极端气温与早产关系的流行病学研究进展

Epidemiological research progress on association of maternal exposure to ambient temperature extremes and preterm birth

  • 摘要: 早产引起的并发症是导致新生儿及5岁以下儿童死亡的首要原因。流行病学研究表明,孕妇在妊娠期暴露于极端气温可能增加早产的风险,但不同极端气温类型(高温、低温、温度变化)与早产之间的关系尚不明确。在气候变化背景下,未来发生极端气温事件的频率和强度均会增加,亟须阐明妊娠期内极端气温暴露对早产的影响及其作用路径,从而为科学指导孕妇预防极端气温的危害提供依据。本文通过系统回顾高温、低温、温度变化与早产关系的流行病学研究,发现当前的研究主要关注极端高温对早产的影响,妊娠期内极端高温(>日均气温P90)暴露可增加孕妇发生早产的风险,且高温效应受暴露孕周、区域气候条件和孕妇健康状况等因素影响。极端低温(<日均气温P10)和温度变化暴露与早产的研究证据有限,且研究结论尚不一致。未来研究应进一步加强极端气温与早产关系的研究,并评估不同孕周、不同气候区域,以及不同人群中各类型极端气温与早产的暴露-反应关系模式差异,阐明极端气温诱发早产的影响机制,为临床上开展干预,降低早产风险提供依据。

     

    Abstract: Complications of preterm birth is the leading cause of deaths in newborns and children under the age of 5 years. Epidemiological evidence indicates that maternal exposure to ambient temperature extremes is associated with a higher risk of preterm birth, but the relationships between different kinds of ambient temperature extremes (heat, cold, and temperature variation) and preterm birth are still unclear. In the climate change context, the frequency and intensity of temperature extremes will increase; therefore, the impacts and pathways of exposure to extreme temperature events during pregnancy on preterm birth require to be elucidated, so as to provide scientific guidance for pregnant women against the health hazards of temperature extremes. Through reviewing epidemiological evidence on associations of preterm birth with heat, cold, and temperature variation, we found current studies mainly focused on heat; i.e., exposure to heat (> P90 of daily mean temperature) during pregnancy increased the risk of preterm birth, and the effect was modified by exposure window, regional climate, and maternal health. However, evidence on the risk of preterm birth caused by cold (< P10 of daily mean temperature) and temperature variation was limited and inconsistent. In the future, more efforts on the research of exposure-response relationship between temperature extremes and preterm birth among mothers at different gestational ages, in regions with different climate regimes, and for different populations, and pathways of temperature extremes leading to preterm birth are urgently needed for developing clinical interventions to reduce the risk of preterm birth.

     

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