Girgin Selin, Erez Offer, Nevo Daniel, Youssim Iaroslav, Kloog Itai, Raz Raanan
Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
Division of Obstetrics and Gynecology, Soroka University Medical Center, Be'er Sheva, Israel.
Int J Epidemiol. 2025 Jun 11;54(4). doi: 10.1093/ije/dyaf106.
Accumulating evidence suggests links between ambient temperature and preterm birth. We aimed to explore susceptible exposure weeks and groups concerning temperature and preterm birth in an innovative methodological approach.
We conducted a historical cohort study of 131 599 singleton live births in Southern Israel in 2005-19. Weekly mean temperatures were assessed based on residential address and a spatiotemporal model. We fitted Cox models with time-dependent covariates and distributed lag non-linear models, adapting them for the challenges of examining prenatal exposures. We further extended the models with time-dependent coefficients to assess variations by preterm birth categories. Finally, we estimated associations of cumulative exposures by using predicted survival curves contrasting realistic exposure trajectories by month of the last menstrual period (LMP).
Exposures to high temperatures in gestation Weeks 29-37 were associated with increased preterm birth risk. The highest hazard ratio was 1.04 [95% confidence interval (CI): 1.01-1.07] in Week 37 for the 99th percentile (31°C) compared with the minimum-risk temperature (16°C). There was a strong seasonal pattern in the estimated risk, with pregnancies with LMP in autumn having a higher risk. The average estimated risk by LMP month varied between 6.5% and 7.6% for pregnancies with LMP in March and October, respectively, corresponding to a relative risk of 1.17 (95% CI: 1.07-1.27).
The final weeks of the third trimester are the key window for heat exposure in Southern Israel, creating a distinguished estimated risk by LMP month, with the highest risk for pregnancies conceived in the autumn.
越来越多的证据表明环境温度与早产之间存在联系。我们旨在采用一种创新的方法来探索与温度和早产相关的易感暴露周数和群体。
我们对2005年至2019年以色列南部131599例单胎活产进行了一项历史性队列研究。根据居住地址和时空模型评估每周平均温度。我们拟合了具有时间依赖性协变量的Cox模型和分布滞后非线性模型，并对其进行调整以应对检查产前暴露的挑战。我们进一步使用具有时间依赖性系数的模型来评估早产类别之间的差异。最后，我们通过使用预测生存曲线来估计累积暴露的关联，该曲线对比了末次月经日期（LMP）月份的实际暴露轨迹。
妊娠第29至37周暴露于高温与早产风险增加相关。与最低风险温度（16°C）相比，第37周第99百分位数（31°C）的最高风险比为1.04[95%置信区间（CI）：1.01-1.07]。估计风险存在强烈的季节性模式，末次月经在秋季的妊娠风险更高。末次月经月份的平均估计风险在3月和10月末次月经的妊娠中分别在6.5%和7.6%之间变化，相对风险为1.17（95%CI：1.
在以色列南部，孕晚期的最后几周是热暴露的关键窗口，末次月经月份会产生显著的估计风险，秋季受孕的妊娠风险最高。
