Dataset Information

Independent and Combined Effects of Heatwaves and PM2.5 on Preterm Birth in Guangzhou, China: A Survival Analysis.

ABSTRACT: BACKGROUND:Both extreme heat and air pollution exposure during pregnancy have been associated with preterm birth; however, their combined effects are unclear. OBJECTIVES:Our goal was to estimate the independent and joint effects of heatwaves and fine particulate matter [PM <2.5?m in aerodynamic diameter (PM2.5)], exposure during the final gestational week on preterm birth. METHODS:Using birth registry data from Guangzhou, China, we included 215,059 singleton live births in the warm season (1 May-31 October) between January 2015 and July 2017. Daily meteorological variables from 5 monitoring stations and PM2.5 concentrations from 11 sites were used to estimate district-specific exposures. A series of cut off temperature thresholds and durations (2, 3, and 4 consecutive d) were used to define 15 different heatwaves. Cox proportional hazard models were used to estimate the effects of heatwaves and PM2.5 exposures during the final week on preterm birth, and departures from additive joint effects were assessed using the relative excess risk due to interaction (RERI). RESULTS:Numbers of preterm births increased in association with heatwave exposures during the final gestational week. Depending on the heatwave definition used, hazard ratios (HRs) ranged from 1.10 (95% CI: 1.01, 1.20) to 1.92 (1.39, 2.64). Associations were stronger for more intense heatwaves. Combined effects of PM2.5 exposures and heatwaves appeared to be synergistic (RERIs>0) for less extreme heatwaves (i.e., shorter or with relatively low temperature thresholds) but were less than additive (RERIs<0) for more intense heatwaves. CONCLUSIONS:Our research strengthens the evidence that exposure to heatwaves during the final gestational week can independently trigger preterm birth. Moderate heatwaves may also act synergistically with PM2.5 exposure to increase risk of preterm birth, which adds new evidence to the current understanding of combined effects of air pollution and meteorological variables on adverse birth outcomes. https://doi.org/10.1289/EHP5117.

SUBMITTER: Wang Q

PROVIDER: S-EPMC7015562 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Independent and Combined Effects of Heatwaves and PM2.5 on Preterm Birth in Guangzhou, China: A Survival Analysis.

Wang Qiong Q Li Bing B Benmarhnia Tarik T Hajat Shakoor S Ren Meng M Liu Tao T Knibbs Luke D LD Zhang Huanhuan H Bao Junzhe J Zhang Yawei Y Zhao Qingguo Q Huang Cunrui C

Environmental health perspectives 20200107 1

<h4>Background</h4>Both extreme heat and air pollution exposure during pregnancy have been associated with preterm birth; however, their combined effects are unclear.<h4>Objectives</h4>Our goal was to estimate the independent and joint effects of heatwaves and fine particulate matter [PM <2.5μm in aerodynamic diameter (PM2.5)], exposure during the final gestational week on preterm birth.<h4>Methods</h4>Using birth registry data from Guangzhou, China, we included 215,059 singleton live births in ...[more]

PMID: 31909654

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Project description:Although effects of weather changes on human health have been widely reported, there is limited information regarding effects on pregnant women in developing countries.We investigated the association between maternal exposure to ambient temperature and the risk of preterm birth (< 37 weeks of gestation) in Guangzhou, China.We used a Cox proportional hazards model to estimate associations between preterm birth and average temperature during each week of gestation, with weekly temperature modeled as a time-varying exposure during four time windows: 1 week (the last week of the pregnancy), 4 weeks (the last 4 weeks of the pregnancy), late pregnancy (gestational week 20 onward), and the entire pregnancy. Information on singleton vaginal birth between 2001 and 2011 was collected. Daily meteorological data during the same period were obtained from the Guangzhou Meteorological Bureau.A total of 838,146 singleton vaginal births were included, among which 47,209 (5.6%) were preterm births. High mean temperatures during the 4 weeks, late pregnancy, and the entire pregnancy time windows were associated with an increased risk of preterm birth. Compared with the median temperature (24.4°C), weekly exposures during the last 4 weeks of the pregnancy to extreme cold (7.6°C, the 1st percentile) and extreme heat (31.9°C, the 99th percentile) were associated with 17.9% (95% CI: 10.2, 26.2%) and 10.0% (95% CI: 2.9, 17.6%) increased risks of preterm birth, respectively. The association between extreme heat and preterm birth was stronger for preterm births during weeks 20-31 and 32-34 than those during weeks 35-36.These findings might have important implications in preventing preterm birth in Guangzhou as well as other areas with similar weather conditions.He JR, Liu Y, Xia XY, Ma WJ, Lin HL, Kan HD, Lu JH, Feng Q, Mo WJ, Wang P, Xia HM, Qiu X, Muglia LJ. 2016. Ambient temperature and the risk of preterm birth in Guangzhou, China (2001-2011). Environ Health Perspect 124:1100-1106;?http://dx.doi.org/10.1289/ehp.1509778.

