Abstract
Extremely preterm births (EPT), require complex decision making and significant medical interventions. While environmental factors such as ambient temperature extremes have been associated with preterm births, little is known of the environmental associations with EPT births. The objective of this study is to explore whether ambient temperature is associated with increased risk of EPT birth. Birth records for 315,226 infants born in Queensland Australia (2007-2015) were matched to average maximum and minimum temperature for the last month of pregnancy. Odds ratios and 95% confidence intervals were calculated using a generalised linear model. Population attributable risk was calculated for a 5% reduction in maximum temperature. Each one degree increase in maximum [aOR 1.03 (95% CI 1.01, 1.05)] and minimum temperature [aOR 1.02 (95% CI 1.01, 1.04)] was associated with an increase in odds for EPT birth. Increased odds for EPT births was found for maternal smoking [aOR 1.46 (95% CI 1.23, 1.72)], increasing plurality [OR 6.38 (95% CI 5.48, 7.42)] and stillbirth [aOR 342.99 (95% CI 295.53, 398.06)]. When stratified by birth status, the association was only found for live births. Higher temperatures are associated with small increases in the odds of delivering an infant in the EPT period. The risk may be enhanced for women who smoke during pregnancy. Women at an increased risk of preterm births should be counselled around methods to reduce their exposure to excessive heat.
Highlights
Preterm births (EPT), require complex decision making and significant medical interventions
Small increases in the median, maximum and minimum temperature were seen for the last month of pregnancy in the Extremely preterm births (EPT) group, compared with the infants born after 26 weeks (Fig. 1)
In unadjusted analysis each increase of one degree of ambient temperature for both maximum temperature and minimum temperatures were associated with an increase in odds for delivering an EPT infant
Summary
Preterm births (EPT), require complex decision making and significant medical interventions. Discussion Higher temperatures are associated with small increases in the odds of delivering an infant in the EPT period. Recent studies have shown an improvement in both survival rates, and survival without morbidity (Bolisetty et al, 2015; Costeloe et al, 2012; Ding et al, 2018; Ishii et al, 2013; Moore et al, 2013; Rysavy et al, 2015; Stoll et al, 2010; Younge et al, 2017) Births at such extreme prematurity require complex decisions around whether to begin medical interventions or move to palliative care (Raju et al, 2014). The same study found a range of socioeconomic variables, such as lower maternal education and a lack of medical insurance, as being associated with higher odds for EPT births (both live and stillborn)
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