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      The Association of Season and Temperature with Adverse Pregnancy Outcome in Two German States, a Time-Series Analysis

      research-article
      Author(s): 1 , * , 1
      Editor(s):
      Publication date (Electronic):
      Journal: PLoS ONE
      Publisher: Public Library of Science

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          Abstract

          Background

          A seasonality of low birth weight (LBW) and preterm birth (PTB) has been described for most regions and there is evidence that this pattern is caused by ambient outdoor temperature. However, the association as such, the direction of effect and the critical time of exposure remain controversial.

          Methods

          Logistic, time-series regression was performed on nearly 300,000 births from two German states to study the association between season and daily mean temperature and changes in daily proportions of term LBW (tLBW) or PTB. Analyses were adjusted for time-varying factors. Temperature exposures were examined during different periods of pregnancy.

          Results

          Weak evidence for an association between season of conception, season of birth or ambient outdoor temperature and tLBW or PTB was found. Results of analyses of temperature were not consistent between the two states. Different sources of bias which would have artificially led to stronger findings were detected and are described.

          Conclusions

          No clear evidence for an association between season of conception, season of birth or temperature and tLBW or PTB was found. In the study of pregnancy outcome different sources of bias can be identified which can potentially explain heterogeneous findings of the past.

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          Most cited references80

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          The role of inflammation and infection in preterm birth.

          Roberto Romero, Jimmy Espinoza, Luis F Goncalves … (2007)
          Inflammation has been implicated in the mechanisms responsible for preterm and term parturition, as well as fetal injury. Out of all of the suspected causes of preterm labor and delivery, infection and/or inflammation is the only pathological process for which both a firm causal link with preterm birth has been established and a molecular pathophysiology defined. Inflammation has also been implicated in the mechanism of spontaneous parturition at term. Most cases of histopathological inflammation and histological chorioamnionitis, both in preterm and term labor, are sub-clinical in nature. The isolation of bacteria in the amniotic fluid, known as microbial invasion of the amniotic cavity, is a pathological finding; the frequency of which is dependent upon the clinical presentation and gestational age. This article reviews the role of inflammation in preterm and term parturition.
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            Models for the relationship between ambient temperature and daily mortality.

            Ben G. Armstrong (2006)
            Ambient temperature is an important determinant of daily mortality that is of interest both in its own right and as a confounder of other determinants investigated using time-series regressions, in particular, air pollution. The temperature-mortality relationship is often found to be substantially nonlinear and to persist (but change shape) with increasing lag. We review and extend models for such nonlinear multilag forms. Popular models for mortality by temperature at given lag include polynomial and natural cubic spline curves, and the simple but more easily interpreted linear thresholds model, comprising linear relationships for temperatures below and above thresholds and a flat middle section. Most published analyses that have allowed the relationship to persist over multiple lags have done so by assuming that spline or threshold models apply to mean temperature in several lag strata (e.g., lags 0-1, 2-6, and 7-13). However, more flexible models are possible, and a modeling framework using products of basis functions ("cross-basis" functions) suggests a wide range, some used previously and some new. These allow for stepped or smooth changes in the model coefficients as lags increase. Applying a range of models to data from London suggest evidence for relationships up to at least 2 weeks' lag, with smooth models fitting best but lag-stratified threshold models allowing the most direct interpretation. A wide range of multilag nonlinear temperature-mortality relationships can be modeled. More awareness of options should improve investigation of these relationships and help control for confounding by them.
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              Ambient Air Pollution and Pregnancy Outcomes: A Review of the Literature

              Radim J. Sram, Blanka Binkova, Jan Dejmek (posthumous) … (2005)
              Over the last decade or so, a large number of studies have investigated the possible adverse effects of ambient air pollution on birth outcomes. We reviewed these studies, which were identified by a systematic search of the main scientific databases. Virtually all reviewed studies were population based, with information on exposure to air pollution derived from routine monitoring sources. Overall, there is evidence implicating air pollution in adverse effects on different birth outcomes, but the strength of the evidence differs between outcomes. The evidence is sufficient to infer a causal relationship between particulate air pollution and respiratory deaths in the postneonatal period. For air pollution and birth weight the evidence suggests causality, but further studies are needed to confirm an effect and its size and to clarify the most vulnerable period of pregnancy and the role of different pollutants. For preterm births and intrauterine growth retardation (IUGR) the evidence as yet is insufficient to infer causality, but the available evidence justifies further studies. Molecular epidemiologic studies suggest possible biologic mechanisms for the effect on birth weight, premature birth, and IUGR and support the view that the relation between pollution and these birth outcomes is genuine. For birth defects, the evidence base so far is insufficient to draw conclusions. In terms of exposure to specific pollutants, particulates seem the most important for infant deaths, and the effect on IUGR seems linked to polycyclic aromatic hydrocarbons, but the existing evidence does not allow precise identification of the different pollutants or the timing of exposure that can result in adverse pregnancy outcomes.
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                Author and article information

                Contributors
                : Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2012
                Publication date (Electronic): 6 July 2012
                Volume: 7
                Issue: 7
                Electronic Location Identifier: e40228
                Affiliations
                [1]Department of Social and Environmental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
                University of Montreal, Canada
                Author notes

                Conceived and designed the experiments: JW BA. Analyzed the data: JW. Contributed reagents/materials/analysis tools: JW BA. Wrote the paper: JW. Supervised the data analyses: BA.

                [¤]

                Current address: Department of Public Health and Environment, World Health Organization, Geneva, Switzerland

                Article
                Publisher ID: PONE-D-12-10970
                DOI: 10.1371/journal.pone.0040228
                PMC ID: 3391296
                PubMed ID: 22792247
                SO-VID: c4a3c176-0513-480e-837a-d7ee011597db
                Copyright © Wolf, Armstrong. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                Date received : 3 April 2012
                Date accepted : 3 June 2012
                Page count
                Pages: 8
                Categories
                Subject: Research Article
                Subject: Biology
                Subject: Population Biology
                Subject: Population Metrics
                Subject: Birth Rate
                Subject: Medicine
                Subject: Epidemiology
                Subject: Environmental Epidemiology
                Subject: Non-Clinical Medicine
                Subject: Environmental Health
                Subject: Obstetrics and Gynecology
                Subject: Pregnancy
                Subject: Pregnancy Complications
                Subject: Preterm Labor
                Subject: Pediatrics
                Subject: Growth Retardation
                Subject: Public Health
                Subject: Environmental Health

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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