Climate Change and Health: Assessing the Risk of Preterm Delivery

气候变化与健康：评估早产风险

• 批准号: 8266093
• 负责人: Lyndsay Ammon Avalos
• 金额: $ 19.51万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8266093
• 关键词: Address; Age Factors; Air Conditioning; Air Pollutants; Air Pollution; Alcohol consumption; American; Behavioral; Birth; Blood flow; Body mass index; California; Carbon Monoxide; Chronic Disease; Clinical; Computerized Medical Record; Cross-Over Studies; Data; Data Sources; Decision Making; Diuretics; Economic Burden; Electrolytes; Environment; Ethnic Origin; Ethnic group; Etiology; Future; Gestational Diabetes; Goals; Health; Heat Waves; Heating; Hormones; Hospitals; Human; Humidity; Hypertension; Induced Labor; Infant Mortality; Integrated Delivery of Health Care; International; Intervention; Irrigation; Liquid substance; Literature; Maternal Age; Measures; Mental Depression; Minority; Morbidity - disease rate; National Institute of Environmental Health Sciences; Nitrogen Dioxide; Outcome; Oxytocin; Ozone; Paper; Particulate Matter; Pharmaceutical Preparations; Pituitary Gland; Policy Research; Population Study; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Public Health; Publishing; Race; Relative (related person); Reporting; Research; Research Design; Research Personnel; Rest; Risk; Risk Factors; Seasons; Security; Severities; Smoking; Socioeconomic Status; Subgroup; Sulfur Dioxide; System; Temperature; Time; United States Environmental Protection Agency; United States National Institutes of Health; Vulnerable Populations; Woman; climate change; cohort; design; drinking; greenhouse gases; health care delivery; health economics; improved; innovation; low socioeconomic status; member; planetary Atmosphere; residence; response; trend

DESCRIPTION (provided by applicant): The National Institutes of Health (NIH) and National Institute of Environmental Health and Science (NIEHS) have recently published a White Paper emphasizing the need to study the impact of climate change on human health, specifically among vulnerable populations including pregnant women. Pre-term delivery (PTD) is the leading cause of infant mortality and morbidity and among the top public health challenges facing our nation as well as the rest of the world. Yet the etiology remains largely unknown. Studies of air pollution and seasonal trends have supported a relationship between adverse birth outcomes, such as PTD, thus supporting the need for more research to elucidate this relationship. Pregnant women may be at increased risk of PTD during periods of heat exposure, since they are more likely to be dehydrated, which could result in decreased uterine blood flow and increased pituitary secretion of anti-diuretic hormone and oxytocin to induce labor. The proposed study examines an innovative hypothesis and a previously unknown risk factor for PTD that has newly emerged from the literature. Specifically, the objective of the proposed study is to examine the impact of climate change on the risk of PTD, and will be among the first such studies designed to address this association in a clinical setting. To achieve the proposed aims, we will conduct a case-crossover study utilizing members of Kaiser Permanente Northern California (KPNC), an integrated health care delivery system with more than 33,000 deliveries each year. The case-crossover is a study design uniquely suited for examining the association between short-term high ambient temperature and the risk of PTD, as it has the advantage of eliminating potential measured and unmeasured confounders inherently by study design. The proposed study will use data on deliveries that occurred between January 1995 and December 2009 from KPNCs electronic medical records (EMR), which includes information on residence at the time of deliveries. Data on maternal residential apparent temperature, a measure of both temperature and relative humidity combined, will be provided by the California Irrigation and Management System and the US Environmental Protection Agency. A cohort of approximately half a million births will be identified through KPNC's EMR, and approximately ten percent of these births are expected to be preterm. The analyses will be stratified by season, and also by maternal race/ethnic group, maternal age, and socioeconomic status. Findings from this study will contribute to the nascent understanding of this relationship. Once the relationship between increased risk of PTD and apparent temperature has been established, public health interventions can be implemented to reduce the impact of increasing heat exposure on pregnant women, while targeting those who are at greatest risk. Precautions may include drinking more fluids and electrolytes, staying indoors in air conditioned environments, and being with others during the warm season, especially during heat waves. PUBLIC HEALTH RELEVANCE: Studies of air pollution and season have found relationships with preterm delivery (PTD) thus, high ambient temperature and PTD could also be associated, and needs to be studied. The proposed project will examine the association between temperature during the warm season and risk of PTD in women who delivered at a hospital in Kaiser Permanente Northern California between 1995 and 2009. Once the relationship between increased risk of PTD and apparent temperature has been established, public health interventions can be implemented to reduce the impact of heat exposure on pregnant women, especially those who are at greatest risk.

描述（由申请人提供）：美国国立卫生研究院（NIH）和国家环境卫生与科学研究所（NIEHS）最近发表了一份白皮书，强​​调了需要研究气候变化对人类健康的影响，特别是在脆弱人群中的影响包括孕妇。术前分娩（PTD）是婴儿死亡率和发病率的主要原因，也是我们国家以及世界其他地区面临的公共卫生挑战。然而，病因仍然在很大程度上未知。空气污染和季节性趋势的研究支持了不良出生结果（例如PTD）之间的关系，因此支持需要进行更多研究以阐明这种关系。在热暴露期间，孕妇可能会增加PTD的风险，因为她们更有可能脱水，这可能导致子宫血流量降低，抗抑制激素和催产素的垂体分泌增加，从而诱导劳动。拟议的研究研究了一种创新的假设和以前未知的PTD风险因素，该假设已从文献中新出现。具体而言，拟议的研究的目的是检查气候变化对PTD风险的影响，并将是旨在在临床环境中解决该关联的首批研究之一。为了实现拟议的目的，我们将利用Kaiser Permanente North California（KPNC）的成员进行一项案例分解研究，这是一个综合的医疗保健提供系统，每年超过33,000个交付。案例交叉是一项非常适合研究短期高环境温度与PTD风险之间关联的研究设计，因为它具有消除通过研究设计固有的潜在测量和未衡量的混杂因素。拟议的研究将使用有关1995年1月至2009年12月在KPNC电子病历（EMR）之间发生的交付的数据，该数据包括交货时有关居住的信息。加利福尼亚灌溉和管理系统以及美国环境保护局将提供有关孕产妇住宅明显温度的数据，即温度和相对湿度的衡量标准。将通过KPNC的EMR确定大约一百万分的出生队列，预计这些分娩中约有十％是早产。分析将按季节以及母体种族/族裔，母亲年龄和社会经济地位进行分层。这项研究的发现将有助于对这种关系的新生理解。一旦建立了PTD的风险增加与明显温度之间的关系，就可以实施公共卫生干预措施，以减少增加热量暴露对孕妇的影响，同时针对那些处于最大风险的人。预防措施可能包括喝更多的液体和电解质，在空调环境中留在室内，并在温暖的季节与其他人在一起，尤其是在热浪期间。 公共卫生相关性：对空气污染和季节的研究发现了与早产（PTD）的关系，因此，较高的环境温度和PTD也可以关联，并且需要研究。拟议的项目将在1995年至2009年间在北加州Kaiser Permanente北加州的一家医院分娩的妇女中的温度与PTD风险之间的关系。可以实施健康干预措施，以减少热暴露对孕妇的影响，尤其是那些面临最大风险的孕妇。