Environmental heat stress on maternal physiology and fetal blood flow in pregnant subsistence farmers in The Gambia, west Africa: an observational cohort study

Bonell, Ana; Sonko, Bakary; Badjie, Jainaba; Samateh, Tida; Saidy, Tida; Sosseh, Fatou; Sallah, Yahya; Bajo, Kebba; Murray, Kris A.; Hirst, Jane E; Vicedo-Cabrera, Ana Maria; Prentice, Andrew M.; Maxwell, Neil; Haines, Andy

doi:10.1016/s2542-5196(22)00242-x

Cited by 49 publications

(31 citation statements)

References 38 publications

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“…In the most recent observational cohort study in The Gambia, 52 50 women were measured to have WBGT exposures over the TLVs during all trimesters, with HSI during pregnancy being associated with fetal heat strain (defined in that study as an increased fetal heart rate). This fetal strain could increase APO risk; however, the exact mechanism remains unclear 7,52,62,63 …”

Section: Discussionmentioning

confidence: 99%

Heat stress and adverse pregnancy outcome: Prospective cohort study

Rekha,

Nalini,

Bhuvana

et al. 2023

BJOG

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ObjectiveTo explore the relationship between occupational heat exposure, physiological heat strain indicators and adverse outcomes in pregnant women.DesignProspective cohort.SettingWorkplaces in Tamil Nadu, India.SampleA cohort of 800 pregnant women engaged in moderate to heavy physical work in 2017–2019 and 2021–2022.MethodsParticipants were recruited at between 8 and 14 weeks of gestation. Occupational heat exposure and heat strain indicators were captured each trimester. ‘Heat exposed’ was defined as heat stress exceeding the threshold limit value (TLV) for safe manual work (with maximum wet‐bulb globe temperatures of 27.5°C for a heavy workload and 28.0°C for a moderate workload). Physiological heat strain indicators (HSIs) such as core body temperature (CBT) and urine specific gravity (USG) were measured before and after each shift. Heat‐related health symptoms were captured using the modified HOTHAPS questionnaire.Main outcome measuresThe main outcome measures included (1) a composite measure of any adverse pregnancy outcome (APO) during pregnancy (including miscarriage, preterm birth, low birthweight, stillbirth, intrauterine growth restriction and birth defects), (2) a composite measure of adverse outcomes at birth (3) and miscarriage.ResultsOf the 800 participants, 47.3% had high occupational heat exposure. A rise in CBT was recorded in 17.4% of exposed workers, and 29.6% of workers experienced moderate dehydration (USG ≥ 1.020). Heat‐exposed women had a doubled risk of miscarriage (adjusted odds ratio, aOR 2.4; 95% confidence interval, 95% CI 1.0–5.7). High occupational heat exposure was associated with an increased risk of any adverse pregnancy and foetal outcome (aOR 2.3; 95% CI 1.4–3.8) and adverse outcome at birth (aOR 2.0; 95% CI 1.2–3.3).ConclusionsHigh occupational heat exposure is associated with HSIs and adverse pregnancy outcomes in India.

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Section: Discussionmentioning

confidence: 99%

Heat stress and adverse pregnancy outcome: Prospective cohort study

Rekha,

Nalini,

Bhuvana

et al. 2023

BJOG

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“…A large proportion of stillbirths among our sites are associated with intrauterine hypoxia and maternal-fetal vascular malperfusion. 24 Given that heat stress also has potential to alter uterine blood supply and be associated with placenta function, 25,26 greater evaluation of stillbirth outcomes is necessary.…”

Section: Discussionmentioning

confidence: 99%

Associations between ambient temperature and pregnancy outcomes from three south Asian sites of the Global Network Maternal Newborn Health Registry: A retrospective cohort study

