First-Trimester Heat Exposure and Maternal One Health: Climate Change Risks at the Environment–Human Interface
1
1 Climate Environment and Health Department, CESHHAR ZIMBABWE, Harare, Zimbabwe
2
3 Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
3
4 Place Alert Labs, Midlands State University, Gweru, Zimbabwe
4
12 Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
5
9 . Liverpool School of Tropical Medicine (LSTM), Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
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7 Wits Planetary Health, University of Witwatersrand, Johannesburg, South Africa
7
10 . Trinity College Dublin’s School of Medicine, Trinity College Dublin’s School of Medicine, Dublin, Ireland
8
11 Medical Research Council Unit at LSHTM, Medical Research Council Unit at LSHTM, Banjul, Gambia
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8 Centre of Excellence in Women & Child Health, The Aga Khan University, Nairobi, Kenya
10
5 Centro de Investigacao em Saude de Manhica, Centro de Investigacao em Saude de Manhica, Manhica, Mozambique
11
6 Faculty of Social Science, Lau China Institute, King’s College, London, United Kingdom
12
2 Department of Women and Children’s Health, School of Life Course and Population Sciences, King’s College London, London, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):A473
ABSTRACT
BACKGROUND:
Climate change, including extreme heat, is reshaping health risks through impacts on people and health systems. Pregnant women are disproportionately vulnerable to extreme heat exposure due to altered thermo-regulation. Evidence linking heat and hypertensive disorders of pregnancy (HDP) remains mixed globally and limited in African settings. HDP remain a major cause of maternal and newborn complications placing an increased burden on specialised obstetric and neonatal care services. We assessed first trimester ambient heat exposure and HDP risk in an African multi-country pregnancy cohort.
METHODS:
We analysed data from the PREgnancy Care Integrating Translational Science Everywhere (PRECISE) pregnancy cohort in Kenya, Mozambique, and The Gambia. Pregnant women were enrolled when they presented for their first antenatal care (ANC) visit. HDP diagnosis, socio-economic status and heat exposure assignment was standardised across sites. A Directed acyclic graph (DAG) informed logistic regression model which adjusted for key environmental, maternal social and maternal health factors was used to assess the relationship between first trimester maximum temperature and risk of HDP during pregnancy follow-up.
RESULTS:
Of 6770 enrolled participants, 5455 were included in the analysis. Women had a median age of 25 years (IQR=21-30). Nearly half of participants attended secondary education (42.9%). Pregnancies were mainly singleton (98.5%) with a median gestational age at delivery of 39.3 weeks (IQR-37.7-40.7). Overall HDP prevalence was 15.9% (The Gambia=23.7%, Kenya=14.3% and Mozambique=13.9%). HDP was more common among older women, hot season conceptions and those with limited social support. Each degree Celsius increase in first-trimester average maximum temperature increased HDP risk ( aOR=1.09, 95%CI=1.04-1.13, p<0.001), when adjusted for maternal age, HIV status, parity, isolation, conception season, Grameen poverty index and maternal mid upper arm circumference
CONCLUSIONS:
These findings position first-trimester heat exposure as an important driver of maternal HDP. Integrating heat-aware antenatal messaging can strengthen resilience and reduce preventable harm.
Climate change, including extreme heat, is reshaping health risks through impacts on people and health systems. Pregnant women are disproportionately vulnerable to extreme heat exposure due to altered thermo-regulation. Evidence linking heat and hypertensive disorders of pregnancy (HDP) remains mixed globally and limited in African settings. HDP remain a major cause of maternal and newborn complications placing an increased burden on specialised obstetric and neonatal care services. We assessed first trimester ambient heat exposure and HDP risk in an African multi-country pregnancy cohort.
METHODS:
We analysed data from the PREgnancy Care Integrating Translational Science Everywhere (PRECISE) pregnancy cohort in Kenya, Mozambique, and The Gambia. Pregnant women were enrolled when they presented for their first antenatal care (ANC) visit. HDP diagnosis, socio-economic status and heat exposure assignment was standardised across sites. A Directed acyclic graph (DAG) informed logistic regression model which adjusted for key environmental, maternal social and maternal health factors was used to assess the relationship between first trimester maximum temperature and risk of HDP during pregnancy follow-up.
RESULTS:
Of 6770 enrolled participants, 5455 were included in the analysis. Women had a median age of 25 years (IQR=21-30). Nearly half of participants attended secondary education (42.9%). Pregnancies were mainly singleton (98.5%) with a median gestational age at delivery of 39.3 weeks (IQR-37.7-40.7). Overall HDP prevalence was 15.9% (The Gambia=23.7%, Kenya=14.3% and Mozambique=13.9%). HDP was more common among older women, hot season conceptions and those with limited social support. Each degree Celsius increase in first-trimester average maximum temperature increased HDP risk ( aOR=1.09, 95%CI=1.04-1.13, p<0.001), when adjusted for maternal age, HIV status, parity, isolation, conception season, Grameen poverty index and maternal mid upper arm circumference
CONCLUSIONS:
These findings position first-trimester heat exposure as an important driver of maternal HDP. Integrating heat-aware antenatal messaging can strengthen resilience and reduce preventable harm.
| eISSN: | 2654-1459 |
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