Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Int J Gynaecol Obstet. 2023 Feb;160(2):421-429. doi: 10.1002/ijgo.14381. Epub 2022 Aug 16.
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 co-designed 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.
解剖学、生理学和社会文化变化在妊娠和分娩期间增加了妇女和新生儿对高温环境的脆弱性。极端高温会使孕妇的体温调节机制不堪重负，尤其是在分娩期间，导致脱水和内分泌功能障碍，并损害胎盘功能。临床后果包括高血压疾病、妊娠糖尿病、早产和死产。高温会增加感染率，并影响卫生工作者的绩效和寻求医疗保健的意愿。气候变化和资源有限导致的气温上升加剧了人们的担忧。我们提出了一个适应框架，包含四个方面。首先，行为改变，例如在怀孕期间减少工作量和使用低成本水喷雾。其次，卫生系统干预措施包括以现有的社区外展为中心的早期预警系统；跟踪热健康指标；在分娩期间补充水分并监测与热相关的情况。建筑改造、被动和主动冷却系统以及基于自然的解决方案可以降低设施内的温度。最后，结构干预和气候融资至关重要。干预措施的整体方案，理想情况下应根据成本效益和热模拟权衡进行选择，需要与受影响的社区共同设计和共同提供，并利用现有的母婴健康平台。强有力的应用研究将为整个非洲的针对孕妇的项目奠定基础。充分的研究和气候融资现在是紧迫的。
