Short-term ambient heat exposure and low APGAR score in newborns: A time-stratified case-crossover analysis in São Paulo state, Brazil (2013–2019)

Michelle Del Carretto, Audrey Godin, Danielson Neves, Enny S Paixão, Kai Wan, Julia Pescarini, Andrêa Ferreira, Taísa R Cortes, Liam Smeeth, Maurício L Barreto, Elizabeth B Brickley and Chérie Part

PLOS Global Public Health, 2025, vol. 5, issue 9, 1-16

Abstract: Exposure to high ambient temperatures near the time of delivery has been associated with adverse birth outcomes, but studies examining the impact on immediate newborn health remain limited. We used a time-stratified case-crossover design combined with a distributed lag nonlinear model to evaluate the short-term effects of ambient heat (0–1 day lag) on low 5-minute APGAR score (≤7; sub-categories: 6–7, 3–5, 0–2). Cases of low APGAR score among low-risk births (n = 34,980) in São Paulo state (274 municipalities), 2013–2019, were extracted from Brazil’s Live Birth Information System (Sistema de Informações Sobre Nascidos Vivos). Municipality-level daily mean temperatures were constructed from ERA5-Land reanalysis data and linked with case and control days by date and municipality of delivery. Models were adjusted for relative humidity and stratified by maternal age, race/ethnicity, education, parity, timing of prenatal care initiation, infant sex, municipality-level deprivation, and Köppen climate zone. Overall, exposure to high (95th percentile: 26.1°C) versus moderate (50th percentile: 20.9°C) temperature 0–1 days before delivery was associated with 8% higher odds (OR: 1.08, 95% CI: 1.02-1.14) of low APGAR score (≤7). In stratified analyses, heat-associated risks were elevated among infants born to women with

Date: 2025
References: Add references at CitEc
Citations:

Downloads: (external link)
https://journals.plos.org/globalpublichealth/artic ... journal.pgph.0004557 (text/html)
https://journals.plos.org/globalpublichealth/artic ... 04557&type=printable (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:plo:pgph00:0004557

DOI: 10.1371/journal.pgph.0004557

Access Statistics for this article

More articles in PLOS Global Public Health from Public Library of Science
Bibliographic data for series maintained by globalpubhealth ().