Temperature and preeclampsia: Epidemiological evidence that perturbation in maternal heat homeostasis affects pregnancy outcome

Abstract

Introduction This study aims to determine the association between temperature and preeclampsia and whether it is affected by seasonality and rural/urban lifestyle. Methods This cohort study included women who delivered at our medical center from 2004 to 2013 (31,101 women, 64,566 deliveries). Temperature values were obtained from a spatiotemporally resolved estimation model performing predictions at a 1×1km spatial resolution. In "Warm" pregnancies >50% of gestation occurred during the spring-summer period. In cold pregnancies >50% of gestation occurred during the fall and winter. Generalized estimating equation multivariable models were used to estimate the association between temperature and incidence of preeclampsia. Results 1) The incidence of preeclampsia in at least one pregnancy was 7% (2173/64,566); 2) during "warm" pregnancies, an elevation of one IQR of the average temperature in the 1 st or the 3 rd trimesters was associated with an increased risk to develop preeclampsia [patients with Jewish ethnicity: 1 st trimester: relative risk (RR) of 2.38(95%CI 1.50; 3.80), 3 rd trimester 1.94(95%CI 1.34;2.81); Bedouins: 1 st trimester: RR = 2.91(95%CI 1.98;4.28), 3 rd trimester: RR = 2.37(95%CI 1.75;3.20)]; 3) In "cold" pregnancies, an elevation of one IQR of average temperature was associated with a lower risk to develop preeclampsia among patients with

The Changing Climate and Pregnancy Health

“…Prolonged heat exposure leads to heat stress and triggers inflammatory and oxidative stress responses that promote endothelial dysfunctions and increase blood viscosity [29][30][31][32]. These effects, coupled with increased peripheral blood flow for heat dissipation, lead to decreased uterine blood flow and impaired oxygen and nutrients transfusion to the developing fetus [20,[33][34][35][36]. Heat exposure can also stimulate maternal antidiuretic hormone and oxytocin, both of which reduce uterine blood flow, and switch fetal metabolism from anabolic to catabolic pathways [37].…”

“…Early pregnancy appears to be the most susceptible window of exposure for stillbirth [ 15 , 16 ]. Meanwhile, high temperatures have also been linked to other serious pregnancy outcomes such as premature rupture of membranes [ 17 ], gestational cardiovascular events [ 18 ], gestational hypertension and preeclampsia [ 19 , 20 ], birth defects [ 21 ], and neonatal mortality. [ 22 ].…”

Physiological mechanisms of the impact of heat during pregnancy and the clinical implications: review of the evidence from an expert group meeting

“…Pregnant women and the fetus are increasingly recognised as being particularly vulnerable to the effects of extreme heat (Roos et al 2021 ). There is mounting epidemiological evidence that high ambient temperatures are associated with pregnancy complications and adverse fetal and neonatal complications and outcomes including preterm birth, stillbirth, low birthweight (Zhang et al 2017 ; Chersich et al 2020 ), congenital anomalies (Haghighi et al 2021 ), pre-eclampsia (Shashar et al 2020 ), gestational diabetes (Pace et al 2021 ) and emergency hospital admissions during pregnancy (Kim et al 2019 ). There is also accumulating evidence of high temperatures negatively impacting the mental health of pregnant women, as well as altering their behaviour (Lin et al 2017 ).…”

Biomimetics provides lessons from nature for contemporary ways to improve human health

“…In hot parts of the world, such as Central America and Sri Lanka, an epidemic of CKD (Mesoamerican nephropathy) is an emerging health concern amongst poor agricultural workers [17]. Moreover, global warming reduces gut microbiota diversity [18] and a recent study of pregnant women suggests that rising temperature is associated with perturbations in maternal heat homeostasis that increase the risk of pre-eclampsia [19]. Concerns have also been raised that global warming increases the risk of tissue hypoxia [20].…”