ABSTRACT:
Environmental and climate-related exposures increasingly shape pregnancy outcomes globally, with disproportionate burdens due to overlapping socioeconomic and environmental vulnerabilities. In Ghana, climate anomalies, ambient air pollution, infectious disease burden, and household environmental conditions jointly influence maternal and fetal health, yet remain insufficiently examined within an integrated socioecological framework. Interpolating the CHIRTS_ERAs5 and 2022 Ghana MHS, this study evaluates the combined effects of climatic stressors, ambient air pollution, and maternal and household socioeconomic and environmental conditions on adverse pregnancy outcomes, with particular attention to early-life exposures. Elevated preconception temperature anomalies were associated with substantially increased risk of adverse outcomes, with mean temperature anomalies linked to more than a twofold increase in risk (HR ≈ 2.4), while higher exposure to ambient air pollutants such as PM₂.₅ and carbon monoxide showed statistically significant associations with miscarriage risk. Beyond climatic and atmospheric exposures, infectious and household environmental factors played a critical role. Malaria in pregnancy remained prevalent (approximately 24%), with evidence indicating lower malaria prevalence among women with higher educational attainment (74.3% reduction), underscoring the protective role of socioeconomic position and preventive behaviors such as insecticide-treated net use. Household energy sources were strongly associated with perinatal outcomes, as use of polluting cooking fuels was linked to markedly higher odds of perinatal mortality (adjusted odds ratio [aOR]: 7.6; 95% CI: 1.67–36.0) and low five-minute Apgar scores (aOR: 3.83; 95% CI: 1.44–10.11). In contrast, improved water access has been inconsistently associated with pregnancy outcomes and is often characterized as a low-impact intervention. Notably, several statistically significant associations observed in this analysis remain underexplored in existing literature, highlighting critical gaps in environmental reproductive health research. Collectively, these findings emphasize that adverse pregnancy outcomes in Ghana arise from interacting climatic, environmental, infectious, and socioeconomic determinants, reinforcing the need for integrated, climate-responsive, and equity-centered maternal health interventions.