The Lancet regional health. Western Pacific · 2026
Temporal trends in late-pregnancy exposure to ambient temperature and risk of preterm birth in Japan, a nationwide study from 1979 to 2023.
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Cao Alton Quan, Yuan Lei, Ith Sophearen, Tomo Yui, Ng Chris Fook Sheng, Yoneoka Daisuke, Hashizume Masahiro
Аннотация
BACKGROUND: Evidence linking heat exposure with preterm birth (PTB) has grown amid climate change. However, evidence remains limited across the temperature spectrum or temporal changes of susceptibility.
METHODS: To assess the temporal and spatial variation in the short-term association between ambient temperature and PTB in Japan from 1979 to 2023, we applied a two-stage design using a time-stratified case-crossover and conditional Poisson model incorporating a 28-day distributed lag non-linear model. Prefecture-specific estimates were pooled using random-effects meta-analysis. To explore temporal changes in susceptibility, the data were split into four decadal subperiods, and mixed-effects meta-regression examined prefecture-level predictors of changing risk.
FINDINGS: Between 1979 and 2023, 2,604,733 singleton PTBs (4.9% of 52,749,360 live births) occurred. Compared to the minimum morbidity temperature, 17.7 °C (56th percentile), relative risks (RRs) were 1.13 [95% CI: 1.10-1.15] for heat (99th percentile) and 1.11 [95% CI: 1.09-1.14] for cold (1st percentile). Nationally, 4.7% [4.3-5.0%] of PTBs (102,266 cases) were attributable to non-optimal temperatures (1.9% heat; 2.8% cold). Heat-related RR declined from 1.16 [1.12-1.21] in 1979-1989 to 1.07 [1.03-1.12; p: 0.0084] in 2001-2011 and then plateaued, while cold-related risk remained stable. Air conditioning prevalence was positively associated with MMT across periods.
INTERPRETATION: Over four decades, Japan experienced modest early declines in heat-related risk, with no further improvement in recent decades, alongside persistent cold-related PTB risk, suggesting limited heat adaptation. Pregnant women remain underrepresented in climate adaptation planning, underscoring the need for gender-inclusive resilience strategies.
FUNDING: Japan's Environmental Restoration and Conservation Agency.
METHODS: To assess the temporal and spatial variation in the short-term association between ambient temperature and PTB in Japan from 1979 to 2023, we applied a two-stage design using a time-stratified case-crossover and conditional Poisson model incorporating a 28-day distributed lag non-linear model. Prefecture-specific estimates were pooled using random-effects meta-analysis. To explore temporal changes in susceptibility, the data were split into four decadal subperiods, and mixed-effects meta-regression examined prefecture-level predictors of changing risk.
FINDINGS: Between 1979 and 2023, 2,604,733 singleton PTBs (4.9% of 52,749,360 live births) occurred. Compared to the minimum morbidity temperature, 17.7 °C (56th percentile), relative risks (RRs) were 1.13 [95% CI: 1.10-1.15] for heat (99th percentile) and 1.11 [95% CI: 1.09-1.14] for cold (1st percentile). Nationally, 4.7% [4.3-5.0%] of PTBs (102,266 cases) were attributable to non-optimal temperatures (1.9% heat; 2.8% cold). Heat-related RR declined from 1.16 [1.12-1.21] in 1979-1989 to 1.07 [1.03-1.12; p: 0.0084] in 2001-2011 and then plateaued, while cold-related risk remained stable. Air conditioning prevalence was positively associated with MMT across periods.
INTERPRETATION: Over four decades, Japan experienced modest early declines in heat-related risk, with no further improvement in recent decades, alongside persistent cold-related PTB risk, suggesting limited heat adaptation. Pregnant women remain underrepresented in climate adaptation planning, underscoring the need for gender-inclusive resilience strategies.
FUNDING: Japan's Environmental Restoration and Conservation Agency.