{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:44:21Z","timestamp":1790815461154,"version":"4.1.0"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,2,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      More intense and longer\u2010lasting heat events are expected in the United States as a consequence of climate change. This study aimed to project the potential changes in maternal heat exposure during early pregnancy (3\u20138\u00a0weeks post conception) and the associated burden of congenital heart defects (\n                      <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>\n                      s) in the future.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      This study expanded on a prior nationwide case\u2010control study that evaluated the association between\n                      <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>\n                      s and maternal heat exposure during early pregnancy in summer and spring. We defined multiple indicators of heat exposure, and applied published odds ratios obtained for the matching season of the baseline (1995\u20132005) into the projection period (2025\u20132035) to estimate potential changes in\n                      <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>\n                      burden throughout the United States. Increases in maternal heat exposure were projected across the United States and to be larger in the summer. The Midwest will potentially have the highest increase in summer maternal exposure to excessively hot days (3.42; 95% CI, 2.99\u20133.88 per pregnancy), heat event frequency (0.52; 95%\n                      <jats:styled-content style=\"fixed-case\">CI,<\/jats:styled-content>\n                      0.44\u20130.60) and heat event duration (1.73; 95%\n                      <jats:styled-content style=\"fixed-case\">CI,<\/jats:styled-content>\n                      1.49\u20131.97). We also found large increases in specific\n                      <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>\n                      subtypes during spring, including a 34.0% (95%\n                      <jats:styled-content style=\"fixed-case\">CI,<\/jats:styled-content>\n                      4.9%\u201370.8%) increase in conotruncal\n                      <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>\n                      in the South and a 38.6% (95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      , 9.9%\u201375.1%) increase in atrial septal defect in the Northeast.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Projected increases in maternal heat exposure could result in an increased\n                      <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>\n                      burden in certain seasons and regions of the United States.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.118.010995","type":"journal-article","created":{"date-parts":[[2019,1,30]],"date-time":"2019-01-30T05:08:15Z","timestamp":1548824895000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":62,"title":["Projected Changes in Maternal Heat Exposure During Early Pregnancy and the Associated Congenital Heart Defect Burden in the United States"],"prefix":"10.1161","volume":"8","author":[{"given":"Wangjian","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Medical Statistics and Epidemiology School of Public Health Sun Yat\u2010sen University Guangzhou China"},{"name":"Department of Environmental Health Sciences University at Albany, State 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