背景:怀孕期间极端环境热暴露与后代神经管缺陷(NTDs)之间的关系尚不清楚。这项研究试图估计在感知期间暴露于极端环境热量与NTD之间的关联。
方法:这项以人群为基础的病例对照研究,美国(1994-2017)包括825例孤立的NTD病例(473例无脑,352个脊柱裂)和3,300个对照在居住县和分娩时间上匹配1:4。每日环境温度数据与居住地县的胎儿死亡和出生记录相关联。极端环境热暴露定义为在八周的周期内,每日表观温度连续超过县特定的95百分位数(在1980-2010年得出)的天数。我们计算调整后的比值比(aORs)和95%置信区间(CI)使用条件逻辑回归模型调整了母亲的年龄,教育,种族和末次月经期的月份和年份。
结果:NTDs的aOR为1.09(95%CI1.01,1.17),1.18(95%CI1.03,1.36),和1.29(95%CI1.04,1.58)暴露于1-2,3-5和6或更长时间连续天,表观环境温度超过县特定的95百分位数,分别,与没有极端环境热暴露的日子相比。对极端热暴露的每周分析表明,在感知期间,后代NTD的几率一直很高。这些结果主要是由脊柱裂病例驱动的。
结论:我们的研究结果强调了全球平均气温升高对孕妇健康造成的潜在威胁,并暗示其后代神经管缺陷风险增加。
BACKGROUND: The association between extreme ambient heat exposures during pregnancy and neural tube defects (NTDs) in offspring remains unclear. This study sought to estimate the association between exposure to extreme ambient heat during periconception and NTDs.
METHODS: This population-based case-control study in Georgia, USA (1994-2017) included 825 isolated NTD cases (473 anencephaly, 352 spina bifida) and 3,300 controls matched 1:4 on county of residence and time period of delivery. Daily ambient temperature data were linked to fetal death and birth records by county of residence. Extreme ambient heat exposure was defined as the number of consecutive days the daily apparent temperature exceeded the county-specific 95th percentile (derived over 1980-2010) during an eight-week periconception period. We calculated adjusted odds ratios (aORs) and 95% confidence intervals (CI) using conditional logistic regression models adjusted for maternal age, education, and ethnicity and month and year of last menstrual period.
RESULTS: The aORs for NTDs were 1.09 (95% CI 1.01, 1.17), 1.18 (95% CI 1.03, 1.36), and 1.29 (95% CI 1.04, 1.58) for exposure to 1-2, 3-5, and 6 or more consecutive days with apparent ambient temperatures exceeding the county-specific 95th percentile during periconception, respectively, compared to no days of extreme ambient heat exposure. Weekly analysis of extreme heat exposure indicated consistently elevated odds of offspring NTDs during periconception. These results were largely driven by spina bifida cases.
CONCLUSIONS: Our results highlight potential health threats posed by increasing global average temperatures for pregnant people with implications for increased risk of neural tube defects in their offspring.