Maternal acute thermophysiological stress and stillbirth in Western Australia, 2000–2015: A space-time-stratified case-crossover analysis

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dc.contributor.authorNyadanu, S.D.
dc.contributor.authorTessema, G.A.
dc.contributor.authorMullins, B.
dc.contributor.authorPereira, G.
dc.date.issued2022
dc.description.abstractBackground: The extreme thermal environment driven by climate change disrupts thermoregulation in pregnant women and may threaten the survival of the developing fetus. Objectives: To investigate the acute effect of maternal exposure to thermophysiological stress (measured with Universal Thermal Climate Index, UTCI) on the risk of stillbirth and modification of this effect by sociodemographic disparities. Methods: We conducted a space-time-stratified case-crossover analysis of daily UTCI and 2835 singleton stillbirths be- tween 1st January 2000 and 31st December 2015 across multiple small areas in Western Australia. Distributed lag non- linear models were combined with conditional quasi-Poisson regression to investigate the effects of the UTCI exposure from the preceding 6 days to the day of stillbirth. We also explored effect modification by fetal and maternal sociodemographic factors. Results: The median UTCI was 13.9 °C (representing no thermal stress) while the 1st and 99th percentiles were 0.7 °C (slight cold stress) and 31.7 °C (moderate heat stress), respectively. Relative to median UTCI, we found positive associations between acute maternal cold and heat stresses and higher risks of stillbirth, increasing with the intensity and duration of the thermal stress episodes. The cumulative risk from the preceding 6 days to the day of stillbirth was stronger in the 99th percentile (RR = 1.19, 95% CI: 1.17, 1.21) than the 1st percentile (RR = 1.14, 95% CI: 1.12, 1.15), relative to the median UTCI. The risks were disproportionately higher in term and male stillborn fetuses, smoking, un- married, ≤19 years old, non-Caucasian, and low socioeconomic status mothers. Discussion: Acute maternal exposure to both cold and heat stresses may contribute to the risk of stillbirth and be exacerbated by sociodemographic disparities. The findings suggest public health attention, especially for the identified higher-risk groups. Future studies should consider the use of a human thermophysiological index, rather than surrogates such as ambient temperature.
dc.description.statementofresponsibilitySylvester Dodzi Nyadanu, Gizachew Assefa Tessema, Ben Mullins, Gavin Pereira
dc.identifier.citationScience of the Total Environment, 2022; 836:155750-1-155750-11
dc.identifier.doi10.1016/j.scitotenv.2022.155750
dc.identifier.issn0048-9697
dc.identifier.issn1879-1026
dc.identifier.orcidTessema, G.A. [0000-0002-4784-8151]
dc.identifier.urihttps://hdl.handle.net/2440/136386
dc.language.isoen
dc.publisherElsevier BV
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1195716
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1099655
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1173991
dc.rights© 2022 Elsevier B.V. All rights reserved.
dc.source.urihttps://doi.org/10.1016/j.scitotenv.2022.155750
dc.subjectUniversal thermal climate index; Heat stress; Cold stress; Climate change; Temperature; Stillbirth
dc.subject.meshHumans
dc.subject.meshHeat Stress Disorders
dc.subject.meshBody Temperature Regulation
dc.subject.meshPregnancy
dc.subject.meshAdult
dc.subject.meshWestern Australia
dc.subject.meshFemale
dc.subject.meshMale
dc.subject.meshStillbirth
dc.subject.meshCold Temperature
dc.subject.meshYoung Adult
dc.titleMaternal acute thermophysiological stress and stillbirth in Western Australia, 2000–2015: A space-time-stratified case-crossover analysis
dc.typeJournal article
pubs.publication-statusPublished

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