Expert Review: Confronting Climate-Driven Heat Risks to Maternal and Fetal Health

Importance In the current era of climate change, extreme heat exposure poses escalating threats to maternal-fetal health. Despite the expansive scale of extreme heat exposure worldwide, dramatized by the record-breaking global ocean and atmospheric temperatures throughout 2023 and into 2024, the extent of the threat posed by heat is underestimated and underappreciated. Unlike the physical destruction wrought by climate-driven events like hurricanes and wildfires, heat exposure does not cause severe damage to the built environment. Yet, in most years, heat has been the deadliest hazard in the United States. Objective This expert review aims to illuminate how climate-related heat affects maternal-fetal health and exacerbates health inequities. It will also discuss current knowledge gaps and underscore the crucial role that obstetric providers play in safeguarding pregnant persons from exposure to hazardous heat and increasing patient awareness of climate-related heat. Evidence Acquisition Evidence for this review was primarily acquired through a comprehensive search of PubMed-indexed articles using MeSH terms and text words to search for concepts related to “climate change,” “heat,” “obstetrics,” “pregnancy,” “heat stress disorders,” and their synonyms. Results Extreme heat exposure threatens the health and well-being of pregnant persons and elevates the likelihood of poor birth outcomes like preterm birth, fetal demise, and stillbirth, among other pregnancy complications. Extreme heat exposure also increases the risk of dehydration, heat exhaustion, heat stroke, and gestational hypertension for pregnant persons. Conclusions and Relevance Ultimately, obstetric professionals are essential to improving the care of pregnant persons at increased risk from salient climate-related heat exposure. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After completing this activity, the learner will be better able to explain the adverse health and pregnancy outcomes associated with climate-related heat or extreme heat exposure; describe current gaps in the literature and what research and guidelines are needed to better the field's understanding of how climate-related heat affects obstetric patients; and identify strategies for communities, providers, and patients to minimize the health harms of climate-related heat or extreme heat exposure.