A prospective study of heat exposure and miscarriage

摘要 鉴于科学界对气候变化在造成气温升高方面的作用达成共识， 在未来几十年中，极端天气事件的频率将更高，澄清气候的影响至关重要 人类生殖的变化。大量的研究表明，暴露在高温下是 与不良妊娠和新生儿结局相关，包括先兆子痫，妊娠期高血压， 低出生体重和早产然而，对两者之间的关联的评估有限。 环境高温和自然流产（SAB），定义为妊娠20周前流产。SAB 是一个特别具有挑战性的生殖事件来衡量，因为许多SAB发生在妊娠早期，往往 怀孕前的确认。准确测量SAB的理想研究设计是孕前队列研究 在那里，早期生殖活动受到密切监测。此外，大多数关于热对健康影响的研究 测量了环境温度而不是个人温度暴露，尽管环境温度 并不能充分代表个人在移动过程中所经历的环境条件 时间和空间在本提案中，我们将利用正在进行的孕前队列的基础设施 研究，怀孕研究在线（PRESTO），探讨环境和个人热暴露在怀孕中的作用。 SAB的病因PRESTO成功地招募了一个地理，种族和社会经济多样化的 来自美国和加拿大的一群夫妇试图怀孕，利用这些数据，我们有 前瞻性识别SAB，包括早期SAB（<6周妊娠），并评估SAB的危险因素。 具体而言，在本提案中，我们的目标是1）检查环境热量和SAB风险之间的关联 并测量所选地理空间要素调解或修改此关联的程度，以及2）部署 在400名新入组的PRESTO女性参与者中， 并使用监测数据来识别热暴露的地理空间、邻居和个人水平的预测因子。 拟议的研究将对生殖流行病学领域产生巨大而持续的影响， 气候健康。这将是第一项测量孕妇个人暴露于高温的研究， 对热具有潜在生理易感性的人群。我们对热暴露的预测模型 在环境暴露评估领域的应用。测量个人热暴露的能力 使用调查问卷和地理空间数据，而不是依靠个人监测，可以彻底改变 研究极端温度对健康的影响。此外，这项研究可以提供关键信息， SAB病因学，提供降低SAB风险的特定干预措施，并挑战当前的临床实践 为怀孕早期的妇女提供建议的指导方针，重点是吸烟和饮食等生活方式因素。 最后，我们寻求通过提高对气候变化在全球变暖中作用的认识来改变当前的研究范式。 塑造生殖成果。

ABSTRACT Given the scientific consensus regarding the role of climate change in causing increased temperatures and higher frequency of extreme weather events in the coming decades, it is crucial to clarify the effects of climate change on human reproduction. A substantial body of research has documented that exposure to heat is associated with adverse pregnancy and neonatal outcomes, including preeclampsia, gestational hypertension, low birth weight, and preterm birth. However, there has been limited assessment of the association between ambient heat and spontaneous abortion (SAB), defined as a pregnancy loss before 20 weeks’ gestation. SAB is a particularly challenging reproductive event to measure because many SABs occur early in gestation, often before pregnancy recognition. The ideal study design for accurately measuring SAB is a preconception cohort where early reproductive events are closely monitored. In addition, most research on the health effects of heat have measured ambient rather than personal temperature exposure, despite the fact that ambient temperature does not sufficiently represent the environmental conditions individuals experience as they move throughout time and space. In the present proposal, we will utilize the infrastructure of an ongoing preconception cohort study, Pregnancy Study Online (PRESTO), to explore the role of ambient and personal heat exposure in the etiology of SAB. PRESTO has successfully enrolled a geographically, racially, and socioeconomically diverse cohort of couples trying to conceive from across the United States and Canada, and using these data, we have prospectively identified SAB, including early SAB (<6 weeks’ gestation), and assessed risk factors for SAB. Specifically, in the present proposal, we aim to 1) examine the association between ambient heat and SAB risk and measure the extent to which select geospatial features mediate or modify this association, and 2) deploy wearable personal temperature monitors for one week among 400 newly-enrolled female PRESTO participants and use monitoring data to identify geospatial, neighborhood, and individual-level predictors of heat exposure. The proposed study will have a large and sustained impact on the fields of reproductive epidemiology and climate health. This will be the first study to measure personal exposure to heat in pregnant women, a population with underlying physiologic susceptibility to heat. Our predictive models of heat exposure have vast applications in fields of environmental exposure assessment. The ability to measure personal heat exposure using questionnaire and geospatial data, rather than relying on personal monitoring, could revolutionize the study of the health effects of extreme temperatures. In addition, this study could provide critical information on the etiology of SAB, inform specific interventions to reduce SAB risk, and challenge current clinical practice guidelines for advising women early in pregnancy that focus on lifestyle factors such as smoking and diet. Finally, we seek to shift current research paradigms by advancing knowledge on the role of climate change in shaping reproductive outcomes.