Maternal exposure to Wenchuan earthquake and prolonged risk of offspring birth outcomes: a natural experiment study
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RESEARCH ARTICLE
Open Access
Maternal exposure to Wenchuan earthquake and prolonged risk of offspring birth outcomes: a natural experiment study Qiguo Lian1, Jiaying Ni2, Jun Zhang3, Julian Little4, Shan Luo5 and Lin Zhang6,2*
Abstract Background: The prolonged effects of disasters on reproductive outcomes among the survivors are less studied, and the findings are inconsistent. We examined the associations of maternal exposure to the 2008 Wenchuan earthquake years before conception with adverse birth outcomes. Methods: We included 73,493 women who delivered in 96 hospitals in 24 provinces and autonomous regions from the 2015/16 China Labor and Delivery Survey. We weighted the multivariable logistic models based on the combination of coarsened exact matching (CEM) weight and survey weight, and performed sex-stratified analysis to test whether associations of maternal earthquake exposure with adverse birth outcomes (Stillbirth, preterm birth [PTB], low birthweight [LBW], and small for gestational age [SGA]) varied by sex. Results: The bivariate models showed that the weighted incidence of each adverse birth outcome was higher in exposed group than unexposed group: stillbirth (2.00% vs. 1.33%), PTB (14.14% vs. 7.32%), LBW (10.82% vs. 5.76%), and SGA (11.32% vs. 9.52%). The multivariable models showed maternal earthquake exposure was only associated significantly with a higher risk of PTB in offspring among all births (adjusted risk ratio [aRR](95%CI):1.25(1.06–1.48), P = 0.010). The sex-stratified analysis showed the association was significant among male births (aRR (95%CI): 1.40(1.12–1.75),P = 0.002),but unsignificant among female births. The sensitivity analysis reported similar findings. Conclusions: The 2008 Wenchuan earthquake exposure has a long-term effect on PTB. Maternal acute exposure to disasters could be a major monitor for long-term reproductive outcomes. More attention should be paid to the underlining reasons for disaster-related adverse birth outcomes. Keywords: Wenchuan earthquake, Adverse birth outcomes, Preterm birth
Background Adverse birth outcomes, such as low birthweight (LBW), preterm birth (PTB) and small for gestational age (SGA), are associated with numerous risk factors, including not only maternal characteristics [1, 2] and environmental * Correspondence: [email protected] 6 Obstetrics Department, International peace maternity and child health hospital of China, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Shanghai 200030, China 2 Obstetric and Gynecology Department, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China Full list of author information is available at the end of the article
contaminants [3], but also external stressors [4]. There is growing evidence that maternal exposure to natural or manmade disasters, including major earthquakes, ice storms and terrorist attacks during pregnancy could impact the birth outcomes intensively [5–9]. However, most of the existing studies to date have focused on the women w
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