PDF(Pubmed)
Abstract：
BACKGROUND: Climate change, particularly global warming, is amongst the greatest threats to human health. While short-term effects of heat exposure in pregnancy, such as preterm birth, are well documented, long-term effects have received less attention. This review aims to systematically assess evidence on the long-term impacts on the foetus of heat exposure in utero.
METHODS: A search was conducted in August 2019 and updated in April 2023 in MEDLINE(PubMed). We included studies on the relationship of environmental heat exposure during pregnancy and any long-term outcomes. Risk of bias was assessed using tools developed by the Joanna-Briggs Institute, and the evidence was appraised using the GRADE approach. Synthesis without Meta-Analysis (SWiM) guidelines were used.
RESULTS: Eighteen thousand six hundred twenty one records were screened, with 29 studies included across six outcome groups. Studies were mostly conducted in high-income countries (n = 16/25), in cooler climates. All studies were observational, with 17 cohort, 5 case-control and 8 cross-sectional studies. The timeline of the data is from 1913 to 2019, and individuals ranged in age from neonates to adults, and the elderly. Increasing heat exposure during pregnancy was associated with decreased earnings and lower educational attainment (n = 4/6), as well as worsened cardiovascular (n = 3/6), respiratory (n = 3/3), psychiatric (n = 7/12) and anthropometric (n = 2/2) outcomes, possibly culminating in increased overall mortality (n = 2/3). The effect on female infants was greater than on males in 8 of 9 studies differentiating by sex. The quality of evidence was low in respiratory and longevity outcome groups to very low in all others.
CONCLUSIONS: Increasing heat exposure was associated with a multitude of detrimental outcomes across diverse body systems. The biological pathways involved are yet to be elucidated, but could include epigenetic and developmental perturbations, through interactions with the placenta and inflammation. This highlights the need for further research into the long-term effects of heat exposure, biological pathways, and possible adaptation strategies in studies, particularly in neglected regions. Heat exposure in-utero has the potential to compound existing health and social inequalities. Poor study design of the included studies constrains the conclusions of this review, with heterogenous exposure measures and outcomes rendering comparisons across contexts/studies difficult.
BACKGROUND: PROSPERO CRD 42019140136.
METHODS: A search was conducted in August 2019 and updated in April 2023 in MEDLINE(PubMed). We included studies on the relationship of environmental heat exposure during pregnancy and any long-term outcomes. Risk of bias was assessed using tools developed by the Joanna-Briggs Institute, and the evidence was appraised using the GRADE approach. Synthesis without Meta-Analysis (SWiM) guidelines were used.
RESULTS: Eighteen thousand six hundred twenty one records were screened, with 29 studies included across six outcome groups. Studies were mostly conducted in high-income countries (n = 16/25), in cooler climates. All studies were observational, with 17 cohort, 5 case-control and 8 cross-sectional studies. The timeline of the data is from 1913 to 2019, and individuals ranged in age from neonates to adults, and the elderly. Increasing heat exposure during pregnancy was associated with decreased earnings and lower educational attainment (n = 4/6), as well as worsened cardiovascular (n = 3/6), respiratory (n = 3/3), psychiatric (n = 7/12) and anthropometric (n = 2/2) outcomes, possibly culminating in increased overall mortality (n = 2/3). The effect on female infants was greater than on males in 8 of 9 studies differentiating by sex. The quality of evidence was low in respiratory and longevity outcome groups to very low in all others.
CONCLUSIONS: Increasing heat exposure was associated with a multitude of detrimental outcomes across diverse body systems. The biological pathways involved are yet to be elucidated, but could include epigenetic and developmental perturbations, through interactions with the placenta and inflammation. This highlights the need for further research into the long-term effects of heat exposure, biological pathways, and possible adaptation strategies in studies, particularly in neglected regions. Heat exposure in-utero has the potential to compound existing health and social inequalities. Poor study design of the included studies constrains the conclusions of this review, with heterogenous exposure measures and outcomes rendering comparisons across contexts/studies difficult.