Project description:Exposure to high air temperature in late pregnancy is increasingly recognized as a risk factor for preterm birth (PTB). However, the combined effects of heatwaves with air pollution and green space are still unexplored. In the context of climate change, investigating the interaction between environmental factors and identifying communities at higher risk is important to better understand the etiological mechanisms and design targeted interventions towards certain women during pregnancy. To examine the combined effects of heatwaves, air pollution and green space exposure on the risk of PTB. California birth certificate records for singleton births (2005-2013) were obtained. Residential zip code-specific daily temperature during the last week of gestation was used to create 12 definitions of heatwave with varying temperature thresholds and durations. We fit multi-level Cox proportional hazard models with time to PTB as the outcome and gestational week as the temporal unit. Relative risk due to interaction (RERI) was applied to estimate the additive interactive effect of air pollution and green space on the effect of heatwaves on PTB. In total, 1,967,300 births were included in this study. For PM2.5, PM10 and O3, we found positive additive interactions (RERIs >0) between heatwaves and higher air pollution levels. Combined effects of heatwaves and green space indicated negative interactions (RERIs <0) for less intense heatwaves (i.e., shorter duration or relatively low temperature), whereas there were potential positive interactions (RERIs >0) for more intense heatwaves. This study found synergistic harmful effects for heatwaves with air pollution, and potential positive interactions with lack of green space on PTB. Implementing interventions, such as heat warning systems and behavioral changes, targeted toward pregnant women at risk for high air pollution and low green space exposures may optimize the benefits of reducing acute exposure to extreme heat before delivery.

Project description:Atmospheric fine particulate matter (PM2.5) causes severe haze in China and is regarded as a threat to human health. The health effects of PM2.5 vary location by location due to the variation in size distribution, chemical com position, and sources. In this study, the cytotoxicity effect, oxidative stress, and gene expression regulation of PM2.5 in Chengdu and Chongqing, two typical urban areas in southern China, were evaluated. Urban PM2.5 in summer and winter significantly inhibited cell viability and increased reactive oxygen species (ROS) levels in A549 cells. Notably, PM2.5 in winter exhibited higher cytotoxicity and ROS level than summer. Moreover, in this study, PM2.5 commonly induced cancer-related gene expression such as cell adhesion molecule 1(PECAM1), interleukin 24 (IL24), and cytochrome P450 (CYP1A1); meanwhile, PM2.5 commonly acted on cancer-related biological functions such as cell-substrate junction, cell-cell junction, and focal adhesion. In partic ular, PM2.5 in Chengdu in summer had the highest carcinogenic potential among PM2.5 at the two sites in summer and winter. Importantly, cancer-related genes were uniquely targeted by PM2.5, such as epithelial splicing regu latory protein 1 (ESRP1) and membrane-associated ring-CH-type finger 1 (1-Mar) by Chengdu summer PM2.5; collagen type IX alpha 3 chain (COL9A3) by Chengdu winter PM2.5; SH2 domain-containing 1B (SH2D1B) by Chongqing summer PM2.5; and interleukin 1 receptor-like 1 (IL1RL1) and zinc finger protein 42 (ZNF423) by Chongqing winter PM2.5. Meanwhile, important cancer-related biological functions were specially induced by PM2.5, such as cell cycle checkpoint by Chengdu summer PM2.5; macromolecule methylation by Chengdu win ter PM2.5; endoplasmic reticulum-Golgi intermediate compartment membrane by Chongqing summer PM2.5;and cellular lipid catabolic process by Chongqing winter PM2.5. Conclusively, in the typical urban areas of southern China, both summer and winter PM2.5 illustrated significant gene regulation effects. This study contrib utes to evaluating the adverse health effects of PM2.5 in southern China and providing public health suggestions for policymakers.

