■极端温度与早产(PTB)的风险有关,但是关于不同临床亚型和不同地区的影响的证据有限.我们的目的是评估中国孕妇暴露于极端温度对PTB及其临床亚型的影响。并确定区域因素在人口维度上的影响变化,经济,医疗资源和环境因素。
■这是2014-2018年期间来自中国八个省份16个县的210,798例单胎活产的前瞻性人群队列。我们使用具有时变变量的扩展Cox回归来评估整个妊娠中极端高温和寒冷对PTB及其亚型的影响,每三个月,妊娠最后一个月和一周。进行了荟萃分析和荟萃回归,以评估每个城市的综合影响以及按区域特征进行的影响修正。
■在整个怀孕期间暴露于热和冷的情况会显着增加PTB的风险。效果因亚型而异,对于医学上有指征和自发性PTB,热的危险比分别为1·84(95%CI:1·29,2·61)和1·50(95%CI:1·11,2·02),2·18(95%CI:1·83,2·60)和2·15(95%CI:1·92,2·41)。少于35周的PTB的关联比35-36周的PTB更强。效果因地点而异,人均GDP(β=-0·16)和每1000人的病床(β=-0·25)是影响的保护因素。
■极端温度会增加医学指示和自发性PTB的风险,较高的区域社会经济地位可能会减轻这种影响。在气候变化的背景下,这些发现可能对保护弱势群体的健康具有重要意义,尤其是新生儿。
■国家重点研发计划(2018YFA0606200),国家自然科学基金(42175183),中国科学院战略优先研究计划(XDA20030302),国家自然科学基金(42071377).
UNASSIGNED: Extreme temperatures are associated with the risk of preterm birth (PTB), but evidence on the effects of different clinical subtypes and across different regions is limited. We aimed to evaluate the effects of maternal exposure to extreme temperature on PTB and its clinical subtypes in China, and to identify effect modification of regional factors in dimensions of population, economy, medical resources and environmental factors.
UNASSIGNED: This was a prospective population-based cohort of 210,798 singleton live births from 16 counties in eight provinces across China during 2014-2018. We used an extended Cox regression with time-varying variables to evaluate the effects of extreme heat and cold on PTB and its subtypes in the entire pregnancy, each trimester, the last gestational month and week. Meta-analysis and meta-regression were conducted to estimate the pooled effects of each city and effect modification by regional characteristics.
UNASSIGNED: Exposure to heat and cold during the entire pregnancy significantly increased the risk of PTB. The effects varied with subtypes, for medically indicated and spontaneous PTB, hazard ratios were 1·84 (95% CI: 1·29, 2·61) and 1·50 (95% CI: 1·11, 2·02) for heat, 2·18 (95% CI: 1·83, 2·60) and 2·15 (95% CI: 1·92, 2·41) for cold. The associations were stronger for PTB less than 35 weeks than those during weeks 35-36. The effects varied across locations, and GDP per capita (β=-0·16) and hospital beds per 1000 persons (β=-0·25) were protective factors for the effects.
UNASSIGNED: Extreme temperature can increase the risk of medically indicated and spontaneous PTB, and higher regional socio-economic status may moderate such effects. In the context of climate change, such findings may have important implications for protecting the health of vulnerable groups, especially newborns.
UNASSIGNED: National Key R&D Program of China (2018YFA0606200), National Natural Science Foundation of China (42175183), Strategic Priority Research Program of the Chinese Academy of Sciences (XDA20030302), National Natural Science Foundation of China (42071377).