A prospective study of heat exposure and miscarriage

热暴露和流产的前瞻性研究

• 批准号: 10701681
• 负责人: Amelia Kent Wesselink
• 金额: $ 21.6万
• 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/10701681
• 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; Conceptions; 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; Perfusion; Persons; Physical environment; Physiological; Placenta; Population; Population Density; Pre-Eclampsia; Predictive Factor; Predisposition; Pregnancy; Pregnancy Tests; Pregnancy loss; Pregnant Women; Premature Birth; Prospective Studies; Province; Questionnaires; Race; Reproduction; Research; Research Design; Risk; Risk Assessment; Risk Factors; Risk Reduction; Role; Sample Size; Shapes; Smoking; Spontaneous abortion; Temperature; Time; United States; Urine; Weather; Woman; Women' s Health; Work; adverse pregnancy outcome; 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; wearable monitor; 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.

摘要 考虑到关于气候变化在导致气温上升和 在未来几十年，极端天气事件的频率将会更高，因此弄清气候的影响至关重要 对人类生殖的改变。大量研究证明，暴露在高温下是 与不良妊娠和新生儿结局有关，包括先兆子痫、妊娠期高血压、 低出生体重和早产。然而，对两者之间的联系的评估有限。 环境高温和自然流产(SAB)，定义为怀孕20周前的妊娠丢失。SAB 是一种特别具有挑战性的生殖事件，因为许多SAB发生在怀孕早期，通常 在确认怀孕之前。准确测量SAB的理想研究设计是一个先入为主的队列 在那里，早期的生殖活动受到密切监测。此外，大多数关于高温对健康影响的研究 测量了环境温度而不是个人温度暴露，尽管环境温度 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先入为主的队列的基础设施 研究，怀孕研究在线(Presto)，以探索环境和个人热暴露在 SAB的病原学。Presto已经成功地招收了一名地理、种族和社会经济多元化的 来自美国和加拿大的一群夫妇试图怀孕，并使用这些数据，我们有 前瞻性地确定SAB，包括早期SAB(妊娠6周)，并评估SAB的危险因素。 具体地说，在目前的提案中，我们的目标是1)检查环境高温和SAB风险之间的关联 并测量所选地理空间要素协调或修改此关联的程度，以及2)部署 400名新登记的女性Presto参与者一周可穿戴式个人体温监测 并使用监测数据确定热暴露的地理空间、社区和个人级别的预测因素。 拟议的研究将对生殖流行病学领域产生重大和持久的影响 气候健康。这将是第一项测量孕妇个人暴露在高温下的研究， 对热有潜在生理易感性的人群。我们的热暴露预测模型有大量的 在环境暴露评价领域的应用。测量个人热暴露的能力 使用调查问卷和地理空间数据，而不是依赖个人监控，可能会使 研究极端温度对健康的影响。此外，这项研究还可以提供以下关键信息 SAB的病因，提供降低SAB风险的具体干预措施，并挑战当前的临床实践 为怀孕早期的妇女提供建议的指南，重点是吸烟和饮食等生活方式因素。 最后，我们寻求通过推进关于气候变化在 塑造生育结果。