Project description:BACKGROUND:The incidence of preterm birth (PTB, <?37?weeks of gestation) has been increasing in China and many other countries in recent years. However, the causes of the increase were not well understood. The current study aims to examine the contribution of maternal age, period of delivery, and maternal birth cohorts to long-term trends in preterm birth in Guangzhou, China. METHODS:In a retrospective population-based study, data were obtained from 2,535,000 singleton live births with 20-43 gestational weeks from 2001 to 2016 and recorded in the Guangzhou Perinatal Health Care and Delivery Surveillance System, in China. The age-period-cohort models were applied to investigate the temporal changes in incidences of PTB, stratified by parity. RESULTS:The incidence of preterm birth steadily increased from 5.1% in 2001 to 5.9% in 2016, with larger rise in primiparous mothers (from 5.0 to 5.9%) compared to multiparous mothers (from 5.6 to 5.9%). A J-shaped and a V-shaped relationship were found between maternal age and PTB among primiparous and multiparous mothers, respectively. A linear cohort effect was found among primiparous mothers with the lowest risk of PTB [risk ratio (RR)?=?0.81, 95% confidence interval (CI): 0.74 to 0.89] in 1961 and the highest risk (RR?=?1.06, 95% CI: 1.00 to 1.13) in 1997 compared to the mothers born in 1981. An inverse U-shaped association between maternal birth cohort and PTB was found in multiparous mothers. There were weak decreasing period effects on the trend of overall PTB among multiparous mothers and on the trend of extremely (<?27?weeks) or very (28-31?weeks) PTB among both parity groups during the period of 2001-2012. CONCLUSIONS:Our findings showed the PTB incidences had been increasing in the past 16?years in Guangzhou, China and both maternal age and cohort effects contributed to these trends. Further studies are recommended on the impact of altered maternal age and parity on premature births and corresponding public education and public health policies.

Project description:BackgroundThe effect of heatwaves on adverse birth outcomes is not well understood and may vary by how heatwaves are defined. The study aims to examine acute associations between various heatwave definitions and preterm and early-term birth.MethodsUsing national vital records from 50 metropolitan statistical areas (MSAs) between 1982 and 1988, singleton preterm (< 37 weeks) and early-term births (37-38 weeks) were matched (1:1) to controls who completed at least 37 weeks or 39 weeks of gestation, respectively. Matching variables were MSA, maternal race, and maternal education. Sixty heatwave definitions including binary indicators for exposure to sustained heat, number of high heat days, and measures of heat intensity (the average degrees over the threshold in the past 7 days) based on the 97.5th percentile of MSA-specific temperature metrics, or the 85th percentile of positive excessive heat factor (EHF) were created. Odds ratios (OR) for heatwave exposures in the week preceding birth (or corresponding gestational week for controls) were estimated using conditional logistic regression adjusting for maternal age, marital status, and seasonality. Effect modification by maternal education, age, race/ethnicity, child sex, and region was assessed.ResultsThere were 615,329 preterm and 1,005,576 early-term case-control pairs in the analyses. For most definitions, exposure to heatwaves in the week before delivery was consistently associated with increased odds of early-term birth. Exposure to more high heat days and more degrees above the threshold yielded higher magnitude ORs. For exposure to 3 or more days over the 97.5th percentile of mean temperature in the past week compared to zero days, the OR was 1.027 for early-term birth (95%CI: 1.014, 1.039). Although we generally found null associations when assessing various heatwave definitions and preterm birth, ORs for both preterm and early-term birth were greater in magnitude among Hispanic and non-Hispanic black mothers.ConclusionAlthough associations varied across metrics and heatwave definitions, heatwaves were more consistently associated with early-term birth than with preterm birth. This study's findings may have implications for prevention programs targeting vulnerable subgroups as climate change progresses.

Dataset Information

Independent and Combined Effects of Heatwaves and PM2.5 on Preterm Birth in Guangzhou, China: A Survival Analysis.

Publications

Independent and Combined Effects of Heatwaves and PM2.5 on Preterm Birth in Guangzhou, China: A Survival Analysis.

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