热暴露对孕产妇、胎儿和新生儿健康影响的系统回顾和荟萃分析

Darshnika P. Lakhoo, Nicholas Brink, Lebohang Radebe, Marlies H. Craig, Minh Duc Pham, Marjan M. Haghighi, Amy Wise, Ijeoma Solarin, Stanley Luchters, Gloria Maimela, Matthew F. Chersich
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摘要

气候变化会对健康产生严重而广泛的影响,尤其是对弱势群体。尽管有越来越多的证据表明,高温会对孕产妇和新生儿的健康造成不利影响,但目前仍缺乏量化相关性和确定特定风险期的综述。我们系统回顾了有关高温对孕产妇、胎儿和新生儿健康影响的文献,并通过荟萃分析对影响进行了量化。我们发现了 198 项研究,涉及 66 个国家,主要是高收入国家(63.3%)和温度气候带国家(40.1%),以及 23 种结果。结果显示,热暴露温度每升高 1°C,早产几率增加 1.04(95%CI = 1.03,1.06;n = 12),热浪期间增加 1.26(95%CI = 1.08,1.47;n = 10)。同样,高温也会增加死胎(OR = 1.13 (95%CI = 0.95, 1.34; n = 9))、先天性畸形(OR = 1.48 (95%CI = 1.16, 1.88; n = 6))和妊娠糖尿病(OR = 1.28 (95%CI = 1.05, 1.74; n = 4))的风险。任何产科并发症的几率在热浪期间增加了 1.25(95%CI = 1.09,1.42;n = 11)。易感窗口的模式因条件而异。研究结果受到暴露指标和研究设计异质性的限制。该系统综述表明,不断升级的热暴露对孕产妇和新生儿健康构成重大威胁,突出了研究重点,为选择和监测热健康指标提供了指导,并强调了在国家气候健康计划中优先考虑孕产妇和新生儿健康的必要性。
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A systematic review and meta-analysis of heat exposure impacts on maternal, fetal and neonatal health

Climate Change has severe and wide-ranging health impacts, especially for vulnerable groups. Despite growing evidence of heat-associated adverse maternal and neonatal health outcomes, there remains a lack of synthesis quantifying associations and identifying specific risk periods. We systematically reviewed the literature on heat impacts on maternal, fetal, and neonatal health, and quantified impacts through meta-analyses. We found 198 studies across66 countries, predominantly high income (63.3%) and temperature climate zones (40.1%), and 23 outcomes. Results showed increased odds of preterm birth of 1.04 (95%CI = 1.03, 1.06; n = 12) per 1°C increase in heat exposure and 1.26 (95%CI = 1.08, 1.47; n = 10) during heatwaves. Similarly high heat exposure increased the risk for stillbirths (OR = 1.13 (95%CI=0.95, 1.34; n = 9)), congenital anomalies (OR=1.48 (95%CI = 1.16, 1.88; n = 6)), and gestational diabetes mellitus (OR = 1.28 (95%CI = 1.05, 1.74; n = 4)). The odds of any obstetric complication increased by 1.25 (95%CI = 1.09, 1.42; n = 11) during heatwaves. Patterns in susceptibility windows varied by condition. The findings were limited by heterogeneity in exposure metrics and study designs. The systematic review demonstrated that escalating heat exposure poses a major threat to maternal and neonatal health, highlighting research priorities, guiding the selection and monitoring of heat-health indicators, and emphasising the need to prioritise maternal and neonatal health in national climate-health programmes.

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