Impact of prenatal exposure to climate stressors and severe maternal morbidity: a retrospective birth cohort study

项目摘要 气候危机与其他社会和环境压力因素相结合， 人类健康;其影响因年龄组和生命阶段而异。怀孕是一个未被充分研究的关键 敏感窗口很少有研究关注产前暴露于气候压力源对胎儿的影响。 美国东南部的孕妇和婴儿，尽管气候变暖趋势明显， 该区域孕产妇死亡率不断上升，孕产妇和婴儿健康持续存在差距。一个重要 在确定国家气候变化和健康监测指标方面仍然存在科学差距，特别是 了解气候变化与怀孕风险之间的关系。我们的长期目标是发展 以诊所为基础的公共卫生干预措施，以减少怀孕期间气候变化的不利影响。 这项以人群为基础的研究的首要目标是检查极端温度敏感性， 孕妇和婴儿在怀孕关键窗口期的健康风险， 气候变化中健康差距的社会环境驱动因素。我们将实现以下两个目标 具体目标：目标1。描述暴露于冷和热环境温度之间的关系 在怀孕关键时期的极端情况和不利的母婴健康结果;目标2。 检查产前暴露于极端温度和社会环境压力的联合影响， 产妇和婴儿健康风险过高。美国国家卫生研究院气候变化与健康战略计划（NIH Climate Change and Health Strategic Initiative） 在极端气温下优先保护孕妇的健康。这种低成本 回顾性出生队列研究将促进对社会和环境条件的理解， 与气候变化压力源相互作用，对孕妇的健康产生负面影响 人口和他们的孩子。我们的预期结果将包括：1）产前暴露的量化， 气候变化是怀孕期间的风险倍增因素; 2）确定产妇和婴儿的 监测气候变化对健康影响的监测指标。该研究具有创新性 因为结果将1）显示气候和社会压力如何相互作用，以加剧气候健康风险， 怀孕，和2）帮助假设生成的途径，有助于气候弹性和 减少母婴健康风险。这项工作具有重大的潜力，可以改变 通过确定产妇或婴儿健康结果作为潜在的监测健康指标， 气候变化的影响，可以用来衡量地方和国家一级的卫生干预措施， 美国的政策变化。研究结果将满足NIH战略计划中一项被广泛引用的研究需求。 关于暴露于气候压力源的时间和相关母婴的气候与健康倡议 并发症和敏感性的关键窗口在产前期间。

PROJECT SUMMARY The climate crisis, in combination with other social and environmental stressors, negatively influences human health; its impact varies across age groups and life stages. Pregnancy is an understudied critical window of susceptibility. Few studies have focused on the impact of prenatal exposure to climate stressors on pregnant populations and infants in the Southeastern US, despite pronounced trends in climate warming, an escalating maternal death rate, and persistent maternal and infant health disparities in the region. An important science gap remains in identifying national climate change and health surveillance indicators, particularly for understanding the relationship between climate change and pregnancy risks. Our long-term goal is to develop clinic-based and public health interventions to reduce the adverse impact of climate change during pregnancy. The overarching goal of this population-based study is to examine extreme temperature-sensitivities in maternal and infant health risk during critical windows of pregnancy and advance understanding of the social-environmental drivers of health disparities in a changing climate. We will achieve the following two specific aims: Aim 1. Characterize the relationship between exposure to cold and hot ambient temperature extremes and adverse maternal and infant health outcomes during critical periods of pregnancy; Aim 2. Examine the joint effects of prenatal exposure to temperature extremes and socio-environmental stressors on excess maternal and infant health risks. The new NIH Climate Change and Health Strategic Initiative has prioritized protecting the health of pregnant populations in the face of extreme temperatures. This low-cost retrospective birth cohort study will advance understanding on how social and environmental conditions that occur during pregnancy interact with climate change stressors to negatively affect the health of pregnant populations and their infants. Our expected outcomes will include: 1) the quantification of prenatal exposure to climate change as a risk multiplier during pregnancy; and 2) the identification of maternal and infant surveillance indicators for tracking the health effects of climate change. The proposed research is innovative because results will 1) show how climate and social stressors interact to exacerbate climate-health risks during pregnancy, and 2) aid in hypothesis generation on the pathways that contribute to climate resilience and the reduction of maternal and infant health risks. This work has significant potential to be transformative to the field through the identification of maternal or infant health outcomes as potential surveillance health indicators of climate change impacts, which can be leveraged to measure local and state-level health interventions and policy changes in the United States. Results will address a well-cited research need from the NIH Strategic Climate & Health Initiative on the timing of exposure to climate stressors and associated maternal and infant complications and the critical windows of susceptibility during the prenatal period.