Ambient Temperature and Stillbirth: A Multi-Center Retrospective Cohort Study

BACKGROUND: Climate change is expected to have adverse health effects, but the association between extreme ambient temperatures and stillbirth is unclear. OBJECTIVES: We investigated acute and chronic associations between extreme ambient temperatures and stillbirth risk, and estimated the attributable risk associated with local temperature extremes in the United States. METHODS: We linked 223,375 singleton births [Formula: see text] of gestation (2002–2008) from 12 U.S. sites to local temperature. Chronic exposure to hot ([Formula: see text]), cold ([Formula: see text]), or mild ([Formula: see text]) temperatures was defined using window- and site-specific temperature distributions for three-months preconception, first and second trimester, and whole-pregnancy averages. For acute exposure, average temperature for the week preceding delivery was compared to two alternative control weeks in a case-crossover analysis. RESULTS: In comparison with mild, whole-pregnancy exposure to cold [adjusted odds ratio (aOR) = 4.75; 95% confidence interval (CI): 3.95, 5.71] and hot (aOR = 3.71; 95% CI: 3.07, 4.47) were associated with stillbirth risk, and preconception and first and second trimester exposures were not. Approximately 17–19% of stillbirth cases were potentially attributable to chronic whole-pregnancy exposures to local temperature extremes. This is equivalent to [Formula: see text] and [Formula: see text] excess cases in the United States annually. In the case-crossover analysis, a 1°C increase during the week preceding delivery was associated with a [Formula: see text] increase in stillbirth risk during the warm season (May–September). This incidence translates to [Formula: see text] additional stillbirths per 10,000 births for each 1°C increase. CONCLUSIONS: Extremes of local ambient temperature may have chronic and acute effects on stillbirth risk, even in temperate zones. Temperature-related effects on pregnancy outcomes merit additional investigation. https://doi.org/10.1289/EHP945