Ambient biothermal stress, preconceptional thyrotropin abnormalities, and the risk of preterm birth: a nationwide Chinese cohort study

Epidemiologic evidence on thermal stress and preterm birth (PTB) is based on ambient temperature rather than a biothermal metric. Thyrotropin abnormalities have been associated with PTB and may increase thermal vulnerability. However, it remains unknown whether thermal stress and thyrotropin abnormalities synergistically contribute to increased risk of PTB. Here we conducted a nationwide cohort study among 6,218,131 singleton live births in China. Biothermal stress was measured using the Universal Thermal Climate Index. We found that both heat stress and cold stress during each trimester were associated with increased risks of PTB, with hazard ratios ranging from 1.06 (95% confidence interval [CI]: 1.05, 1.07) to 2.33 (95% CI: 2.30, 2.35) and from 1.08 (95% CI: 1.07, 1.09) to 1.68 (95% CI:1.67, 1.70), respectively. Participants with subnormal (<0.37 mIU/L) or supranormal thyrotropin levels (≥4.88 mIU/L) and biothermal stress had higher risks of PTB, compared with those with normal thyrotropin levels and non-thermal stress. Additive interactions were also identified between biothermal stress and thyrotropin abnormalities. We estimated that up to 13.52% of PTB were attributable to biothermal stress and thyrotropin abnormalities. Our study showed a synergistic effect of biothermal stress and preconceptional thyrotropin abnormalities, highlighting the importance of climate adaption measures and thyroid management toward pregnant women under climate change scenario.

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Journal
Nature Communications
Published
2025-10-23
DOI
https://doi.org/10.1038/s41467-025-64410-1
Citations
1
Primary Topic
Neonatal Respiratory Health Research
Type
article
Field-Weighted Citation Impact
1.52

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article

Ambient biothermal stress, preconceptional thyrotropin abnormalities, and the risk of preterm birth: a nationwide Chinese cohort study

Xu Ma, Wei Huang, Xinghou He, Yuan Yuan Wang et al.
1 citations
Nature Communications
Neonatal Respiratory Health Research
1.52
article

Ambient biothermal stress, preconceptional thyrotropin abnormalities, and the risk of preterm birth: a nationwide Chinese cohort study

Xu Ma, Wei Huang, Xinghou He, Yuan Yuan Wang, Huiying Xu, Xuyang Shan, Yan Fang, Xiaoming Song, Ying Yang, Chuanyu Zhao, Bin Zhang, Mengyao Li, Hongguang Zhang, Long Wang, Ya Zhang, Xinyi Lv, Hongbing Xu, Jihong Xu, Yuan He
article en
1 citations

Abstract

Epidemiologic evidence on thermal stress and preterm birth (PTB) is based on ambient temperature rather than a biothermal metric. Thyrotropin abnormalities have been associated with PTB and may increase thermal vulnerability. However, it remains unknown whether thermal stress and thyrotropin abnormalities synergistically contribute to increased risk of PTB. Here we conducted a nationwide cohort study among 6,218,131 singleton live births in China. Biothermal stress was measured using the Universal Thermal Climate Index. We found that both heat stress and cold stress during each trimester were associated with increased risks of PTB, with hazard ratios ranging from 1.06 (95% confidence interval [CI]: 1.05, 1.07) to 2.33 (95% CI: 2.30, 2.35) and from 1.08 (95% CI: 1.07, 1.09) to 1.68 (95% CI:1.67, 1.70), respectively. Participants with subnormal (<0.37 mIU/L) or supranormal thyrotropin levels (≥4.88 mIU/L) and biothermal stress had higher risks of PTB, compared with those with normal thyrotropin levels and non-thermal stress. Additive interactions were also identified between biothermal stress and thyrotropin abnormalities. We estimated that up to 13.52% of PTB were attributable to biothermal stress and thyrotropin abnormalities. Our study showed a synergistic effect of biothermal stress and preconceptional thyrotropin abnormalities, highlighting the importance of climate adaption measures and thyroid management toward pregnant women under climate change scenario.

Nature CommunicationsVol. 16(1)
Chinese Academy of Medical Sciences & Peking Union Medical College (CN), Peking University (CN), Peking Union Medical College Hospital (CN), Chinese National Human Genome Center (CN), Genetic Resources Center (JP), China National Petroleum and Chemical Planning Institute (CN), Tianjin Municipal Research Institute for Family Planning (CN), George Institute for Global Health (CN), Lanzhou University (CN)
National Natural Science Foundation of China, National Key Research and Development Program of China
Openalex Percentile: Top 13%
Neonatal Respiratory Health Research
1.52
DOIOpen Access PDFOpenAlex
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