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Giorgis-Allemand L, Pedersen M, Bernard C, Aguilera I, Beelen RMJ, Chatzi L, Cirach M, Danileviciute A, Dedele A, van Eijsden M, Estarlich M, Fernández-Somoano A, Fernández MF, Forastiere F, Gehring U, Grazuleviciene R, Gruzieva O, Heude B, Hoek G, de Hoogh K, van den Hooven EH, Håberg SE, Iñiguez C, Jaddoe VWV, Korek M, Lertxundi A, Lepeule J, Nafstad P, Nystad W, Patelarou E, Porta D, Postma D, Raaschou-Nielsen O, Rudnai P, Siroux V, Sunyer J, Stephanou E, Sørensen M, Eriksen KT, Tuffnell D, Varró MJ, Vrijkotte TGM, Wijga A, Wright J, Nieuwenhuijsen MJ, Pershagen G, Brunekreef B, Kogevinas M, Slama R. The Influence of Meteorological Factors and Atmospheric Pollutants on the Risk of Preterm Birth. Am J Epidemiol 2017; 185:247-258. [PMID: 28087514 DOI: 10.1093/aje/kww141] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 10/20/2016] [Indexed: 12/13/2022] Open
Abstract
Atmospheric pollutants and meteorological conditions are suspected to be causes of preterm birth. We aimed to characterize their possible association with the risk of preterm birth (defined as birth occurring before 37 completed gestational weeks). We pooled individual data from 13 birth cohorts in 11 European countries (71,493 births from the period 1994-2011, European Study of Cohorts for Air Pollution Effects (ESCAPE)). City-specific meteorological data from routine monitors were averaged over time windows spanning from 1 week to the whole pregnancy. Atmospheric pollution measurements (nitrogen oxides and particulate matter) were combined with data from permanent monitors and land-use data into seasonally adjusted land-use regression models. Preterm birth risks associated with air pollution and meteorological factors were estimated using adjusted discrete-time Cox models. The frequency of preterm birth was 5.0%. Preterm birth risk tended to increase with first-trimester average atmospheric pressure (odds ratio per 5-mbar increase = 1.06, 95% confidence interval: 1.01, 1.11), which could not be distinguished from altitude. There was also some evidence of an increase in preterm birth risk with first-trimester average temperature in the -5°C to 15°C range, with a plateau afterwards (spline coding, P = 0.08). No evidence of adverse association with atmospheric pollutants was observed. Our study lends support for an increase in preterm birth risk with atmospheric pressure.
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Affiliation(s)
- Lise Giorgis-Allemand
- Inserm and Univ. Grenoble Alpes, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Grenoble, France
| | - Marie Pedersen
- Department of Cancer and Inflammation Research, Institute of Molecular Medicine, University of Southern Denmark, Odense C, Denmark
| | - Claire Bernard
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Inmaculada Aguilera
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Rob M J Beelen
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD, Utrecht, The Netherlands
- Center for Sustainability, Environment and Health, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Leda Chatzi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Marta Cirach
- Campus MAR, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Asta Danileviciute
- Department of Environmental Science, Vytauto Didziojo Universitetas, K. Donelaicio 58, Kaunas 44248, Lithuania
| | - Audrius Dedele
- Department of Environmental Sciences , Vytautas Magnus University , Kaunas , Lithuania
| | - Manon van Eijsden
- Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands
| | | | - Ana Fernández-Somoano
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Dept of Medicine, University of Oviedo, Asturias, Spain
| | - Mariana F Fernández
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Hospitales Universitarios de Granada, Spain
| | | | - Ulrike Gehring
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Regina Grazuleviciene
- Department of Environmental Sciences , Vytautas Magnus University , Kaunas , Lithuania
| | - Olena Gruzieva
- Department of Environmental Sciences , Vytautas Magnus University , Kaunas , Lithuania
| | - Barbara Heude
- Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences (IRAS), University of Utrecht, Utrecht, The Netherlands
| | - Kees de Hoogh
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Environmental Science, Vytauto Didziojo Universitetas, K. Donelaicio 58, Kaunas 44248, Lithuania
| | - Edith H van den Hooven
- Department of Environmental Sciences , Vytautas Magnus University , Kaunas , Lithuania
- Department of Environmental Sciences , Vytautas Magnus University , Kaunas , Lithuania
- Department of Environmental Sciences , Vytautas Magnus University , Kaunas , Lithuania
| | - Siri E Håberg
- Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands
| | - Carmen Iñiguez
- University of Malaga, Department of Ecology, Faculty of Sciences, Boulevard Louis Pasteur s/n, 29010 Málaga, Spain
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Paediatrics, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michal Korek
- Department of Environmental Sciences , Vytautas Magnus University , Kaunas , Lithuania
| | - Aitana Lertxundi
- Universidad del País Vasco UPV-EUH, Spain; Health Research Institute, Biodonostia, San Sebastián, Spain
| | - Johanna Lepeule
- Université Grenoble Alpes, CNRS UMR 5309, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Grenoble, France
- INSERM U1209, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Grenoble, France
- CHU de Grenoble, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Grenoble, France
