Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou 510080, Guangdong, China; Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY 12144, USA.
Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY 12144, USA.
Sci Total Environ. 2021 Jul 10;777:146134. doi: 10.1016/j.scitotenv.2021.146134. Epub 2021 Mar 1.
Although extreme heat exposure (EHE) was reported to be associated with increased risks of multiple diseases, little is known about the effects of EHE on pregnancy complications. We examined the EHE-pregnancy complications associations by lag days, subtypes, sociodemographic characteristics, and areas in New York State (NYS). We conducted a case-crossover analysis to assess the EHE-pregnancy complications associations in summer (June-August) and transitional months (May and September). All emergency department (ED) visits and hospital admissions due to pregnancy complications (ICD 9 codes: 630-649) from 2005 to 2013 in NYS were included. Daily mean temperature > 90th percentile of the monthly mean temperature in each county was defined as an EHE. We used conditional logistic regression while controlling for other weather factors, air pollutants and holidays to assess the EHE-pregnancy complications associations. EHE was significantly associated with increased ED visits for pregnancy complications in summer (ORs ranged: 1.01-1.04 from lag days 0-5). There was also a significant and stronger association in transitional months (ORs ranged: 1.02-1.06, Lag 0). Furthermore, we found EHE affected multiple subtypes of pregnancy complications, including threatened/spontaneous abortion, renal diseases, infectious diseases, diabetes, and hypertension (ORs range: 1.13-1.90) during transitional months. A significant concentration response effect between the number of consecutive days of EHE and ED visits in summer (P for trend <0.001), ED visits in September (P for trend =0.03), and hospital admission in May (P for trend<0.001) due to pregnancy complications was observed, respectively. African Americans and residents in lower socioeconomic position (SEP) counties were more susceptible to the effects of EHE. In conclusion, we found an immediate and prolonged effect of EHE on pregnancy complications in summer and a stronger, immediate effect in transitional months. These effects were stronger in African Americans and counties with lower SEP. Earlier warnings regarding extreme heat are recommended to decrease pregnancy complications.
尽管已有研究报道极端高温暴露（EHE）与多种疾病的风险增加有关，但对于 EHE 对妊娠并发症的影响知之甚少。我们通过滞后天数、亚型、社会人口特征和纽约州（NYS）地区研究了 EHE 与妊娠并发症的关联。我们进行了病例交叉分析，以评估夏季（6 月至 8 月）和过渡月份（5 月和 9 月）EHE 与妊娠并发症的关联。纳入了 2005 年至 2013 年期间由于妊娠并发症（ICD-9 代码：630-649）在 NYS 急诊部（ED）就诊和住院的所有病例。每个县每日平均气温高于该月平均气温第 90 百分位数的定义为 EHE。我们使用条件逻辑回归，同时控制其他天气因素、空气污染物和节假日，以评估 EHE 与妊娠并发症的关联。EHE 与夏季 ED 就诊的妊娠并发症显著相关（滞后 0-5 天的 OR 值范围为 1.01-1.04）。在过渡月份也存在显著且更强的关联（OR 值范围为 1.02-1.06，滞后 0）。此外，我们发现 EHE 在过渡月份影响多种妊娠并发症亚型，包括威胁性/自发性流产、肾脏疾病、传染病、糖尿病和高血压（OR 值范围为 1.13-1.90）。在夏季（P<0.001）、9 月（P=0.03）和 5 月（P<0.001），ED 就诊因妊娠并发症而住院的患者中，EHE 连续天数与 ED 就诊次数之间存在显著的浓度反应关系。非裔美国人和社会经济地位较低（SEP）县的居民更容易受到 EHE 的影响。总之，我们发现 EHE 对夏季妊娠并发症有即时和长期的影响，在过渡月份的影响更强、更即时。这些影响在非裔美国人和社会经济地位较低的县更强。建议提前发布有关极端高温的警报，以降低妊娠并发症的风险。