Shankar

Hwang

Westcott

et al. 2023

BJOG

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ObjectiveGrowing evidence suggests that environmental heat stress negatively influences fetal growth and pregnancy outcomes. However, few studies have examined the impact of heat stress on pregnancy outcomes in low‐resource settings. We combined data from a large multi‐country maternal–child health registry and meteorological data to assess the impacts of heat stress.DesignRetrospective cohort study.SettingThree sites based in south Asia as part of the Global Network for Women's and Children's Health research in India (Belagavi and Nagpur) and Pakistan (Thatta).Population or SampleData from women enrolled between 2014 and 2020 in the Global Network's Maternal Newborn Health Registry (MNHR), a prospective, population‐based registry of pregnancies, were used.MethodsA total of 126 273 pregnant women were included in this analysis. Daily maximal air temperatures (Tmax) were acquired from local meteorological records. Associations between averages of daily maximal temperatures for each trimester and main outcomes were analysed using a modified Poisson regression approach.Main outcomes measuresIncidence of stillbirth, preterm birth, low birthweight (<2500 g) or evidence of pregnancy hypertension or pre‐eclampsia.ResultsIn the overall cohort, risk of preterm birth was positively associated with greater temperature in the second trimester (relative risk [RR] 1.05, 95% CI 1.02–1.07, p = 0.0002). Among individual sites, the risk of preterm birth was greatest in Nagpur (RR 1.07, 95% CI 1.03–1.11, p = 0.0005) and associated with second‐trimester temperature. The overall risk of low birthweight was associated with ambient temperature in second trimester (RR 1.02, 95% CI 1.01–1.04, p = 0.01). The risk for LBW was associated with first‐trimester heat in Thatta and with second‐trimester heat in Nagpur. Finally, the overall risk of gestational hypertensive disease was associated with greater temperature in the third trimester among all sites (RR 1.07, 95% CI 1.02–1.12, p = 0.005) and was particularly significant for Nagpur (RR 1.13, 95% CI 1.05–1.23, p = 0.002). These findings highlight the increased risk of detrimental obstetric and neonatal outcomes with greater temperature.ConclusionIn a multi‐country, community‐based study, greater risk of adverse outcomes was observed with increasing temperature. The study highlights the need for deeper understanding of covarying factors and intervention strategies, especially in regions where high temperatures are common.

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“…Where extreme heat events are predicted to increase, agrivoltaics could reduce heat stress not only for crops and livestock, but also for workers beneath them. Outdoor workers, including farm labourers, subjected to heat stress show adverse health impacts to themselves 58 and, for pregnant women, their unborn child 59 . An increase of 3°C is projected to decrease agricultural labour capacity by 30-50% due to increased heat stress and resulting decrease in productive work hours 60 .…”

Section: Discussionmentioning

confidence: 99%

Modelling the suitability of agrivoltaics to deliver sustainable energy and food production in East Africa

Neesham-McTiernan¹,

Randle-Boggis

Cinderby³

et al. 2023

Preprint

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Agrivoltaics address energy, food, and water security concomitantly, yet little research has addressed the opportunities and barriers for this technology in East Africa, a region facing substantial challenges across the water-energy-food nexus. Here, we identify possible use cases for the technology in five East African nations and determine the factors influencing delivery of potential benefits, before assessing the spatial suitability of the technology for two of the emergent use cases: agribusiness and marginal farming. Our findings show there is a moderate to high suitability for AV across both use cases, with a range of biophysical and social factors driving successful outputs; land tenure and solar radiation were the most important for determining suitability. Our analysis indicates where AVs would be best developed to improve access to, and resilience of, energy and food production in East Africa, and our methods could be applied to other locations to support agrivoltaics development internationally.

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Environmental heat stress on maternal physiology and fetal blood flow in pregnant subsistence farmers in The Gambia, west Africa: an observational cohort study

Cited by 49 publications

References 38 publications

Heat stress and adverse pregnancy outcome: Prospective cohort study

Heat stress and adverse pregnancy outcome: Prospective cohort study

Associations between ambient temperature and pregnancy outcomes from three south Asian sites of the Global Network Maternal Newborn Health Registry: A retrospective cohort study

Modelling the suitability of agrivoltaics to deliver sustainable energy and food production in East Africa

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