title: The impact of maternal factors on the association between temperature and preterm delivery.
abstract: Few studies have examined maternal modifiers of temperature and adverse birth outcomes because of lack of data. We assessed the relationship between apparent temperature, preterm delivery (PTD) and maternal demographics, medical and mental health conditions, and behaviors.
  
  
  
  A time-stratified case-crossover analysis was conducted using 14,466 women who had a PTD (20 to less than 37 gestational weeks) from 1995 to 2009 using medical records from a large health maintenance organization in Northern California. Effect modifiers considered by stratification included several maternal factors: age, race/ethnicity, depression, hypertension, diabetes, smoking, alcohol use, pre-pregnancy body mass index, and Medicaid status. Apparent temperature data for women who had a monitor located within 20km of their residential zip codes were included. All analyses were stratified by warm (May 1 through October 31) and cold (November 1 through April 30) seasons.
  
  
  
  For every 10°F (5.6°C) increase in average cumulative weekly apparent temperature (lag06), a greater risk was observed for births occurring during the warm season (11.63%; 95% CI: 4.08, 19.72%) compared to the cold season (6.18%; -2.96, 16.18%), especially for mothers who were younger, Black, Hispanic, underweight, smoked or consumed alcohol during pregnancy, or had pre-existing /gestational hypertension, diabetes, or pre-eclampsia.
  
  
  
  Our findings suggest that warmer apparent temperatures exacerbate the risk of PTD, particularly for subgroups of more vulnerable women.
authors.affiliation: California Office of Environmental Health Hazard Assessment, Air and Climate Epidemiology Section, Oakland, CA, United States. Electronic address: Rupa.Basu@oehha.ca.gov.
authors.forename: Rupa
authors.initials: R
authors.lastname: Basu
authors.affiliation: Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States.
authors.forename: Hong
authors.initials: H
authors.lastname: Chen
authors.affiliation: Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States.
authors.forename: De-Kun
authors.initials: DK
authors.lastname: Li
authors.affiliation: Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States.
authors.forename: Lyndsay A
authors.initials: LA
authors.lastname: Avalos
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D002140:California / Q000453:epidemiology; D018592:Cross-Over Studies; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008423:Maternal Age; D008484:Medicaid; D011225:Pre-Eclampsia / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology; D047928:Premature Birth / Q000453:epidemiology* / Q000209:etiology*; D012621:Seasons; D013696:Temperature; D014481:United States; D014887:Weather; D055815:Young Adult
keywords: California; Case-crossover; Epidemiology; Heat; Preterm birth; Preterm delivery; Temperature