A prospective study of heat exposure and miscarriage

热暴露和流产的前瞻性研究

• 批准号: 10452143
• 负责人: Amelia Kent Wesselink
• 金额: $ 25.21万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-10 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10452143
• 关键词: Affect; American College of Obstetricians and Gynecologists; Behavior Therapy; Biological; Birth; Blood flow; Budgets; Canada; Characteristics; Clinical; Clinical Practice Guideline; Cohort Studies; Consensus; Couples; Data; Development; Diet; Emergency Situation; Enrollment; Environment; Environmental Exposure; Etiology; Event; Exposure to; Female; Fetal health; Frequencies; Funding; Geography; Green space; Health; Home; Household; Housing; Human; Income; Individual; Infrastructure; Intervention; Knowledge; Long-Term Effects; Low Birth Weight Infant; Measurement; Measures; Mediating; Microclimate; Monitor; Morbidity - disease rate; National Institute of Environmental Health Sciences; Neighborhoods; Online Systems; Outcome; Ozone; Participant; Pattern; Persons; Physical environment; Physiological; Population; Population Density; Pre-Eclampsia; Predictive Factor; Predisposition; Pregnancy; Pregnancy Tests; Pregnancy loss; Pregnant Women; Premature Birth; Prospective Studies; Province; Questionnaires; Reproduction; Reproductive Health; Research; Research Design; Risk; Risk Factors; Role; Sample Size; Shapes; Smoking; Spontaneous abortion; Temperature; Time; United States; Urine; Weather; Woman; Women' s Health; Work; adverse pregnancy outcome; base; built environment; climate change; climate zone; climate-related health; cohort; early pregnancy; experience; extreme heat; extreme temperature; extreme weather; heat island; high risk; improved; insight; lifestyle factors; neonatal outcome; parent grant; people of color; perinatal health; predictive modeling; pregnancy hypertension; pregnant; prospective; psychologic; recruit; reproductive; reproductive epidemiology; reproductive outcome; socioeconomics; stillbirth; teratogenesis; trying to conceive; weather stations

ABSTRACT Given the scientific consensus regarding the role of climate change in causing increased temperatures and higher frequency of extreme weather events in the coming decades, it is crucial to clarify the effects of climate change on human reproduction. A substantial body of research has documented that exposure to heat is associated with adverse pregnancy and neonatal outcomes, including preeclampsia, gestational hypertension, low birth weight, and preterm birth. However, there has been limited assessment of the association between ambient heat and spontaneous abortion (SAB), defined as a pregnancy loss before 20 weeks’ gestation. SAB is a particularly challenging reproductive event to measure because many SABs occur early in gestation, often before pregnancy recognition. The ideal study design for accurately measuring SAB is a preconception cohort where early reproductive events are closely monitored. In addition, most research on the health effects of heat have measured ambient rather than personal temperature exposure, despite the fact that ambient temperature does not sufficiently represent the environmental conditions individuals experience as they move throughout time and space. In the present proposal, we will utilize the infrastructure of an ongoing preconception cohort study, Pregnancy Study Online (PRESTO), to explore the role of ambient and personal heat exposure in the etiology of SAB. PRESTO has successfully enrolled a geographically, racially, and socioeconomically diverse cohort of couples trying to conceive from across the United States and Canada, and using these data, we have prospectively identified SAB, including early SAB (<6 weeks’ gestation), and assessed risk factors for SAB. Specifically, in the present proposal, we aim to 1) examine the association between ambient heat and SAB risk and measure the extent to which select geospatial features mediate or modify this association, and 2) deploy wearable personal temperature monitors for one week among 400 newly-enrolled female PRESTO participants and use monitoring data to identify geospatial, neighborhood, and individual-level predictors of heat exposure. The proposed study will have a large and sustained impact on the fields of reproductive epidemiology and climate health. This will be the first study to measure personal exposure to heat in pregnant women, a population with underlying physiologic susceptibility to heat. Our predictive models of heat exposure have vast applications in fields of environmental exposure assessment. The ability to measure personal heat exposure using questionnaire and geospatial data, rather than relying on personal monitoring, could revolutionize the study of the health effects of extreme temperatures. In addition, this study could provide critical information on the etiology of SAB, inform specific interventions to reduce SAB risk, and challenge current clinical practice guidelines for advising women early in pregnancy that focus on lifestyle factors such as smoking and diet. Finally, we seek to shift current research paradigms by advancing knowledge on the role of climate change in shaping reproductive outcomes.

抽象的 鉴于关于气候变化在导致气温升高和 未来几十年极端天气事件发生频率更高，澄清气候影响至关重要 大量研究表明，暴露于高温会影响人类生殖。 与不良妊娠和新生儿结局相关，包括先兆子痫、妊娠高血压、 然而，对低出生体重和早产之间的关联的评估有限。 环境热自然流产 (SAB)，定义为妊娠 20 周之前流产。 是一个特别具有挑战性的生殖事件，因为许多 SAB 发生在妊娠早期，通常 准确测量 SAB 的理想研究设计是孕前队列。 此外，大多数研究都是关于热量对健康的影响。 测量了环境温度而不是个人温度暴露，尽管环境温度 不能充分代表个人在整个过程中经历的环境条件 在本提案中，我们将利用正在进行的孕前队列的基础设施。 研究，怀孕研究在线（PRESTO），探索环境和个人热暴露在怀孕中的作用 SAB 的病因学已成功招募了地理、种族和社会经济多样化的人群。 来自美国和加拿大各地试图怀孕的夫妇的队列，并使用这些数据，我们有 前瞻性识别 SAB，包括早期 SAB（妊娠 <6 周），并评估 SAB 的危险因素。 具体来说，在本提案中，我们的目标是 1) 检查环境热量与 SAB 风险之间的关联 并测量所选地理空间特征调解或修改此关联的程度，以及 2) 部署 为 400 名新注册的女性 PRESTO 参与者提供为期一周的可穿戴式个人体温监测器 并使用监测数据来识别地理空间、社区和个人层面的热暴露预测因素。 拟议的研究将对生殖流行病学和生殖流行病学领域产生巨大且持续的影响。 这将是第一项测量孕妇个人暴露于高温的研究。 我们的热暴露预测模型有大量对热具有潜在生理敏感性的人群。 环境暴露评估领域的应用 测量个人热暴露的能力。 使用调查问卷和地理空间数据，而不是依赖个人监控，可以彻底改变 此外，这项研究还可以提供有关极端温度对健康影响的重要信息。 SAB 的病因学，为降低 SAB 风险的具体干预措施提供信息，并挑战当前的临床实践 为怀孕早期妇女提供建议的指南，重点关注吸烟和饮食等生活方式因素。 最后，我们寻求通过推进关于气候变化在气候变化中的作用的知识来改变当前的研究范式。 塑造生殖结果。