孕妇在怀孕期间暴露于极端环境温度已被认为是出生缺陷的潜在危险因素。对该协会的全面调查仍然有限,特别是在低收入和中等收入国家。这项研究旨在研究怀孕期间环境温度暴露与巴西出生缺陷风险之间的关系。有助于更广泛地了解环境对出生结局的影响。使用超过1100万条活产记录的大型数据集,我们分析了12类出生缺陷,涵盖2001年至2018年的时间框架。环境温度数据是在市政级别分配的。对于暴露评估,我们通过将妊娠期划分为两个特定窗口:妊娠早期(第1周~第12周)和妊娠中期(第13周~第28周),考虑了两个生物学驱动的妊娠阶段.我们采用了两阶段病例控制设计。在第一阶段,我们应用条件逻辑回归模型来估计特定出生缺陷和五个巴西地区(北,东北,中西部,东南,和南方)。该模型针对潜在的混杂变量进行了调整,包括PM2.5、相对湿度、和社会经济地位。使用时间分层抽样来解决时间趋势。在第二阶段,我们使用混合效应荟萃分析来汇集特定地区的估计值.我们的分析显示,孕妇在孕早期暴露于较高的环境温度与特定出生缺陷类别的风险增加之间存在显着关联。包括影响生殖器官的那些(OR=1.08,95%CI:1.02;1.14),消化系统(OR=1.12,95%CI:1.06;1.19);循环系统(OR=1.08,95%CI:1.01;1.17);眼睛,耳朵,脸,和颈部(OR=1.08,95%CI:1.02;1.15);良性肿瘤(OR=1.17,95%CI:1.03;1.32),肌肉骨骼系统(OR=1.03,95%CI:1.01;1.05);和其他先天性异常(OR=1.22,95%CI:1.15;1.29)。与呼吸系统的联系,神经系统,染色体异常为零。这些发现对旨在减轻环境因素对出生结局的影响的公共卫生政策具有重要意义。在巴西和全球。
Maternal exposure to extreme ambient temperature during pregnancy has been proposed as a potential risk factor for birth defects. Comprehensive investigations on this association remain limited, particularly in low- and middle-income countries. This study aims to examine the association between ambient temperature exposure during pregnancy and the risk of birth defects in Brazil, contributing to the broader understanding of environmental influences on birth outcomes. Using a large dataset of over 11 million live birth records, we analyzed 12 categories of birth defects, encompassing a time frame from 2001 to 2018. Ambient temperature data were assigned at the municipality level. For the exposure assessment, we considered two biologically driven pregnancy stages by dividing the gestational period into two specific windows: the first trimester (from week 1 to week 12) and the second trimester (from week 13 to week 28). We employed a two-stage case-control design. In the first stage, we applied a conditional logistic regression model to estimate the odds ratio (OR) for specific birth defects and each of the five Brazilian regions (North, Northeast, Midwest, Southeast, and South). The model was adjusted for potential confounding variables, including PM2.5, relative humidity, and socioeconomic status. Temporal trends were addressed using time-stratified sampling. In the second stage, we used mixed-effects meta-analysis to pool region-specific estimates. Our analysis revealed a significant association between maternal exposure to higher ambient temperatures during the first trimester and an increased risk of specific birth defect categories, including those affecting the genital organs (OR = 1.08, 95% CI: 1.02; 1.14), digestive system (OR = 1.12, 95% CI: 1.06; 1.19); circulatory system (OR = 1.08, 95% CI: 1.01; 1.17); eyes, ears, face, and neck (OR = 1.08, 95% CI: 1.02; 1.15); benign neoplasms tumors (OR = 1.17, 95% CI: 1.03; 1.32), musculoskeletal system (OR = 1.03, 95% CI: 1.01; 1.05); and other congenital anomalies (OR = 1.22, 95% CI: 1.15; 1.29). The associations with respiratory system, nervous system, and chromosomal anomalies were null. These findings have significant implications for public health policies aimed at mitigating the impact of environmental factors on birth outcomes, both in Brazil and globally.