是早产的一个危险因素。因此，气候变化导致的热暴露增加是孕妇关注的问题。然而，研究设计和统计方法在以往研究中的巨大异质性使解释和比较复杂化。我们调查了瑞典短期暴露于高环境温度与早产的关系，采用了三种互补的分析方法。方法：我们纳入了2014年至2019年期间在瑞典妊娠登记中确定的560，615例单胎活产。我们使用时空机器学习方法估计了1 km（2）空间分辨率的每周平均温度，并将其分配给研究参与者的住宅地址。该研究的主要结果是以周为单位的胎龄和早产的子类别（< 37周）：极早产（< 28周），极早产（从28周到< 32周）和中度早产（从32周到< 37周）。采用病例交叉、分位数回归和事件发生时间分析来估计出生前一周内短期暴露于升高的环境温度对早产的影响。此外，应用分布滞后非线性模型（DLNM）确定整个妊娠期暴露与早产相关的敏感性窗口。结果：共有1924例出生为极早产（0.4%），2636例为极早产（0.5%），23,664例为中度早产（4.2%）。在所有三种分析方法（病例交叉、分位数回归和事件发生时间分析）中一致，较高的环境温度（第95百分位数与第50百分位数）表明极早产风险增加，但相关性未达到统计学显著性。在DLNM模型中，我们没有观察到任何证据表明高温对早产风险的影响增加。即便如此，在分位数回归和至事件发生时间分析中均观察到一种趋势，即出生前最后一周体温较高的极早产风险较高。
Background: Evidence indicates that high temperatures are a risk factor for preterm birth. Increasing heat exposures due to climate change are therefore a concern for pregnant women. However, the large heterogeneity of study designs and statistical methods across previous studies complicate interpretation and comparisons. We investigated associations of short-term exposure to high ambient temperature with preterm birth in Sweden, applying three complementary analytical approaches. Methods: We included 560,615 singleton live births between 2014 and 2019, identified in the Swedish Pregnancy Register. We estimated weekly mean temperatures at 1-km(2) spatial resolution using a spatiotemporal machine learning methodology, and assigned them at the residential addresses of the study participants. The main outcomes of the study were gestational age in weeks and subcategories of preterm birth (< 37 weeks): extremely preterm birth (< 28 weeks), very preterm birth (from week 28 to < 32), and moderately preterm birth (from week 32 to < 37). Case-crossover, quantile regression and time-to-event analyses were applied to estimate the effects of short-term exposure to increased ambient temperature during the week before birth on preterm births. Furthermore, distributed lag nonlinear models (DLNM) were applied to identify susceptibility windows of exposures throughout pregnancy in relation to preterm birth. Results: A total of 1924 births were extremely preterm (0.4%), 2636 very preterm (0.5%), and 23,664 moderately preterm (4.2%). Consistent across all three analytical approaches (case-crossover, quantile regression and time to-event analyses), higher ambient temperature (95th vs 50th percentile) demonstrated increased risk of extremely preterm birth, but associations did not reach statistical significance. In DLNM models, we observed no evidence to suggest an increased effect of high temperature on preterm birth risk. Even so, a suggested trend was observed in both the quantile regression and time-to-event analyses of a higher risk of extremely preterm birth with higher temperature during the last week before birth.