Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
London School of Hygiene and Tropical Medicine, London, UK.
Nat Med. 2024 Nov;30(11):3106-3113. doi: 10.1038/s41591-024-03245-7. Epub 2024 Sep 3.
Growing evidence suggests that extreme heat events affect both pregnant women and their infants, but few studies are available from sub-Saharan Africa. Using data from 138,015 singleton births in 16 hospitals in Benin, Malawi, Tanzania and Uganda, we investigated the association between extreme heat and early perinatal deaths, including antepartum and intrapartum stillbirths, and deaths within 24 h after birth using a time-stratified case-crossover design. We observed an association between an increase from the 75th to the 99th percentile in mean temperature 1 week (lag 0-6 d) before childbirth and perinatal mortality (odds ratio (OR) = 1.34 (95% confidence interval (CI) 1.01-1.78)). The estimates for stillbirths were similarly positive, but CIs included unity: OR = 1.29 (95% CI 0.95-1.77) for all stillbirths, OR = 1.18 (95% CI 0.71-1.95) for antepartum stillbirths and OR = 1.64 (95% CI 0.74-3.63) for intrapartum stillbirths. The cumulative exposure-response curve suggested that the steepest slopes for heat for intrapartum stillbirths and associations were stronger during the hottest seasons. We conclude that short-term heat exposure may increase mortality risks, particularly for intrapartum stillbirths, raising the importance of improved intrapartum care.
越来越多的证据表明，极端高温事件不仅会影响孕妇，还会影响她们的婴儿，但来自撒哈拉以南非洲的研究很少。本研究使用来自贝宁、马拉维、坦桑尼亚和乌干达 16 家医院的 138015 例单胎分娩数据，采用时间分层病例交叉设计，调查了极端高温与早期围产儿死亡（包括产前和产时死胎以及出生后 24 小时内死亡）之间的关联。我们观察到，分娩前 1 周（滞后 0-6 天）平均温度从第 75 百分位数增加到第 99 百分位数与围产儿死亡率之间存在关联（比值比 (OR) = 1.34（95%置信区间 (CI) 1.01-1.78））。死产的估计值也呈正相关，但 CI 包含 1：所有死产的 OR = 1.29（95% CI 0.95-1.77），产前死产的 OR = 1.18（95% CI 0.71-1.95），产时死产的 OR = 1.64（95% CI 0.74-3.63）。累积暴露-反应曲线表明，产时死产的高温暴露与关联的斜率最陡，且在最热的季节更强。我们的结论是，短期热暴露可能会增加死亡风险，特别是产时死产，这提高了加强产时护理的重要性。
