A prospective study of heat exposure and miscarriage

热暴露和流产的前瞻性研究

• 批准号: 10452143
• 负责人: Amelia Kent Wesselink
• 金额: $ 25.21万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-10 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10452143
• 关键词: Affect; American College of Obstetricians and Gynecologists; Behavior Therapy; Biological; Birth; Blood flow; Budgets; Canada; Characteristics; Clinical; Clinical Practice Guideline; Cohort Studies; Consensus; Couples; Data; Development; Diet; Emergency Situation; Enrollment; Environment; Environmental Exposure; Etiology; Event; Exposure to; Female; Fetal health; Frequencies; Funding; Geography; Green space; Health; Home; Household; Housing; Human; Income; Individual; Infrastructure; Intervention; Knowledge; Long-Term Effects; Low Birth Weight Infant; Measurement; Measures; Mediating; Microclimate; Monitor; Morbidity - disease rate; National Institute of Environmental Health Sciences; Neighborhoods; Online Systems; Outcome; Ozone; Participant; Pattern; Persons; Physical environment; Physiological; Population; Population Density; Pre-Eclampsia; Predictive Factor; Predisposition; Pregnancy; Pregnancy Tests; Pregnancy loss; Pregnant Women; Premature Birth; Prospective Studies; Province; Questionnaires; Reproduction; Reproductive Health; Research; Research Design; Risk; Risk Factors; Role; Sample Size; Shapes; Smoking; Spontaneous abortion; Temperature; Time; United States; Urine; Weather; Woman; Women' s Health; Work; adverse pregnancy outcome; base; built environment; climate change; climate zone; climate-related health; cohort; early pregnancy; experience; extreme heat; extreme temperature; extreme weather; heat island; high risk; improved; insight; lifestyle factors; neonatal outcome; parent grant; people of color; perinatal health; predictive modeling; pregnancy hypertension; pregnant; prospective; psychologic; recruit; reproductive; reproductive epidemiology; reproductive outcome; socioeconomics; stillbirth; teratogenesis; trying to conceive; weather stations

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.

抽象的 鉴于关于气候变化在导致温度升高和的科学共识 在未来几十年中，极端天气事件的频率更高，澄清攀登的影响至关重要 改变人类繁殖。一项大量研究表明，暴露于热量是 与不良怀孕和新生儿结局有关，包括先兆子痫，妊娠高血压， 低出生体重和早产。但是，对 环境热量和赞助堕胎（SAB）定义为妊娠20周之前的妊娠损失。 sab 是一个特别具有挑战性的生殖事件，因为许多SAB发生在妊娠的早期，通常是 在识别怀孕之前。精确测量SAB的理想研究设计是一个先入为主的队列 密切监测早期生殖事件的地方。此外，大多数对热健康影响的研究 已经测量了环境而不是个人温度暴露，使周围温度的事实 当个人在整个过程中移动时，没有足够代表环境条件所经历的环境条件 时间和空间。在本提案中，我们将利用正在进行的先选人群的基础架构 研究，在线怀孕研究（PRESTO），以探讨环境和个人热暴露在 SAB的病因。普雷斯托成功地招募了地理，种族和社会经济上的潜水员 一群试图从美国和加拿大构想的夫妇，使用这些数据，我们有 前瞻性鉴定的SAB，包括早期SAB（妊娠6周），并评估了SAB的危险因素。 具体而言，在本提案中，我们的目标是1）检查环境热量与SAB风险之间的关联 并测量选择地理空间特征介导或修改此关联的程度，以及2）部署 在400名新入选的女性Presto参与者中，可穿戴的个人温度监视器一周 并使用监视数据来识别热暴露的地理空间，邻居和个体级别的预测指标。 拟议的研究将对生殖流行病学和 气候健康。这将是衡量孕妇个人热量暴露的第一项研究，一个 具有潜在生理敏感的热量的人群。我们的热暴露的预测模型具有广泛的 在环境暴露评估领域的应用。测量个人热暴露的能力 使用问卷和地理空间数据，而不是依靠个人监控，可以彻底改变 研究极端温度的健康影响。此外，这项研究可以提供有关的关键信息 SAB的病因，为降低SAB风险的特定干预措施提供信息，并挑战当前的临床实践 怀孕早期咨询妇女的指南，该指南重点是吸烟和饮食等生活方式因素。 最后，我们试图通过促进有关气候变化在气候变化中的作用的知识来改变当前的研究范例 塑造复制品结果。