Climate Change and Adverse Birth Outcomes: Assessing the Vulnerability of Pregnan

气候变化和不良出生结果：评估孕妇的脆弱性

• 批准号: 8266120
• 负责人: Shao Lin
• 金额: $ 17.53万
• 依托单位: CENTER OF ENVIRONMENTAL HEALTH
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-05-25 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8266120
• 关键词: Acclimatization; Address; Adverse effects; Affect; Air Pollution; Air Pressure; Alcohol consumption; Animal Experiments; Animals; Anti-Cholinergics; Antipsychotic Agents; Behavior; Behavioral; Beverages; Biological; Biometry; Birth; Birth Weight; Case-Control Studies; Characteristics; Chronic Disease; Classification; Climate; Cluster Analysis; Code; Congenital Abnormality; Control Groups; Data; Diabetes Mellitus; Diuretics; Elderly; Ensure; Environmental Epidemiology; Environmental Health; Environmental Wind; Epidemiologist; Epidemiology; Event; Exposure to; Farming environment; Federal Government; Fetal Growth Retardation; Fever; Frequencies; Future; Genetic; Gestational Age; Global Warming; Health; Health Professional; Heat Waves; Heating; Human; Humidity; Hypertension; Individual; Infant; Infant Health; Interdisciplinary Study; Intervention; Joints; Lead; Life; Maps; Maternal Exposure; Medical; Medicine; Modeling; Modification; Monte Carlo Method; Morbidity - disease rate; Obesity; Occupations; Outcome; Pharmaceutical Preparations; Population; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Prevention; Public Health; Research; Research Personnel; Risk; Risk Factors; Sauna; Small for Gestational Age Infant; Smoke; Smoking; Socioeconomic Status; Special Event; Staging; System; Techniques; Temperature; Testing; Time; Uncertainty; United States National Institutes of Health; Vulnerable Populations; Weather; Woman; climate change; education planning; experience; geographic difference; high risk; indexing; low socioeconomic status; mortality; population based; programs; reproductive epidemiology; spelling

DESCRIPTION (provided by applicant): Global warming will lead to more intense, frequent, and longer-lasting extreme weather events, that have been associated with increased mortality. However, significant gaps remain in our understanding of the impact of climate change on health, including its impact on morbidity, the joint effects of multiple weather factors, effects o extreme cold weather, and whether there are especially vulnerable subpopulations. Little is known about the effect of extreme weather on birth outcomes in spite of biological plausibility suggested by animal experiments and limited human studies. The proposed study will fill these gaps by examining whether exposures to various extreme weather conditions or their joint effects during pregnancy are associated with adverse birth outcomes, including selected birth defects, preterm birth, and fetal growth restriction. To assess acclimatization and potential modification by air pollution, we will examine geographic variation and interactive effects of air pollution on the associations tested. Moreover, the study will assess whether pregnant women with certain chronic diseases, those taking heat-sensitizing medications, those of low socioeconomic status, those who smoke or drink alcohol, or those with outdoor occupations are more vulnerable to extreme weather conditions. Finally, we will estimate weather-attributable risks for pregnant women and women with certain characteristics, project the birth outcome burden of climate change, and develop vulnerability maps. We will use the National Birth Defects Prevention Study (NBDPS), the largest US population-based case-control study of potential risk factors of birth defects. The birth defect cases include infants with confirmed, selected major birth defects excluding genetic causes (N=23,333) and the controls are non-malformed live-born infants, randomly selected from each center (N= 8,494 controls). Other pregnancy outcomes will be selected from within the NBDPS control group, such as preterm (< 37 weeks) including severe preterm (<32 weeks) and moderately preterm (32-37 weeks), and small-for-gestational-age (below 10% of birth weight for gestational age). Extreme weather indicators defined by the 90th percentile of average summer temperature or the 10th percentile of winter temperature will be evaluated by intensity, duration, frequency, and timing. Other indicators including heat waves and cold spells, the full spectrum of temperature, humidity, air pressure and wind as well as a composite weather index using the Spatial Synoptic Classification system will also be examined. A two-stage Bayesian hierarchical model will be used to first examine the association in each region and then to control for regional characteristics to obtain a nationwide estimate. K-means cluster analysis and Monte Carlo methods will be used to estimate weather factor clusters and uncertainty, respectively. The findings may identify a vulnerable population which has been ignored, and thereby guide climate intervention and adaptation. The multidisciplinary research team has a unique opportunity to use the data already collected and geo-coded through the NBDPS and other ongoing projects, which ensures the project is feasible and sustainable. PUBLIC HEALTH RELEVANCE: The proposed study will evaluate whether exposures to various extreme weather conditions and different climate systems during pregnancy are associated with adverse birth outcomes, including selected birth defects, preterm birth, and fetal growth restriction. It will be the first study to assess whether pregnant women with certain physical (chronic diseases or taking specific medications) and behavioral factors (smoking and alcohol use), having low socioeconomic status, and with outdoor occupations during their pregnancy are more vulnerable to extreme weather conditions. The findings from this study will help guide the state/federal environmental and health agencies to plan intervention and climate adaptation programs for pregnant women.

