Increasing global temperatures threaten gains in maternal and newborn health in Africa: A review of impacts and an adaptation framework

Abstract

Anatomical, physiologic, and socio-cultural changes during pregnancy and childbirth increase vulnerability of women and newborns to high ambient temperatures.Extreme heat can overwhelm thermoregulatory mechanisms in pregnant women, especially during labor, cause dehydration and endocrine dysfunction, and compromise placental function. Clinical sequelae include hypertensive disorders, gestational diabetes, preterm birth, and stillbirth. High ambient temperatures increase rates of infections, and affect health worker performance and healthcare seeking. Rising temperatures with climate change and limited resources heighten concerns. We propose an adaptation framework containing four prongs. First, behavioral changes such as reducing workloads during pregnancy and using low-cost water sprays. Second, health system interventions encompassing Early Warning Systems centered around existing community-based outreach; heat-health indicator tracking; water supplementation and monitoring for heat-related conditions during labor. Building modifications, passive and active cooling systems, and nature-based solutions can reduce temperatures in facilities. Lastly, structural interventions and climate financing are critical. The overall package of interventions, ideally selected following cost-effectiveness and thermal modeling trade-offs, needs to be codesigned and co-delivered with affected communities, and take advantage of existing maternal and child health platforms. Robust-applied research will set the stage for programs across Africa that target pregnant women. Adequate research and climate financing are now urgent.

Extreme temperature increases the risk of stillbirth in the third trimester of pregnancy

“…In addition to direct climatic factors, thermal adaptation behaviors also indirectly affect the effects of heat stress on pregnant women 24 , such as reducing workloads during pregnancy, establishing early warning systems in the community, water supplementation, increasing medical accessibility, monitoring for heat-related conditions during labor, building modifications, and use of cooling systems 25 . We recommend more behavioral and health service-related researches to formulate recommendations for prevention.…”

Code OB: We need urgent action on climate change and toxic chemicals

“…For example, in sub-Saharan Africa, droughts in 2010-2019 have tripled compared to 1970-79. 15 Extreme weather events that cause flooding and other ecological changes have led to increases in communicable diseases, 3 which are more prevalent in LMIC. Even in higherwealth countries, such as the US, analyses show lower-income communities and communities of color are more likely to live in areas that will be disproportionately affected by climate change effects.…”

“…Many African nations, along with other LMIC, will be more adversely affected by climate change. For example, in sub‐Saharan Africa, droughts in 2010–2019 have tripled compared to 1970–79 15 . Extreme weather events that cause flooding and other ecological changes have led to increases in communicable diseases, 3 which are more prevalent in LMIC.…”

Protocol of an individual participant data meta-analysis to quantify the impact of high ambient temperatures on maternal and child health in Africa (HE2AT IPD)

“…Heat is hazardous for high-risk populations, including pregnant women and children (figure 1). The physiological and anatomical changes in pregnancy, pregnancy-related weight gain, heat generated by fetal metabolism, and exertion during labour, makes it challenging for pregnant women to maintain a normal temperature range when exposed to heat 14 15. Manifestations of heat exposure include adverse pregnancy and birth outcomes, such as preterm birth, low birth weight, stillbirths,13 gestational diabetes,16 17 and hypertension in pregnancy 18.…”