Health disparities in the impact of prenatal temperature exposure on birth outcomes: A nationwide population-based study in the Netherlands

OBJECTIVE: This study aimed to investigate the impact of prenatal temperature exposure on birth outcomes and related health disparities across socioeconomic status (SES) levels.

STUDY DESIGN: Retrospective study, based on birth registry national data comprising the years 2003-2017.

METHODS: Data on singleton births from the Dutch perinatal registry (N = 2,472,352) were analysed. We measured exposure as the number of days during gestation when mean ambient temperature fell into specific, mutually exclusive bins, using the 8-12 °C range as a reference. A robust method based on a temperature-bin regression model was employed to capitalize on the unpredictability of daily temperature fluctuations, assessing the impact on birth outcomes while accounting for seasonal and other underlying trends. This method also enabled an exploration of effect heterogeneity across variables such as household income, neighbourhood SES, and maternal education levels.

RESULTS: In-utero exposure to an additional hot day (with a mean temperature exceeding 20 °C), relative to the reference range, led to increased odds of low birth weight (LBW) (OR [95 % CI] = 1.007 [1.005, 1.009]), small for gestational age (SGA) (OR [95 % CI] = 1.004 [1.003, 1.005]), and preterm birth (PTB) (OR [95 % CI] = 1.006 [1.005, 1.007]). Exposure during the second trimester to an additional cold day led to increased odds of LBW and PTB. The observed impact was the most detrimental for births in low-SES households.

CONCLUSIONS: Prenatal exposure to extreme temperatures has a detrimental impact on birth outcomes in the Netherlands. Projected increases in extreme temperatures may further exacerbate health inequalities in early life. These findings underscore the need for targeted public health policy strategies such as heat-health guidance during pregnancy to protect vulnerable populations.