Vrkljan Kaylin A, Oblath Rachel, Black-Ingersoll Flannery, Grady Stephanie T, Burrows Kate, Fabian M Patricia, Parker Samantha E, Nori-Sarma Amruta, Willis Mary D
Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.
Department of Psychiatry, Boston Medical Center, Boston, Massachusetts, USA.
Paediatr Perinat Epidemiol. 2025 Jul 10. doi: 10.1111/ppe.70044.
Extreme ambient heat has been linked to maternal and neonatal mortality and morbidity. However, less is known regarding the impact of extreme ambient heat on mental health outcomes, particularly among socially vulnerable pregnant people.
We aimed to estimate the effect of ambient heat exposure on psychiatric emergency services encounters among pregnant people served by a public program in the metropolitan Boston area. We hypothesised that days of extreme heat would have higher odds of an encounter with psychiatric emergency services when compared to normal temperature days.
Using electronic health records from the Boston Emergency Services Team program, we identified 861 geocodable encounters for pregnant people who utilised psychiatric emergency services between 2005-2009 and 2017-2021. Using a time-stratified case-crossover design, we matched each case (psychiatric emergency services encounter) with 3-5 control dates (matched by day-of-week and month). We obtained daily temperature (degrees Celsius) measures (mean, minimum, maximum) at an 800 m gridded resolution for cases/controls. Extreme heat exposure was defined at the 95th percentile, and exposure-response relationships were analysed using distributed lag nonlinear models with a 5-day lag period. We used conditional logistic regression models to estimate the association between ambient temperature exposure and odds of psychiatric emergency services encounters, controlling for U.S. federal holidays, relative humidity, and week of case/control date. Effect measure modification by time was examined (e.g., 2005-2009, 2017-2021).
Among socially vulnerable pregnant people, we found no evidence of an association between days of extreme heat and the odds of psychiatric emergency services encounters, compared to normal temperature days.
This study does not support our a priori hypothesis. Future research is needed to confirm to what extent this association is truly null, as opposed to being obscured by selection bias into psychiatric emergency services, among socially vulnerable pregnant people.
极端环境高温与孕产妇和新生儿死亡率及发病率有关。然而，关于极端环境高温对心理健康结局的影响，尤其是对社会弱势群体中孕妇的影响，我们了解得较少。
我们旨在评估环境高温暴露对波士顿大都市区一项公共项目所服务孕妇的精神科急诊服务就诊情况的影响。我们假设，与正常温度的日子相比，极端高温天气下孕妇遭遇精神科急诊服务的几率更高。
利用波士顿应急服务团队项目的电子健康记录，我们确定了2005 - 2009年和2017 - 2021年期间使用精神科急诊服务的孕妇的861次可地理编码的就诊情况。采用时间分层病例交叉设计，我们将每个病例（精神科急诊服务就诊）与3 - 5个对照日期（按星期几和月份匹配）进行匹配。我们以800米的网格分辨率获取病例/对照的每日温度（摄氏度）测量值（平均值、最小值、最大值）。极端高温暴露定义为第95百分位数，并使用具有5天滞后期的分布滞后非线性模型分析暴露 - 反应关系。我们使用条件逻辑回归模型来估计环境温度暴露与精神科急诊服务就诊几率之间的关联，同时控制美国联邦假日、相对湿度以及病例/对照日期所在的周。我们检验了时间对效应量的修正（例如，2005 - 2009年，2017 - 2021年）。
在社会弱势群体中的孕妇中，与正常温度的日子相比，我们没有发现极端高温天气与精神科急诊服务就诊几率之间存在关联的证据。
本研究不支持我们的先验假设。未来需要开展研究，以确认在社会弱势群体中的孕妇中，这种关联在何种程度上是真正不存在的，而不是被精神科急诊服务的选择偏倚所掩盖。
