Programme d'impulsion

Heat-Preg

Heat stress in pregnancy and the perinatal period: understanding and mitigating risk

| Overview

Duration: 36 months
Budget: 182 000 euros

Scientific coordination:
Johanna Lepeule, Edes Team, U1209 Inserm, IAB

Partner:
Jennifer Zeitlin, EPOPé Team, U1153 Inserm, CRESS

| Context

Climate change has made heat adaptation a public health priority in Western Europe, particularly in heatwave-prone regions like Western Europe. France, for instance, has witnessed a significant increase in heat warnings due to climate change. Accumulating evidence suggests that heat exposure during pregnancy can lead to maternal complications and adverse perinatal outcomes.

However, the underlying causal mechanisms, critical exposure windows and factors affecting vulnerability are poorly understood and there is a need for large-scale and replication studies. These issues arise in part because much of the existing research relies on outcomes that lack specificity in elucidating underlying mechanisms and often overlook maternal complications in their analyses. This knowledge gap hinders evidence-based public health strategies.

| