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ItemThe association of maternal exposure to ambient temperature with low birth weight in term pregnancies varies by location: in Brazil, positive associations may occur only in the Amazon region(Elsevier, 2022) Réquia Júnior, Weeberb João; Koutrakis, Petros; Papatheodorou, StefaniaExposure to ambient temperature has been linked to adverse birth outcomes in several regions, including the USA, Australia, China, countries in the Middle East, and European countries. To date, no studies were performed in South America, a region with serious challenges related to climate change. Our investigation addresses this literature lack by examining the association between Low Birth Weight (LBW) and ambient temperature exposure in the largest county in South America, Brazil. We applied a nationwide case-control study design using a logistic regression model to estimate the odds ratio (OR) for LBW associated with ambient temperature during a specific trimester of pregnancy (1–3 trimester). Our sample size includes 5,790,713 birth records nationwide over 18 years (2001–2018), of which 264,967 infants were included in the model as cases of LBW, representing 4.6% of our total sample. We adjusted our model for several confounding variables, including weather factors, air pollution, seasonality, and SES variables at the individual level. Our findings indicate that North was the only region with positive and statistically significant associations in the primary analysis and most of the sensitivity analysis, which is the region where the Amazon is located. In this region, we estimated an increase of 5.16% (95%CI: 3.60; 6.74) in the odds of LBW per 1 ◦C increase in apparent temperature when the exposure occurred in the second trimester. Our results may be explained by the climate conditions in the Amazon region in the past years. A large body of literature indicates that the Amazon region has been facing serious climate challenges including issues related to policy, governance, and deforestation. Specifically, regarding deforestation, it is suggested that land use change and deforestation is projected to increase heat stress in the Amazon region, because of Amazon savannization, increasing the risk of heat stress exposure in Northern Brazil. Our study can assist public sectors and clinicians in mitigating the risk and vulnerability of the Amazonian population. ItemPrenatal exposure to wildfire-related air pollution and birth defects in Brazil(Springer Nature America,, 2022) Réquia Júnior, Weeberb João; Kill, Erick; Papatheodorou, Stefania; Koutrakis, Petros; Schwartz, Joel D.BBackground Birth defects are a major cause of poor health outcomes during both childhood and adulthood. A growing body of evidence demonstrated associations between air pollution exposure during pregnancy and birth defects. To date, there is no study looking at birth defects and exposure to wildfire-related air pollution, which is suggested as a type of air pollution source with high toxicity for reproductive health. Objective Our study addresses this gap by examining the association between birth defects and wildfire smoke exposure in Brazil between 2001 and 2018. Based on known differences of impacts of wildfires across different regions of Brazil, we hypothesized differences in risks of birth defects for different regions. Methods We used a logistic regression model to estimate the odds ratios (ORs) for individual birth defects (12 categories) associated with wildfire exposure during each trimester of pregnancy. Results Among the 16,825,497 birth records in our study population, there were a total of 7595 infants born in Brazil between 2001 and 2018 with birth defects in any of the selected categories. After adjusting for several confounders in the primary analysis, we found statistically significant OR for three birth defects, including cleft lip/cleft palate [OR: 1.007 (95% CI: 1.001; 1.013)] during the second trimester of exposure, congenital anomalies of the respiratory system [OR: 1.013 (95% CI: 1.002; 1.023)] in the second trimester of exposure, and congenital anomalies of the nervous system [OR: 1.002 (95% CI: 1.001; 1.003)] during the first trimester of exposure for the regions South, North, and Midwest, respectively. Significance Our results suggest that maternal exposure to wildfire smoke during pregnancy may increase the risk of an infant being born with some congenital anomaly. Considering that birth defects are associated with long-term disability, impacting families and the healthcare system (e.g., healthcare costs), our findings should be of great concern to the public health community. Impact statement Our study focused on the association between maternal exposure to wildfire smoke in Brazil during pregnancy and the risk of an infant being born with congenital anomalies, which presents serious public health and environmental challenges. ItemIncreased preterm birth following maternal wildfire smoke exposure in Brazil(Elsevier, 2022) Réquia Júnior, Weeberb João; Papatheodorou, Stefania; Koutrakis, Petros; Mukherjee, Rajarshi; Roig, Henrique L.Preterm birth (PTB) complications are the leading cause of death among children under 5 years of age, responsible for approximately 1 million deaths in 2015, according to the World Health Organization. Those infants born prematurely who survived the first 5 years, studies suggest that these infants are more likely to experience a range of poor health outcomes during childhood and even adulthood. Wildfire smoke has been suggested as a type of air pollution source with high toxicity for reproductive health. In this study, we estimated the association between preterm birth and wildfire periods in Brazil, a country included in the list of the 10 nations with the greatest number of preterm birth and also considered as a very fire-prone region. We applied a time-stratified case-crossover study design using conditional logistic regression models to estimate the odds ratio for preterm birth associated with wildfire-related prenatal PM2.5, during different windows of exposure, including trimesters 1–3. After adjusting for several confounders (other air pollutants, demographics, meteorological variables, and spatiotemporal terms), we found that wildfire smoke exposure during pregnancy may be associated with preterm birth in Brazil. Southeast was the region with the highest increase in the odds of PTB (OR:1.41 (95%CI: 1.31–1.51) when the exposure occurred in the first trimester. In the North, exposure to PM2.5 during wildfire periods in the second trimester of pregnancy was associated with increased odds of PTB (OR:1.05 (95%CI: 1.01–1.09) in preterm birth when the exposure occurred in the second trimester. This study suggests that wildfire smoke exposure during pregnancy may increase the risk for preterm birth in Brazil. This should be of great concern to the public health authorities, obstetricians, and policymakers. ItemBirth weight following pregnancy wildfire smoke exposure in more than 1.5 million newborns in Brazil: a nationwide case-control study(2022) Réquia Júnior, Weeberb João; Amini, Heresh; Adams, Matthew D.; Schwartz, Joel D.Air pollution exposure has been associated with critical neonatal morbidities, including low birth weight (LBW). However, little is known on short-term exposure to wildfire smoke and LBW. In this study, we estimated the association between birth weight following pregnancy and wildfire smoke exposure in more than 1.5 million newborns in Brazil (considered as a very fire-prone region worldwide).