BACKGROUND: PROSPERO CRD 42019140136.
摘要：
背景：气候变化，特别是全球变暖，是对人类健康的最大威胁之一。虽然怀孕期间热暴露的短期影响，比如早产,有据可查,长期影响受到的关注较少。这篇综述旨在系统地评估子宫内热暴露对胎儿的长期影响的证据。
方法：于2019年8月进行了搜索，并于2023年4月在MEDLINE（PubMed）中进行了更新。我们纳入了怀孕期间环境热暴露与任何长期结局关系的研究。使用Joanna-Briggs研究所开发的工具评估偏差风险，并使用等级方法对证据进行了评估。使用无荟萃分析（SWiM）指南的综合。
结果：筛选了一万八千六百二十一条记录，纳入6个结局组的29项研究.研究大多在高收入国家进行(n=16/25)，在凉爽的气候中。所有研究都是观察性的，有17个队列，5个病例对照和8个横断面研究。数据的时间表是从1913年到2019年，个体的年龄从新生儿到成年人，和老人。怀孕期间热暴露的增加与收入减少和受教育程度降低有关（n=4/6），以及心血管恶化（n=3/6），呼吸（n=3/3），精神病学（n=7/12）和人体测量学（n=2/2）结果，可能导致总死亡率增加（n=2/3）。在9项性别差异研究中，有8项对女性婴儿的影响大于对男性婴儿的影响。呼吸和长寿结果组的证据质量较低，而所有其他组的证据质量都很低。
结论：增加热暴露与不同身体系统的多种有害结果相关。涉及的生物学途径尚未阐明，但可能包括表观遗传和发育扰动，通过与胎盘和炎症的相互作用。这凸显了需要进一步研究热暴露的长期影响，生物途径，以及研究中可能的适应策略，特别是在被忽视的地区。子宫内的热暴露有可能加剧现有的健康和社会不平等。纳入研究的不良研究设计限制了本综述的结论，由于异质性的暴露措施和结果，使得跨环境/研究的比较变得困难。
背景：PROSPEROCRD42019140136。
方法：于2019年8月进行了搜索，并于2023年4月在MEDLINE（PubMed）中进行了更新。我们纳入了怀孕期间环境热暴露与任何长期结局关系的研究。使用Joanna-Briggs研究所开发的工具评估偏差风险，并使用等级方法对证据进行了评估。使用无荟萃分析（SWiM）指南的综合。
结果：筛选了一万八千六百二十一条记录，纳入6个结局组的29项研究.研究大多在高收入国家进行(n=16/25)，在凉爽的气候中。所有研究都是观察性的，有17个队列，5个病例对照和8个横断面研究。数据的时间表是从1913年到2019年，个体的年龄从新生儿到成年人，和老人。怀孕期间热暴露的增加与收入减少和受教育程度降低有关（n=4/6），以及心血管恶化（n=3/6），呼吸（n=3/3），精神病学（n=7/12）和人体测量学（n=2/2）结果，可能导致总死亡率增加（n=2/3）。在9项性别差异研究中，有8项对女性婴儿的影响大于对男性婴儿的影响。呼吸和长寿结果组的证据质量较低，而所有其他组的证据质量都很低。
结论：增加热暴露与不同身体系统的多种有害结果相关。涉及的生物学途径尚未阐明，但可能包括表观遗传和发育扰动，通过与胎盘和炎症的相互作用。这凸显了需要进一步研究热暴露的长期影响，生物途径，以及研究中可能的适应策略，特别是在被忽视的地区。子宫内的热暴露有可能加剧现有的健康和社会不平等。纳入研究的不良研究设计限制了本综述的结论，由于异质性的暴露措施和结果，使得跨环境/研究的比较变得困难。
背景：PROSPEROCRD42019140136。
