背景:存在关于产前环境温度和不良分娩结局的多个系统评价,但总体流行病学证据和热应激的适当度量仍不清楚.进行了总括审查,以总结和评估证据并提出建议。
方法:关于环境温度与不良分娩结局(早产,死产,出生体重,低出生体重,并且小于胎龄),直到2023年12月20日,根据已发布的协议进行合成。PubMed数据库,CINAHL,Scopus,MEDLINE/Ovid,EMBASE/Ovid,WebofScience核心合集,系统评价库,电子灰色文献,并搜索了参考资料。使用乔安娜·布里格斯研究所的关键评估工具评估偏倚风险。
结果:11项系统评价,包括两个荟萃分析,包括在内。这包括90个不同的观察性研究,这些研究采用了多个温度评估指标,与主要研究有很高的重叠。主要研究主要来自美国,而非洲和南亚仅贡献了三项研究。大多数(11个中的7个)的系统评价被评为中度偏倚风险。所有系统评价都表明,产妇暴露在极高和极低的温度下,特别是在妊娠晚期与早产风险增加有关,死产,减少胎儿生长。然而,由于暴露评估的巨大差异,高度异质性,不精确,以及所包括的系统评价的方法局限性,总体流行病学证据被归类为可能的因果关系证据.没有研究评估热应力的生物热指标。
结论:尽管方法上存在显著差异,产前暴露在极端环境温度下,特别是在怀孕后期,与不良分娩结局相关。坚持适当的环境卫生研究系统审查指南,将生物热指标纳入暴露评估,来自更广泛的地理人口统计环境的证据,并在未来的研究中建议采取干预措施.
BACKGROUND: Multiple systematic reviews on prenatal ambient temperature and adverse birth outcomes exist, but the overall epidemiological evidence and the appropriate metric for thermal stress remain unclear. An umbrella
review was performed to summarise and appraise the evidence with recommendations.
METHODS: Systematic reviews and meta-analyses on the associations between ambient temperature and adverse birth outcomes (preterm birth, stillbirth, birth weight, low birth weight, and small for gestational age) up to December 20, 2023, were synthesised according to a published protocol. Databases PubMed, CINAHL, Scopus, MEDLINE/Ovid, EMBASE/Ovid, Web of Science Core Collection, systematic reviews repositories, electronic grey literature, and references were searched. Risk of bias was assessed using Joanna Briggs Institute\'s critical appraisal tool.
RESULTS: Eleven systematic reviews, including two meta-analyses, were included. This comprised 90 distinct observational studies that employed multiple temperature assessment metrics with a very high overlap of primary studies. Primary studies were mostly from the United States while both Africa and South Asia contributed only three studies. A majority (7 out of 11) of the systematic reviews were rated as moderate risk of bias. All systematic reviews indicated that maternal exposures to both extremely high and low temperatures, particularly during late gestation are associated with increased risks of preterm birth, stillbirth, and reduced fetal growth. However, due to great differences in the exposure assessments, high heterogeneity, imprecision, and methodological limitations of the included systematic reviews, the overall epidemiological evidence was classified as probable evidence of causation. No study assessed biothermal metrics for thermal stress.
CONCLUSIONS: Despite the notable methodological differences, prenatal exposure to extreme ambient temperatures, particularly during late pregnancy, was associated with adverse birth outcomes. Adhering to the appropriate systematic
review guidelines for environmental health research, incorporating biothermal metrics into exposure assessment, evidence from broader geodemographic settings, and interventions are recommended in future studies.