Associations between ambient temperature and risk of preterm birth in Sweden: A comparison of analytical approaches
Evidence indicates that high temperatures are a risk factor for preterm birth. Increasing heat exposures due to climate change are therefore a concern for pregnant women. However, the large heterogeneity of study designs and statistical methods across previous studies complicate interpretation and c...
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| Veröffentlicht in: | Environmental research 2022-10, Vol.213, p.113586, Article 113586 |
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| creator | de Bont, Jeroen Stafoggia, Massimo Nakstad, Britt Hajat, Shakoor Kovats, Sari Part, Chérie Chersich, Matthew Luchters, Stanley Filippi, Veronique Stephansson, Olof Ljungman, Petter Roos, Nathalie |
| description | Evidence indicates that high temperatures are a risk factor for preterm birth. Increasing heat exposures due to climate change are therefore a concern for pregnant women. However, the large heterogeneity of study designs and statistical methods across previous studies complicate interpretation and comparisons. We investigated associations of short-term exposure to high ambient temperature with preterm birth in Sweden, applying three complementary analytical approaches.
We included 560,615 singleton live births between 2014 and 2019, identified in the Swedish Pregnancy Register. We estimated weekly mean temperatures at 1-km2 spatial resolution using a spatiotemporal machine learning methodology, and assigned them at the residential addresses of the study participants. The main outcomes of the study were gestational age in weeks and subcategories of preterm birth ( |
| doi_str_mv | 10.1016/j.envres.2022.113586 |
| format | Article |
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We included 560,615 singleton live births between 2014 and 2019, identified in the Swedish Pregnancy Register. We estimated weekly mean temperatures at 1-km2 spatial resolution using a spatiotemporal machine learning methodology, and assigned them at the residential addresses of the study participants. The main outcomes of the study were gestational age in weeks and subcategories of preterm birth (<37 weeks): extremely preterm birth (<28 weeks), very preterm birth (from week 28 to <32), and moderately preterm birth (from week 32 to<37). Case-crossover, quantile regression and time-to-event analyses were applied to estimate the effects of short-term exposure to increased ambient temperature during the week before birth on preterm births. Furthermore, distributed lag nonlinear models (DLNM) were applied to identify susceptibility windows of exposures throughout pregnancy in relation to preterm birth.
A total of 1924 births were extremely preterm (0.4%), 2636 very preterm (0.5%), and 23,664 moderately preterm (4.2%). Consistent across all three analytical approaches (case-crossover, quantile regression and time-to-event analyses), higher ambient temperature (95th vs 50th percentile) demonstrated increased risk of extremely preterm birth, but associations did not reach statistical significance. In DLNM models, we observed no evidence to suggest an increased effect of high temperature on preterm birth risk. Even so, a suggested trend was observed in both the quantile regression and time-to-event analyses of a higher risk of extremely preterm birth with higher temperature during the last week before birth.
In Sweden, with high quality data on exposure and outcome, a temperate climate and good quality ante-natal health care, we did not find an association between high ambient temperatures and preterm births. Results were consistent across three complementary analytical approaches.
•Comprehensive nation-wide pregnancy registry and spatiotemporal temperature model.•Comparison between case-crossover, quantile regression and time-to-event analyses.•Short-term exposure to ambient temperature was not associated with preterm births.•Non-significant associations between high temperature and extremely preterm births.•Consistent results across the three complementary analytical approaches.</description><identifier>ISSN: 0013-9351</identifier><identifier>ISSN: 1096-0953</identifier><identifier>EISSN: 1096-0953</identifier><identifier>DOI: 10.1016/j.envres.2022.113586</identifier><identifier>PMID: 35671796</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Ambient air temperature ; Case-crossover ; Climate change ; Medicin och hälsovetenskap ; Preterm births ; Quantile regression ; Time-to-event analyses</subject><ispartof>Environmental research, 2022-10, Vol.213, p.113586, Article 113586</ispartof><rights>2022 The Authors</rights><rights>Copyright © 2022. Published by Elsevier Inc.</rights><rights>info:eu-repo/semantics/openAccess</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c487t-d056ed5107c1a7c3815c6a3214c259af7da96ccde64d0b67fff7a837c010713a3</citedby><cites>FETCH-LOGICAL-c487t-d056ed5107c1a7c3815c6a3214c259af7da96ccde64d0b67fff7a837c010713a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.envres.2022.113586$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,315,554,782,786,887,3554,26576,27933,27934,46004</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35671796$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:150165867$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>de Bont, Jeroen</creatorcontrib><creatorcontrib>Stafoggia, Massimo</creatorcontrib><creatorcontrib>Nakstad, Britt</creatorcontrib><creatorcontrib>Hajat, Shakoor</creatorcontrib><creatorcontrib>Kovats, Sari</creatorcontrib><creatorcontrib>Part, Chérie</creatorcontrib><creatorcontrib>Chersich, Matthew</creatorcontrib><creatorcontrib>Luchters, Stanley</creatorcontrib><creatorcontrib>Filippi, Veronique</creatorcontrib><creatorcontrib>Stephansson, Olof</creatorcontrib><creatorcontrib>Ljungman, Petter</creatorcontrib><creatorcontrib>Roos, Nathalie</creatorcontrib><title>Associations between ambient temperature and risk of preterm birth in Sweden: A comparison of analytical approaches</title><title>Environmental research</title><addtitle>Environ Res</addtitle><description>Evidence indicates that high temperatures are a risk factor for preterm birth. Increasing heat exposures due to climate change are therefore a concern for pregnant women. However, the large heterogeneity of study designs and statistical methods across previous studies complicate interpretation and comparisons. We investigated associations of short-term exposure to high ambient temperature with preterm birth in Sweden, applying three complementary analytical approaches.