| | - Per Nafstad
- Institute of Health and Society, University of Oslo, P.O. Box 1130 Blindern, Oslo, 0318 Norway
| | | | - Evridiki Patelarou
- Department of Adult Nursing, Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Daniela Porta
- Department of Epidemiology, Lazio Regional Health System, Rome, Italy
| | - Dirkje Postma
- Dept of Pulmonary Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center , Copenhagen , Denmark
- Department of Environmental Science , Aarhus University , Roskilde , Denmark
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Peter Rudnai
- National Public Health Center, National Directorate of Environmental Health, 1097 Budapest, Hungary
| | - Valérie Siroux
- Inserm, Institut Albert Bonniot (IAB),Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Grenoble F-38042,France
| | - Jordi Sunyer
- Campus MAR, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Euripides Stephanou
- Environmental Chemical Processes Laboratory (ECPL), Department of Chemistry, University of Crete, 71003, Heraklion, Greece
| | - Mette Sørensen
- Department of Pathology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kirsten Thorup Eriksen
- Diet Genes Environment Unit, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark
| | - Derek Tuffnell
- Bradford Women's and Newborn Unit, Bradford Teaching Hospitals NHS Foundation, Bradford, UK
| | - Mihály J Varró
- Department of Community Health,National Institute of Environmental Health,Hungary
| | - Tanja G M Vrijkotte
- Academic Medical Centre, Amsterdam Public Health research institute, Department of Public Health, Amsterdam, The Netherlands
| | - Alet Wijga
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Hospitales Universitarios de Granada, Spain
| | - John Wright
- Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Dept of Medicine, University of Oviedo, Asturias, Spain
| | - Mark J Nieuwenhuijsen
- Joint Research Unit for Epidemiology and Environmental Health, FISABIO-Universitat de València-Universitat Jaume I, Valencia, Spain
- Joint Research Unit for Epidemiology and Environmental Health, FISABIO-Universitat de València-Universitat Jaume I, Valencia, Spain
| | - Göran Pershagen
- Institute for Risk Assessment Sciences (IRAS), University of Utrecht, Utrecht, The Netherlands
| | - Bert Brunekreef
- Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands
| | - Manolis Kogevinas
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Environmental Science, Vytauto Didziojo Universitetas, K. Donelaicio 58, Kaunas 44248, Lithuania
- Department of Environmental Sciences , Vytautas Magnus University , Kaunas , Lithuania
| | - Rémy Slama
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
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Joy E, Van Baak K, Dec KL, Semakula B, Cardin AD, Lemery J, Wortley GC, Yaron M, Madden C. Wilderness Preparticipation Evaluation and Considerations for Special Populations. Wilderness Environ Med 2015; 26:S76-91. [PMID: 26617382 DOI: 10.1016/j.wem.2015.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Children, older adults, disabled and special needs athletes, and female athletes who participate in outdoor and wilderness sports and activities each face unique risks. For children and adolescents traveling to high altitude, the preparticipation physical evaluation should focus on risk assessment, prevention strategies, early recognition of altitude-related symptoms, management plans, and appropriate follow-up. As the risk and prevalence of chronic disease increases with age, both older patients and providers need to be aware of disease and medication-specific risks relative to wilderness sport and activity participation. Disabled and special needs athletes benefit from careful pre-event planning for the potential medical issues and equipment modifications that may affect their health in wilderness environments. Issues that demand special consideration for female adventurers include pregnancy, contraceptive use, menses, and ferritin levels at altitude. A careful preparticipation evaluation that factors in unique, population- specific risks will help special populations stay healthy and safe on wilderness adventures. The PubMed and SportDiscus databases were searched in 2014 using both MeSH terms and text words and include peer-reviewed English language articles from 1977 to 2014. Additional information was accessed from Web-based sources to produce this narrative review on preparticipation evaluation for special populations undertaking wilderness adventures. Key words include children, adolescent, pediatric, seniors, elderly, disabled, special needs, female, athlete, preparticipiation examination, wilderness medicine, and sports.
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Affiliation(s)
- Elizabeth Joy
- Clinical Outcomes Research, Intermountain Healthcare, Salt Lake City, Utah (Dr Joy).
| | - Karin Van Baak
- Department of Family Medicine, University of Colorado, Denver, Colorado (Dr Van Baak)
| | | | - Barbara Semakula
- Anne Arundel Medical Center, Orthopedic and Sports Medicine Center, Annapolis, Maryland (Dr Semakula)
| | - Ashlea D Cardin
- Missouri State University, Springfield, Missouri (Dr Cardin)
| | - Jay Lemery
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado (Drs Lemery and Yaron)
| | - George C Wortley
- Big Island Family Medicine Center, Lynchburg, Virginia (Dr Wortley)
| | - Michael Yaron
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado (Drs Lemery and Yaron)
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