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Associations of climatic factors with pregnancy loss in Nicosia, Cyprus

Journal of Exposure Science & Environmental Epidemiology volume 35, pages 831–838 (2025)Cite this article

Abstract

Background

While ambient climatic factors are linked to adverse pregnancy outcomes, only a few studies examine the risk of pregnancy loss.

Objective

This study aims to examine the effects of climatic factors on pregnancy loss in Nicosia, Cyprus, an area that is highly affected by climate change.

Methods

Birth registry data obtained from maternity units in Nicosia from 2014–2019 were linked with daily meteorological and traffic pollution data (minimum and maximum temperature, °C; relative humidity [RH], %; and nitrogen dioxide [NO2], μg/m3). We also estimated other climatic factors from the obtained data (mean weekly temperature, standard deviation of weekly temperature and RH [temperature and RH variability], and heat index [HI]). We used a novel variation of time-series design and distributed lag models adjusting for secular trends and air pollution to explore the association between climatic factors and weekly live-birth identified conceptions (LBICs), to indirectly estimate pregnancy losses.

Results

There were 26,382 live births over the study period, with an average weekly LBICs of 84.7( ± 12.2). We found an association between exposure to higher temperature between gestation weeks 0–9 and pregnancy loss, with the strongest association in weeks 0–1. Specifically, for a 5°C increase in mean week 0–1 temperature, 3.17 (95% Confidence Interval [CI]: 1.06–5.28) additional conceptions would result in pregnancy losses. A similar effect during early pregnancy was found for exposure to minimum and maximum temperature, HI, and RH. Furthermore, we found that temperature variability may have an impact in later weeks during pregnancy, with the strongest estimate in week 26 (6.70 [95% CI: 0.78–13.21] losses per 5 °C increase in standard deviation of weekly temperature). Similar results were observed for RH variability.

Impact Statement

This research investigates the link between climatic factors and pregnancy loss in Nicosia, Cyprus, a region experiencing rising temperatures and humidity levels. By analyzing live birth data using a novel time-series approach, the study finds that higher temperatures and humidity levels are associated with increased pregnancy loss, particularly in early gestation. These findings underscore the need for targeted public health interventions, such as heat warning systems, to mitigate the impact of climate change on vulnerable populations. As climate change escalates, understanding these associations is crucial for developing effective strategies to protect maternal and fetal health.

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Fig. 1: Risk Ratio of live birth over gestation (week 0–40) per 5 ˚C increase in mean weekly temperature in Nicosia.
Fig. 2: Risk Ratio of live birth over gestation (week 0–40) per 5 ˚C increase in the standard deviation of the weekly temperature in Nicosia.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due the sensitive nature of the data used in this study, and access to the raw data is restricted to ensure confidentiality and compliance with ethical guidelines, but are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to acknowledge the Cyprus Department of Meteorology, Ministry of Agriculture, Rural Development and Environment for providing the daily meteorological data, and the Air Quality and Strategic Planning Section, Department of Labor Inspection, Ministry of Labor and Social Insurance of Cyprus for providing the hourly data on nitrogen dioxide. The birth data used in this study was collected by the Health Monitoring Unit of the Ministry of Health of Cyprus. The ideas and opinions expressed herein are those of the author. Endorsement of these ideas and opinions by the Ministry of Health of Cyprus is not intended nor should it be inferred.

Funding

This work was supported by the Cyprus Harvard Internship Program in Environmental Health, the Harvard Cyprus Endowment Fund on Environmental and Public Health, and by the National Institute of Environmental Health Sciences (NIEHS) under award numbers R01ES034038, R01ES029943, and P30ES000002.

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Authors and Affiliations

  1. Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA

    Aashna Pranav Shah, Veronica A. Wang, Michael Leung, Marc G. Weisskopf & Petros Koutrakis

  2. Department of Primary Care and Population Health, University of Nicosia Medical School, 93 Agiou Nikolaou Street, Engomi, 2408, Nicosia, Cyprus

    Souzana Achilleos

  3. Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA

    Michael Leung & Marc G. Weisskopf

  4. Health Monitoring Unit, Ministry of Health, Nicosia, Corner of Prodromou 1 & Chilonos 17 1448, Nicosia, Cyprus

    Theopisti Kyprianou

  5. Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Ln W, Piscataway, NJ, 08854, USA

    Stefania Papatheodorou

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  1. Aashna Pranav Shah
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  2. Souzana Achilleos
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Contributions

Aashna Pranav Shah: Methodology, Formal analysis, Software, Visualization, Writing – original draft. Souzana Achilleos: Methodology, Software, Supervision, Writing – review & editing. Veronica A. Wang: Methodology, Writing – review & editing. Michael Leung: Methodology, Writing – review & editing. Marc G. Weisskopf: Methodology, Writing – review & editing. Theopisti Kyprianou: Writing – review & editing. Petros Koutrakis: Funding acquisition, Writing – review & editing. Stefania Papatheodorou: Funding acquisition, Methodology, Software, Supervision, Writing – review & editing.

Corresponding author

Correspondence to Aashna Pranav Shah.

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The authors declare no competing interests.

Ethical approval

This is an ecological study utilizing anonymized non-confidential data collected by the Health Monitoring Unit, Ministry of Health of Cyprus. Approval to access this data for the purposes of the study was obtained from the Ministry of Health. No further ethics approval was required for its use.

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Shah, A.P., Achilleos, S., Wang, V.A. et al. Associations of climatic factors with pregnancy loss in Nicosia, Cyprus. J Expo Sci Environ Epidemiol 35, 831–838 (2025). https://doi.org/10.1038/s41370-025-00781-3

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