We included 560,615 singleton live births between 2014 and 2019, identified in the Swedish Pregnancy Register. We estimated weekly mean temperatures at 1-km2 spatial resolution using a spatiotemporal machine learning methodology, and assigned them at the residential addresses of the study participants. The main outcomes of the study were gestational age in weeks and subcategories of preterm birth (<37 weeks): extremely preterm birth (<28 weeks), very preterm birth (from week 28 to <32), and moderately preterm birth (from week 32 to<37). Case-crossover, quantile regression and time-to-event analyses were applied to estimate the effects of short-term exposure to increased ambient temperature during the week before birth on preterm births. Furthermore, distributed lag nonlinear models (DLNM) were applied to identify susceptibility windows of exposures throughout pregnancy in relation to preterm birth.
A total of 1924 births were extremely preterm (0.4%), 2636 very preterm (0.5%), and 23,664 moderately preterm (4.2%). Consistent across all three analytical approaches (case-crossover, quantile regression and time-to-event analyses), higher ambient temperature (95th vs 50th percentile) demonstrated increased risk of extremely preterm birth, but associations did not reach statistical significance. In DLNM models, we observed no evidence to suggest an increased effect of high temperature on preterm birth risk. Even so, a suggested trend was observed in both the quantile regression and time-to-event analyses of a higher risk of extremely preterm birth with higher temperature during the last week before birth.
In Sweden, with high quality data on exposure and outcome, a temperate climate and good quality ante-natal health care, we did not find an association between high ambient temperatures and preterm births. Results were consistent across three complementary analytical approaches.
•Comprehensive nation-wide pregnancy registry and spatiotemporal temperature model.•Comparison between case-crossover, quantile regression and time-to-event analyses.•Short-term exposure to ambient temperature was not associated with preterm births.•Non-significant associations between high temperature and extremely preterm births.•Consistent results across the three complementary analytical approaches.</description><subject>Ambient air temperature</subject><subject>Case-crossover</subject><subject>Climate change</subject><subject>Medicin och hälsovetenskap</subject><subject>Preterm births</subject><subject>Quantile regression</subject><subject>Time-to-event analyses</subject><issn>0013-9351</issn><issn>1096-0953</issn><issn>1096-0953</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>3HK</sourceid><sourceid>D8T</sourceid><recordid>eNp9kV1vFCEUhonR2LX6D4zyB2aFYYAZL0w2jV9JEy_Ua3IGzqRsd2ACtJv-e9lMt17pFR95nnPgvIS85WzLGVcf9lsM9wnztmVtu-VcyF49IxvOBtWwQYrnZMMYF80gJL8gr3Le1yOXgr0kF0IqzfWgNiTvco7WQ_ExZDpiOSIGCvPoMRRacF4wQblLSCE4mny-pXGiS8KCaaajT-WG-kB_HtFh-Eh31MZ5gcrFcAIhwOGheAsHCsuSItgbzK_JiwkOGd88rpfk95fPv66-Ndc_vn6_2l03tut1aRyTCp3kTFsO2oqeS6tAtLyzrRxg0g4GZa1D1Tk2Kj1Nk4ZeaMuqwgWIS9KsdfMRl7vRLMnPkB5MBG8er27rDk0n277nlR_-yde3u7_SWeSyJlHnrqv7fnVt_XvxwYSYwHDWy9YMWqu2Et2ZiDknnJ7qc2ZOiZq9WRM1p0TNmmjV3q1a7Tyje5LOEVbg0wpgHeW9x2SyreFZdD6hLcZF__8OfwB1LLYx</recordid><startdate>20221001</startdate><enddate>20221001</enddate><creator>de Bont, Jeroen</creator><creator>Stafoggia, Massimo</creator><creator>Nakstad, Britt</creator><creator>Hajat, Shakoor</creator><creator>Kovats, Sari</creator><creator>Part, Chérie</creator><creator>Chersich, Matthew</creator><creator>Luchters, Stanley</creator><creator>Filippi, Veronique</creator><creator>Stephansson, Olof</creator><creator>Ljungman, Petter</creator><creator>Roos, Nathalie</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3HK</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope></search><sort><creationdate>20221001</creationdate><title>Associations between ambient temperature and risk of preterm birth in Sweden: A comparison of analytical approaches</title><author>de Bont, Jeroen ; Stafoggia, Massimo ; Nakstad, Britt ; Hajat, Shakoor ; Kovats, Sari ; Part, Chérie ; Chersich, Matthew ; Luchters, Stanley ; Filippi, Veronique ; Stephansson, Olof ; Ljungman, Petter ; Roos, Nathalie</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c487t-d056ed5107c1a7c3815c6a3214c259af7da96ccde64d0b67fff7a837c010713a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Ambient air temperature</topic><topic>Case-crossover</topic><topic>Climate change</topic><topic>Medicin och hälsovetenskap</topic><topic>Preterm births</topic><topic>Quantile regression</topic><topic>Time-to-event analyses</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>de