Chersich Matthew Francis, Pham Minh Duc, Areal Ashtyn, Haghighi Marjan Mosalam, Manyuchi Albert, Swift Callum P, Wernecke Bianca, Robinson Matthew, Hetem Robyn, Boeckmann Melanie, Hajat Shakoor
Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Hillbrow, Johannesburg 2001, South Africa
Burnet Institute, Melbourne, VIC, Australia.
BMJ. 2020 Nov 4;371:m3811. doi: 10.1136/bmj.m3811.
To assess whether exposure to high temperatures in pregnancy is associated with increased risk for preterm birth, low birth weight, and stillbirth.
Systematic review and random effects meta-analysis.
Medline and Web of Science searched up to September 2018, updated in August 2019.
Clinical studies on associations between high environmental temperatures, and preterm birth, birth weight, and stillbirths.
14 880 records and 175 full text articles were screened. 70 studies were included, set in 27 countries, seven of which were countries with low or middle income. In 40 of 47 studies, preterm births were more common at higher than lower temperatures. Exposures were classified as heatwaves, 1°C increments, and temperature threshold cutoff points. In random effects meta-analysis, odds of a preterm birth rose 1.05-fold (95% confidence interval 1.03 to 1.07) per 1°C increase in temperature and 1.16-fold (1.10 to 1.23) during heatwaves. Higher temperature was associated with reduced birth weight in 18 of 28 studies, with considerable statistical heterogeneity. Eight studies on stillbirths all showed associations between temperature and stillbirth, with stillbirths increasing 1.05-fold (1.01 to 1.08) per 1°C rise in temperature. Associations between temperature and outcomes were largest among women in lower socioeconomic groups and at age extremes. The multiple temperature metrics and lag analyses limited comparison between studies and settings.
Although summary effect sizes are relatively small, heat exposures are common and the outcomes are important determinants of population health. Linkages between socioeconomic status and study outcomes suggest that risks might be largest in low and middle income countries. Temperature rises with global warming could have major implications for child health.
PROSPERO CRD 42019140136 and CRD 42018118113.
评估孕期暴露于高温环境是否会增加早产、低出生体重和死产的风险。
系统评价和随机效应荟萃分析。
检索了截至2018年9月的Medline和Web of Science数据库，并于2019年8月更新。
关于高环境温度与早产、出生体重和死产之间关联的临床研究。
筛选了14880条记录和175篇全文文章。纳入了70项研究，这些研究来自27个国家，其中7个是低收入或中等收入国家。在47项研究中的40项里，较高温度下早产比低温下更常见。暴露情况分为热浪、温度每升高1°C以及温度阈值临界点。在随机效应荟萃分析中，温度每升高1°C，早产几率增加1.05倍（95%置信区间1.03至1.07），热浪期间增加1.16倍（1.10至1.23）。在28项研究中的18项里，较高温度与出生体重降低相关，存在相当大的统计异质性。8项关于死产的研究均显示温度与死产之间存在关联，温度每升高1°C，死产增加1.05倍（1.01至1.08）。温度与结局之间的关联在社会经济地位较低的女性和极端年龄组中最为明显。多种温度指标和滞后分析限制了不同研究和环境之间的比较。
尽管汇总效应量相对较小，但高温暴露很常见，且这些结局是人群健康的重要决定因素。社会经济地位与研究结局之间的联系表明，低收入和中等收入国家的风险可能最大。全球变暖导致的温度上升可能对儿童健康产生重大影响。
PROSPERO CRD 42019140136和CRD 42018118113。
Zotero 插件
