ArticleEBioMedicine2023
Increased late preterm birth risk and altered uterine blood flow upon exposure to heat stress.
Article in EBioMedicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 40 citations in OpenAlex.
- A systematic review and meta-analysis of heat exposure impacts on maternal, fetal and neonatal health.Nature medicine · 2025Pooled it
- The effect of intrapartum maternal fever on neonatal outcomes: a systematic review and meta-analysis.Frontiers in pediatrics · 2025Pooled it
- Association between extreme heat exposure and risk of preterm birth and its effect modifiers: a systematic review and meta-analysis.Journal of exposure science & environmental epidemiology · 2026Article
- Immunological maladaptation preceding spontaneous preterm birth in human pregnancies.Nature communications · 2026Article
- The Impact of Ambient Heat on Perinatal and Neonatal Health in the Context of Climate Change: A Scoping Review.Current environmental health reports · 2026Article
- Investigating environmental heat exposure and its effects on maternal and fetal health in rural Northern Ghana (Physio-HeMAB Study): a study protocol for a cluster randomized trial.BMC public health · 2026Article
- Intersection of Climate and Environmental Change and Priority Health Outcomes Across the Life Course: Working Group 1 Report from the "Agriculture and Diet: Value Added for Nutrition, Translation, and Adaptation in a Global Ecology" (ADVANTAGE) Project.Advances in nutrition (Bethesda, Md.) · 2026Review
- Heat spells and birth and peripartum pregnancy complications in Germany: a scoping review.Archives of gynecology and obstetrics · 2026Article
- Evaluating the association between household water, sanitation and hygiene (WASH) and selected placenta-related complications in The Gambia, Kenya and Mozambique.PLOS global public health · 2026Article
- Impacts of the Pacific Northwest Heat Dome on preterm birth rates in Oregon and Washington State.medRxiv : the preprint server for health sciences · 2025Article
- Lethal Heat and Humidity Events.Annual review of environment and resources · 2025Article
- Association between embryo transfer season and the risks of hypertensive disorders of pregnancy and gestational diabetes mellitus.Journal of assisted reproduction and genetics · 2025Article
- Scoping review of climate drivers on maternal health: current evidence and clinical implications.AJOG global reports · 2025Review
- Greening the future of healthcare: implementation of sustainability strategies in German hospitals and beyond-a review.Frontiers in public health · 2025Review
- Analysis of clinical risk factors of premature infants in Chinese women based on anemia status.Frontiers in pediatrics · 2025Article
- Heat exposure induced risks of preterm birth mediated by maternal hypertension.Nature medicine · 2024Article
- Predicting Spontaneous Preterm Birth Using the Immunome.Clinics in perinatology · 2024Review
- Preterm and Early-Term Delivery After Heat Waves in 50 US Metropolitan Areas.JAMA network open · 2024Article
- Controlling fetal stress for preventing adverse health conditions in neonates and children.Frontiers in pain research (Lausanne, Switzerland) · 2024Article
Corrections and comments
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Authors and funding
11 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundClimate change, in particular the exposure to heat, impacts on human health and can trigger diseases. Pregnant people are considered a vulnerable group given the physiological changes during pregnancy and the potentially long-lasting consequences for the offspring. Evidence published to date on higher risk of pregnancy complications upon heat stress exposure are from geographical areas with high ambient temperatures. Studies from geographic regions with temperate climates are sparse; however, these areas are critical since individuals may be less equipped to adapt to heat stress. This study addresses a significant gap in knowledge due to the temperature increase documented globally.
methodsBirth data of singleton pregnancies (n = 42,905) from a tertiary care centre in Hamburg, Germany, between 1999 and 2021 were retrospectively obtained and matched with climate data from the warmer season (March to September) provided by the adjacent federal meteorological station of the German National Meteorological Service to calculate the relative risk of heat-associated preterm birth. Heat events were defined by ascending temperature percentiles in combination with humidity over exposure periods of up to 5 days. Further, ultrasound data documented in a longitudinal prospective pregnancy cohort study (n = 612) since 2012 were used to identify pathophysiological causes of heat-induced preterm birth.
findingsBoth extreme heat and prolonged periods of heat exposure increased the relative risk of preterm birth (RR: 1.59; 95% CI: 1.01-2.43; p = 0.045; RR: 1.20; 95% CI: 1.02-1.40; p = 0.025). We identified a critical period of heat exposure during gestational ages 34-37 weeks that resulted in increased risk of late preterm birth (RR: 1.67; 95% CI: 1.14-1.43; p = 0.009). Pregnancies with a female fetus were more prone to heat stress-associated preterm birth. We found heat exposure was associated with altered vascular resistance within the uterine artery.
interpretationHeat stress caused by high ambient temperatures increases the risk of preterm birth in a geographical region with temperate climate. Prenatal routine care should be revised in such regions to provide active surveillance for women at risk.
fundingFound in acknowledgements.
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