描述（由申请人提供）：全球变暖将导致更激烈，频繁且持久的极端天气事件与死亡率增加有关。但是，我们对气候变化对健康的影响的理解仍然存在很大的差距，包括其对发病率的影响，多种天气因素的关节影响，极端寒冷的天气以及是否特别脆弱的亚群体。尽管有动物实验和人类研究有限的人类研究表明，尽管极端天气对出生结果的影响知之甚少。拟议的研究将通过检查对各种极端天气状况的暴露或怀孕期间的关节影响与不良的出生结果有关，包括某些出生缺陷，早产和胎儿生长限制。为了评估空气污染的适应和潜在修饰，我们将检查空气污染对所测试关联的地理变化和交互作用。此外，该研究将评估患有某些慢性疾病的孕妇，服用热敏性药物，社会经济状况低下的药物，吸烟或饮酒的孕妇，或者患有户外职业的孕妇更容易受到极端天气状况的影响。最后，我们将估计具有某些特征的孕妇和妇女的天气征收风险，预测气候变化的出生结果负担，并发展脆弱性图。我们将使用国家最大的预防性预防研究（NBDPS），这是美国最大的基于人群的病例对照研究，研究了先天缺陷的潜在危险因素。出生缺陷病例包括具有确认的，选定的主要出生缺陷的婴儿，包括遗传原因（n = 23,333），并且对照是非损坏的活体婴儿，从每个中心随机选择（n = 8,494个对照组）。其他妊娠结局将在NBDPS对照组内选择，例如早产（<37周），包括严重的早产（<32周）和中度早产（32-37周），以及胎龄小（低于妊娠年龄的10％的出生体重）。极端天气指标由平均夏季温度的第90个百分点或冬季温度的第10个百分点定义，将通过强度，持续时间，频率和时间来评估。还将检查其他指标，包括热浪和寒冷法术，温度，湿度，气压和风的全光谱以及使用空间概要分类系统的复合天气指数。将使用两个阶段的贝叶斯分层模型首先检查每个区域中的关联，然后控制区域特征以获得全国范围的估计。 K-均值聚类分析和蒙特卡洛方法将分别用于估计天气因子簇和不确定性。这些发现可能会确定被忽略的脆弱人群，从而指导气候干预和适应。多学科研究团队有一个独特的机会，可以使用NBDP和其他正在进行的项目已经收集和地理编码的数据，这确保了该项目可行且可持续。 公共卫生相关性：拟议的研究将评估怀孕期间对各种极端天气状况和不同气候系统的暴露是否与不良的出生结果有关，包括选定的出生缺陷，早产和胎儿生长限制。这将是第一个评估患有某些身体（慢性疾病或服用特定药物）（吸烟和饮酒），社会经济状况低的孕妇以及怀孕期间的户外职业更容易受到极端天气状况的影响。这项研究的发现将有助于指导州/联邦环境和卫生机构为孕妇计划干预和气候适应计划。