MATERNAL HEAT EXPOSURE AND NEURAL-TUBE DEFECTS
MATERNAL HEAT EXPOSURE AND NEURAL-TUBE DEFECTS
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DOI：
10.1001/jama.268.7.882
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发表时间：
1992-08-19
影响因子：
120.7
通讯作者：
JICK, H
中科院分区：
文献类型：
--
作者：
MILUNSKY, A;ULCICKAS, M;JICK, H
客观。-为了确定在怀孕早期暴露于热水浴缸，桑拿，发烧或电热毯是否与神经管缺陷（NTDs）的风险增加有关。前瞻性随访研究。设置。大多数是私人产科诊所，主要在新英格兰。一个队列的23491名妇女血清甲胎蛋白筛查或子宫颈穿刺术进行了鉴定。完整的暴露和结果的信息可用于97%的这些妇女。相对危险度（RR）用于比较暴露于热与未暴露于任何热的人群中NTD的发生率。根据数据直接计算粗RR。使用逻辑回归计算未混淆的RR。在怀孕早期报告任何热暴露（桑拿、热水浴缸、发烧或电热毯）的妇女，其胎儿发生NTD的粗风险为1.6（95%CI [置信区间]，0.9至2.9）。怀孕早期暴露于桑拿、热水浴缸或发热的妇女，其胎儿发生NTD的粗风险是未暴露于热的妇女的2.2倍（95%CI，1.2至4.1）。使用热水浴缸的粗RR为2.9（95% CI，1.4至6.3）;桑拿浴为2.6（95% CI，0.7至10.1）;发热为1.9（95% CI，0.8至4.1）;电热毯为1.2（95% CI，0.5至2.6）。在控制了母亲年龄、叶酸补充剂、NTD家族史和暴露于其他热源后，单独热源的多变量调整RR为2.8（95% CI，1.2至6.5）;桑拿，1.8（95% CI，0.4至7.9）;发热，1.8（95% CI，0.8至4.1）;和电热毯，1.2（95% CI，0.5至2.6）。当仅考虑热水浴缸，桑拿和发烧时，与没有热暴露相比，女性暴露于每种情况，NTD的RR从一种热暴露后的1.9（95%CI，0.9至3.7）增加到两种热暴露后的6.2（95%CI，2.2至17.2）。在怀孕的前三个月，暴露于热水浴缸，桑拿或发烧等形式的热量与NTD的风险增加有关。热水浴缸暴露似乎有任何单一的热暴露最强的效果。接触电热毯与NTD风险增加无实质性相关性。
Objective.-To determine if exposure to hot tub, sauna, fever, or electric blanket during early pregnancy was associated with an increased risk for neural tube defects (NTDs).Design.-Prospective follow-up study.Setting.-Mostly private obstetric practices, primarily in New England.Participants.-A cohort of 23491 women having serum alpha-fetoprotein screening or an amniocentesis were identified. Complete exposure and outcome information was available for 97% of these women.Outcome Measures.-Relative risks (RRs) were used to compare incidence of NTD in those exposed to heat with those who were not exposed to any heat. Crude RRs were calculated directly from the data. Unconfounded RRs were calculated using logistic regression.Results.-Women reporting any heat exposure (sauna, hot tub, fever, or electric blanket) in early pregnancy had a crude risk of their fetuses developing NTD of 1.6 (95% CI [confidence interval], 0.9 to 2.9). Women reporting exposure to sauna, hot tub, or fever in early pregnancy had a crude risk of their fetuses developing NTD 2.2 times that of women without heat exposure (95% CI, 1.2 to 4.1). For hot tub use, the crude RR was 2.9 (95% CI, 1.4 to 6.3); for sauna, 2.6 (95% CI, 0.7 to 10.1); for fever, 1.9 (95% CI, 0.8 to 4.1); and for electric blanket, 1.2 (95% CI, 0.5 to 2.6). Multivariate adjusted RRs for individual heat sources, after controlling for maternal age, folic acid supplements, family history of NTD, and exposure to other heat sources, were for hot tub use, 2.8 (95% CI, 1.2 to 6.5); sauna, 1.8 (95% CI, 0.4 to 7.9); fever, 1.8 (95% CI, 0.8 to 4.1); and electric blanket, 1.2 (95% CI, 0.5 to 2.6). When only hot tub, sauna, and fever were considered and the women's exposure to each tallied, compared with no heat exposure, the RR for NTDs increased from 1.9 (95% CI, 0.9 to 3.7) after one type of heat exposure to 6.2 (95% CI, 2.2 to 17.2) after two types of heat exposure.Conclusions.-Exposure to heat in the form of hot tub, sauna, or fever in the first trimester of pregnancy was associated with an increased risk for NTDs. Hot tub exposure appeared to have the strongest effect of any single heat exposure. Exposure to electric blanket was not materially associated with increased risk for NTDs.