Bonell Ana, Hirst Jane, Vicedo-Cabrera Ana M, Haines Andy, Prentice Andrew M, Maxwell Neil S
Medical Research Council Gambia @ London School of Hygiene and Tropical Medicine, Fajara, The Gambia.
Nuffield Department of Women's and Reproductive Health and the George Institute for Global Health, University of Oxford, Oxford, UK.
Wellcome Open Res. 2020 Mar 31;5:32. doi: 10.12688/wellcomeopenres.15731.2. eCollection 2020.
Climate change predictions indicate that global temperatures are likely to exceed those seen in the last 200,000 years, rising by around 4°C above pre-industrial levels by 2100 (without effective mitigation of current emission rates). In regions of the world set to experience extreme temperatures, women often work outside in agriculture even during pregnancy. The implications of heat strain in pregnancy on maternal health and pregnancy outcome are not well understood. This protocol describes a study to assess the physiological response of pregnant women to environmental heat stress and the immediate effect this has on fetal wellbeing. The study will be performed in West Kiang district, The Gambia; a semi-arid zone in West Africa with daily maximum temperatures ranging from approximately 32 to 40°C. We will recruit 125 pregnant women of all ages who perform agricultural work during their pregnancy. Participants will be followed every two months until delivery. At each study visit fetal growth will be measured by ultrasound scan. During the course of their working day we will take the following measurements: continuous maternal physiological measurements (heart rate, respiratory rate, chest skin temperature and tri-axis accelerometer data); intermittent maternal tympanic core temperature, four point skin temperature, blood pressure; intermittent fetal heart rate and, if eligible, umbilical artery doppler; intermittent environmental measurements of air temperature, humidity, solar radiation and wind speed. Venous blood and urine will be collected at beginning and end of day for biomarkers of heat strain or fetal distress and hydration status.
气候变化预测表明，全球气温很可能超过过去20万年的水平，到2100年将比工业化前水平上升约4°C（前提是不有效减缓当前的排放率）。在世界上即将经历极端气温的地区，即使在怀孕期间，女性也经常在户外从事农业劳动。孕期热应激对孕产妇健康和妊娠结局的影响尚未得到充分了解。本方案描述了一项研究，旨在评估孕妇对环境热应激的生理反应以及这对胎儿健康的直接影响。该研究将在冈比亚的西江区进行；西非的一个半干旱地区，日最高气温约为32至40°C。我们将招募125名在孕期从事农业劳动的各年龄段孕妇。参与者将每两个月随访一次直至分娩。每次研究访视时，将通过超声扫描测量胎儿生长情况。在她们的工作日期间，我们将进行以下测量：连续的孕产妇生理测量（心率、呼吸频率、胸部皮肤温度和三轴加速度计数据）；间歇性的孕产妇鼓膜核心温度、四点皮肤温度、血压；间歇性的胎儿心率，以及符合条件时的脐动脉多普勒检查；间歇性的环境测量，包括气温、湿度、太阳辐射和风速。将在一天开始和结束时采集静脉血和尿液，用于检测热应激或胎儿窘迫的生物标志物以及水合状态。
