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We examined associations between seasonality and adverse birth outcomes among women with and without HIV in a large geographically representative birth outcomes surveillance study in Botswana from 2015 to 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We evaluated stillbirth, preterm delivery, very preterm delivery, small for gestational age (SGA), very SGA, and combined endpoints of any adverse or severe birth outcome. We estimated the risk of each outcome by month and year of delivery, and adjusted risks ratios (ARRs) of outcomes during the early wet (1 November\u201315 January), late wet (16 January\u201331 March) and early dry (1 April\u201315 July) seasons, compared with the late dry (16 July\u201331 October) season. Analyses were conducted overall and separately by HIV status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 73 178 women (24% with HIV), the risk of all adverse birth outcomes peaked in November\u2013January and reached low points in September. Compared with the late dry season, the ARRs for any adverse birth outcome were 1.03 (95% CI 1.00 to 1.06) for the early dry season, 1.08 (95% CI 1.04 to 1.11) for the early wet season and 1.07 (95% CI 1.03 to 1.10) for the late wet season. Comparing the early wet season to the late dry season, we found that ARRs for stillbirth and very preterm delivery were higher in women with HIV (1.23, 95% CI 0.96 to 1.59, and 1.33, 95% CI 1.10 to 1.62, respectively) than in women without HIV (1.07, 95% CI 0.91 to 1.26, and 1.19, 95% CI 1.04 to 1.36, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We identified a modest association between seasonality and adverse birth outcomes in Botswana, which was greatest among women with HIV. Understanding seasonal patterns of adverse birth outcomes and the role of HIV status may allow for mitigation of their impact in the face of seasonal extremes related to climate change.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-045882","type":"journal-article","created":{"date-parts":[[2021,9,3]],"date-time":"2021-09-03T12:19:21Z","timestamp":1630671561000},"page":"e045882","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Seasonality of adverse birth outcomes in women with and without HIV in a representative birth outcomes surveillance study in Botswana"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8667-6471","authenticated-orcid":false,"given":"Ellen C","family":"Caniglia","sequence":"first","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jasmyn","family":"Abrams","sequence":"additional","affiliation":[{"name":"Department of Population Health, NYU Langone Health, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Modiegi","family":"Diseko","sequence":"additional","affiliation":[{"name":"Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gloria","family":"Mayondi","sequence":"additional","affiliation":[{"name":"Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judith","family":"Mabuta","sequence":"additional","affiliation":[{"name":"Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Makhema","sequence":"additional","affiliation":[{"name":"Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mompati","family":"Mmalane","sequence":"additional","affiliation":[{"name":"Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahin","family":"Lockman","sequence":"additional","affiliation":[{"name":"Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana"},{"name":"Department of Infectious Disease, Brigham and Women's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron","family":"Bernstein","sequence":"additional","affiliation":[{"name":"Immunology and Infectious Diseases, Center for Climate, Health, and the Global Environment, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Zash","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, BIDMC, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roger","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana"},{"name":"Immunology and Infectious Diseases, Center for Climate, Health, and the Global Environment, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,9,3]]},"reference":[{"key":"2025121221151164000_11.9.e045882.1","unstructured":"World Health Organization . 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