Cox Bianca, Vicedo-Cabrera Ana M, Gasparrini Antonio, Roels Harry A, Martens Evelyne, Vangronsveld Jaco, Forsberg Bertil, Nawrot Tim S
Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium.
Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
J Epidemiol Community Health. 2016 Dec;70(12):1191-1199. doi: 10.1136/jech-2015-206384. Epub 2016 Jun 3.
Recent evidence suggests that elevated ambient temperatures may trigger preterm delivery. Since results from studies in temperate climates are inconclusive, we investigated the association between temperature and the risk of preterm birth in Flanders (Belgium).
We used data on 807 835 singleton deliveries (January 1998-July 2011). We combined a quasi-Poisson model with distributed lag non-linear models to allow for delayed and non-linear temperature effects, accounting for the daily pregnancies at risk and their gestational age distribution.
For moderate heat (95th vs 50th centile) up to 1 day before delivery (lag 0-1), the risk of preterm birth increased by 8.5% (95% CI 2.4% to 15.0%) when minimum temperature increased from 8.3°C to 16.3°C and by 9.6% (95% CI 1.1% to 18.7%) when maximum temperature increased from 14.7°C to 26.5°C. Corresponding estimates for extreme heat (99th vs 50th centile) were 15.6% (95% CI 4.8% to 27.6%) for minimum temperature (19.0°C vs 8.3°C) and 14.5% (95% CI 0.5% to 30.6%) for maximum temperature (30.7°C vs 14.7°C). Despite the increased risk of preterm birth associated with cold at lag 2 (and lag 1 for minimum temperature), cumulative cold effects were small. The per cent change in preterm birth associated with moderate cold (5th vs 50th centile) up to 3 days before delivery (lag 0-3) was 2.1% (95% CI -4.1% to 8.7%) for minimum temperature (-2.0°C vs 8.3°C) and 0.6% (95% CI -7.3% to 9.2%) for maximum temperature (2.5°C vs 14.7°C).
Even in a temperate climate, ambient temperature may trigger preterm delivery, suggesting that pregnant women should avoid temperature extremes.
近期证据表明，环境温度升高可能引发早产。由于温带气候地区的研究结果尚无定论，我们调查了比利时弗拉芒地区温度与早产风险之间的关联。
我们使用了1998年1月至2011年7月期间807835例单胎分娩的数据。我们将准泊松模型与分布滞后非线性模型相结合，以考虑温度的延迟和非线性效应，同时考虑每日的妊娠风险及其孕周分布。
在分娩前1天（滞后0 - 1），对于中度高温（第95百分位数与第50百分位数相比），当最低温度从8.3°C升至16.3°C时，早产风险增加8.5%（95%置信区间2.4%至15.0%）；当最高温度从14.7°C升至26.5°C时，早产风险增加9.6%（95%置信区间1.1%至18.7%）。对于极端高温（第99百分位数与第50百分位数相比），最低温度（19.0°C与8.3°C相比）对应的估计值为15.6%（95%置信区间4.8%至27.6%），最高温度（30.7°C与14.7°C相比）对应的估计值为14.5%（95%置信区间0.5%至30.6%）。尽管在滞后2天（最低温度为滞后1天）时，寒冷与早产风险增加有关，但累积寒冷效应较小。在分娩前3天（滞后0 - 3），对于中度寒冷（第5百分位数与第50百分位数相比），最低温度（-2.0°C与8.3°C相比）时早产相关的百分比变化为2.1%（95%置信区间 - 4.1%至8.7%），最高温度（2.5°C与14.7°C相比）时为0.6%（95%置信区间 - 7.3%至9.2%）。
即使在温带气候地区，环境温度也可能引发早产，这表明孕妇应避免温度极端情况。
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