Bont, Jeroen</creatorcontrib><creatorcontrib>Stafoggia, Massimo</creatorcontrib><creatorcontrib>Nakstad, Britt</creatorcontrib><creatorcontrib>Hajat, Shakoor</creatorcontrib><creatorcontrib>Kovats, Sari</creatorcontrib><creatorcontrib>Part, Chérie</creatorcontrib><creatorcontrib>Chersich, Matthew</creatorcontrib><creatorcontrib>Luchters, Stanley</creatorcontrib><creatorcontrib>Filippi, Veronique</creatorcontrib><creatorcontrib>Stephansson, Olof</creatorcontrib><creatorcontrib>Ljungman, Petter</creatorcontrib><creatorcontrib>Roos, Nathalie</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>NORA - Norwegian Open Research Archives</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>Environmental research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>de Bont, Jeroen</au><au>Stafoggia, Massimo</au><au>Nakstad, Britt</au><au>Hajat, Shakoor</au><au>Kovats, Sari</au><au>Part, Chérie</au><au>Chersich, Matthew</au><au>Luchters, Stanley</au><au>Filippi, Veronique</au><au>Stephansson, Olof</au><au>Ljungman, Petter</au><au>Roos, Nathalie</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Associations between ambient temperature and risk of preterm birth in Sweden: A comparison of analytical approaches</atitle><jtitle>Environmental research</jtitle><addtitle>Environ Res</addtitle><date>2022-10-01</date><risdate>2022</risdate><volume>213</volume><spage>113586</spage><pages>113586-</pages><artnum>113586</artnum><issn>0013-9351</issn><issn>1096-0953</issn><eissn>1096-0953</eissn><abstract>Evidence indicates that high temperatures are a risk factor for preterm birth. Increasing heat exposures due to climate change are therefore a concern for pregnant women. However, the large heterogeneity of study designs and statistical methods across previous studies complicate interpretation and comparisons. We investigated associations of short-term exposure to high ambient temperature with preterm birth in Sweden, applying three complementary analytical approaches.
We included 560,615 singleton live births between 2014 and 2019, identified in the Swedish Pregnancy Register. We estimated weekly mean temperatures at 1-km2 spatial resolution using a spatiotemporal machine learning methodology, and assigned them at the residential addresses of the study participants. The main outcomes of the study were gestational age in weeks and subcategories of preterm birth (<37 weeks): extremely preterm birth (<28 weeks), very preterm birth (from week 28 to <32), and moderately preterm birth (from week 32 to<37). Case-crossover, quantile regression and time-to-event analyses were applied to estimate the effects of short-term exposure to increased ambient temperature during the week before birth on preterm births. Furthermore, distributed lag nonlinear models (DLNM) were applied to identify susceptibility windows of exposures throughout pregnancy in relation to preterm birth.
A total of 1924 births were extremely preterm (0.4%), 2636 very preterm (0.5%), and 23,664 moderately preterm (4.2%). Consistent across all three analytical approaches (case-crossover, quantile regression and time-to-event analyses), higher ambient temperature (95th vs 50th percentile) demonstrated increased risk of extremely preterm birth, but associations did not reach statistical significance. In DLNM models, we observed no evidence to suggest an increased effect of high temperature on preterm birth risk. Even so, a suggested trend was observed in both the quantile regression and time-to-event analyses of a higher risk of extremely preterm birth with higher temperature during the last week before birth.
In Sweden, with high quality data on exposure and outcome, a temperate climate and good quality ante-natal health care, we did not find an association between high ambient temperatures and preterm births. Results were consistent across three complementary analytical approaches.
•Comprehensive nation-wide pregnancy registry and spatiotemporal temperature model.•Comparison between case-crossover, quantile regression and time-to-event analyses.•Short-term exposure to ambient temperature was not associated with preterm births.•Non-significant associations between high temperature and extremely preterm births.•Consistent results across the three complementary analytical approaches.</abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>35671796</pmid><doi>10.1016/j.envres.2022.113586</doi><oa>free_for_read</oa></addata></record> |
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| source | NORA - Norwegian Open Research Archives; Access via ScienceDirect (Elsevier); SWEPUB Freely available online |
| subjects | Ambient air temperature Case-crossover Climate change Medicin och hälsovetenskap Preterm births Quantile regression Time-to-event analyses |
| title | Associations between ambient temperature and risk of preterm birth in Sweden: A comparison of analytical approaches |
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