Institutional members access full text with Ovid®

Share this article on:

Acute Associations Between Outdoor Temperature and Premature Rupture of Membranes

Ha, Sandiea,b; Liu, Danpingc; Zhu, Yeyia,d; Sherman, Sethe; Mendola, Paulinea

doi: 10.1097/EDE.0000000000000779
Environmental epidemiology

Background: Extreme ambient temperatures have been linked to preterm birth. Preterm premature rupture of membranes is a common precursor to preterm birth but is rarely studied in relation to temperature.

Methods: We linked 15,381 singleton pregnancies with premature rupture of membranes from a nationwide US obstetrics cohort (2002–2008) to local temperature. Case-crossover analyses compared daily temperature during the week preceding delivery and the day of delivery to 2 control periods, before and after the case period. Conditional logistic regression models calculated the odds ratio (OR) and 95% confidence intervals (CIs) of preterm and term premature rupture of membranes for a 1°C increase in temperature during the warm (May–September) and cold (October–April) season separately after adjusting for humidity, barometric pressure, ozone, and particulate matter.

Results: During the warm season, 1°C increase during the week before delivery was associated with a 5% (95% CI, 3%, 6%) increased preterm premature rupture of membranes risk, and a 4% (95% CI, 3%, 5%) increased term premature rupture of membranes risk. During the cold season, 1°C increase was associated with a 2% decreased risk for both preterm (95% CI, 1%, 3%) and term premature rupture of membranes (95% CI, 1%, 3%). The day-specific associations for the week before delivery were similar, but somewhat stronger for days closer to delivery.

Conclusions: Relatively small ambient temperature changes were associated with the risk of both preterm and term premature of membranes. Given the adverse consequences of premature rupture of membranes and concerns over global climate change, these findings merit further investigation. See video abstract at,

From the aEpidemiology Branch, Division of Intramural Population Health Research, NICHD, Bethesda, MD; bDepartment of Public Health, College of Social Sciences, Humanities and Arts, University of California, Merced, CA; cBiostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, NICHD, Bethesda, MD; dKaiser Permanente, Oakland, CA; and eThe Emmes Corporation, Rockville, MD.

Submitted January 20, 2017; accepted October 27, 2017.

The data of this study are currently not publicly available. A data use agreement is required and can be obtained from the corresponding author.

Supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health; including Contract No. HHSN267200603425C (Consortium on Safe Labor), Contract No. HHSN275200800002I, and Task Order No. HHSN27500008 (Air Quality and Reproductive Health). Although the NICHD cleared this manuscript for publication, it had no role in the design, conduct, or writing of this manuscript.

The authors report no conflicts of interest.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (

Correspondence: Pauline Mendola, Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, 6710B Rockledge Drive Room 3119, MSC 7004, Bethesda, MD 20892. E-mail:

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.