背景:暴露于洪水可能会增加不良分娩结局的风险。然而,目前的证据很少,不一致,并且有知识差距。这项研究旨在评估怀孕前和怀孕期间洪水暴露与不良分娩结局的关联,并确定易感暴露窗口和效应调节剂。
方法:在这项队列研究中,我们获得了大悉尼的所有出生记录,澳大利亚,从2001年1月1日到2020年12月31日,来自新南威尔士州助产士数据收集和布里斯班都会区,澳大利亚,从1995年1月1日至2014年12月31日,来自昆士兰州卫生围产期数据收集。对于每一个出生,居住地址和达特茅斯洪水天文台的历史洪水信息被用来估计五个暴露窗口中洪水的天数(Pre-1被定义为最后一次月经期前13-24周[LMP],Pre-2是LMP前0-12周,LMP后第1期[Tri-1]为0-12周,妊娠2[Tri-2]在LMP后13-28周,LMP后3个月[Tri-3]≥29周)。我们估计了不良分娩结局的风险比(HR)(早产、死产,术语低出生体重[TLBW],并且小于胎龄[SGA])使用Cox比例风险回归模型在五个暴露窗口中与洪水暴露相关。
结果:1338314个出生记录被纳入我们的分析,其中包括91851例(6·9%)早产,9831(0·7%)死胎,25567(1·9%)TLBW,和108658(8·1%)SGA。Pre-1的洪水暴露与TLBW(HR1·06[95%CI1·01-1·12])和SGA(1·04[1·01-1·06])的风险增加相关;Tri-1期间的洪水暴露与早产风险增加相关(1·03[1·002-1·05]),死产(1·11[1·03-1·20]),和SGA(1·03[1·01-1·06])。相比之下,Pre-2和Tri-3期间的洪水暴露与降低的风险有关。
结论:在Pre-1和Tri-1发生洪水都与不良分娩结局的风险增加有关。风险随着风险的增加而增加。在计划怀孕和产前护理后,个人和卫生从业人员应提高对洪水后不良分娩结局风险增加的认识.
背景:澳大利亚研究委员会和澳大利亚国家健康与医学研究委员会。
BACKGROUND: Exposure to floods might increase the risks of adverse birth outcomes. However, the current evidence is scarce, inconsistent, and has knowledge gaps. This study aims to estimate the associations of flood exposure before and during pregnancy with adverse birth outcomes and to identify susceptible exposure windows and effect modifiers.
METHODS: In this cohort study, we obtained all the birth records occurring in Greater Sydney, Australia, from Jan 1, 2001, to Dec 31, 2020, from the New South Wales Midwives Data Collection and in the Brisbane metropolitan region, Australia, from Jan 1, 1995, to Dec 31, 2014, from the Queensland Health Perinatal Data Collection. For each birth, residential address and historical flood information from the Dartmouth Flood Observatory were used to estimate the numbers of days with floods during five exposure windows (Pre-1 was defined as 13-24 weeks before the last menstrual period [LMP], Pre-2 was 0-12 weeks before the LMP, trimester 1 [Tri-1] was 0-12 weeks after the LMP, trimester 2 [Tri-2] was 13-28 weeks after the LMP, and trimester 3 [Tri-3] was ≥29 weeks after the LMP). We estimated the hazard ratios (HRs) of adverse birth outcomes (preterm births, stillbirths, term low birthweight [TLBW], and small for gestational age [SGA]) associated with flood exposures in the five exposure windows using Cox proportional hazards regression models.
RESULTS: 1 338 314 birth records were included in our analyses, which included 91 851 (6·9%) preterm births, 9831 (0·7%) stillbirths, 25 567 (1·9%) TLBW, and 108 658 (8·1%) SGA. Flood exposure in Pre-1 was associated with increased risks of TLBW (HR 1·06 [95% CI 1·01-1·12]) and SGA (1·04 [1·01-1·06]); flood exposure during Tri-1 was associated with increased risks of preterm births (1·03 [1·002-1·05]), stillbirth (1·11 [1·03-1·20]), and SGA (1·03 [1·01-1·06]). In contrast, flood exposures during Pre-2 and Tri-3 were associated with reduced risks.
CONCLUSIONS: Exposures to floods in Pre-1 and Tri-1 are both associated with increased risks of adverse birth outcomes, and the risks increase with a higher exposure. Upon planning for conception and prenatal care, individuals and health practitioners should raise awareness of the increased risks of adverse birth outcomes after experiencing floods.
BACKGROUND: The Australian Research Council and the Australian National Health and Medical Research Council.