The role of extreme heat exposure on premature rupture of membranes in Southern California: A study from a large pregnancy cohort

Anqi Jiao; Yi Sun; David A. Sacks; Chantal Avila; Vicki Chiu; John Molitor; Jiu-Chiuan Chen; Kelly T Sanders; John T Abatzoglou; Jeff Slezak; Tarik Benmarhnia; Darios Getahun; Jun Wu

Environment International (Mar 2023)

The role of extreme heat exposure on premature rupture of membranes in Southern California: A study from a large pregnancy cohort

Anqi Jiao,
Yi Sun,
David A. Sacks,
Chantal Avila,
Vicki Chiu,
John Molitor,
Jiu-Chiuan Chen,
Kelly T Sanders,
John T Abatzoglou,
Jeff Slezak,
Tarik Benmarhnia,
Darios Getahun,
Jun Wu

Affiliations

Anqi Jiao: Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA
Yi Sun: Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA; Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
David A. Sacks: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
Chantal Avila: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
Vicki Chiu: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
John Molitor: College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA
Jiu-Chiuan Chen: Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90033, USA
Kelly T Sanders: Department of Civil and Environmental Engineering, University of Southern California, CA, USA
John T Abatzoglou: School of Engineering, University of California, Merced, USA
Jeff Slezak: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
Tarik Benmarhnia: Scripps Institution of Oceanography, University of California, San Diego, 9500 Gilman Drive #0725, CA La Jolla 92093, USA
Darios Getahun: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA; Corresponding authors at: 100 S. Los Robles Avenue 2nd Floor, Pasadena, CA 91101, USA.
Jun Wu: Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA; Corresponding authors at: 856 Health Sciences Rd (Quad), Suite 3200, Irvine, CA 92697-1830, USA.

Journal volume & issue: Vol. 173
p. 107824

Abstract

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Background: Significant mortality and morbidity in pregnant women and their offspring are linked to premature rupture of membranes (PROM). Epidemiological evidence for heat-related PROM risk is extremely limited. We investigated associations between acute heatwave exposure and spontaneous PROM. Methods: We conducted this retrospective cohort study among mothers in Kaiser Permanente Southern California who experienced membrane ruptures during the warm season (May-September) from 2008 to 2018. Twelve definitions of heatwaves with different cut-off percentiles (75th, 90th, 95th, and 98th) and durations (≥ 2, 3, and 4 consecutive days) were developed using the daily maximum heat index, which incorporates both daily maximum temperature and minimum relative humidity in the last gestational week. Cox proportional hazards models were fitted separately for spontaneous PROM, term PROM (TPROM), and preterm PROM (PPROM) with zip codes as the random effect and gestational week as the temporal unit. Effect modification by air pollution (i.e., PM2.5 and NO2), climate adaptation measures (i.e., green space and air conditioning [AC] penetration), sociodemographic factors, and smoking behavior was examined. Results: In total, we included 190,767 subjects with 16,490 (8.6%) spontaneous PROMs. We identified a 9–14% increase in PROM risks associated with less intense heatwaves. Similar patterns as PROM were found for TPROM and PPROM. The heat-related PROM risks were greater among mothers exposed to a higher level of PM2.5 during pregnancy, under 25 years old, with lower education and household income level, and who smoked. Even though climate adaptation factors were not statistically significant effect modifiers, mothers living with lower green space or lower AC penetration were at consistently higher heat-related PROM risks compared to their counterparts. Conclusion: Using a rich and high-quality clinical database, we detected harmful heat exposure for spontaneous PROM in preterm and term deliveries. Some subgroups with specific characteristics were more susceptible to heat-related PROM risk.

Published in Environment International

ISSN: 0160-4120 (Print)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Geography. Anthropology. Recreation: Environmental sciences
Website: https://www.journals.elsevier.com/environment-international

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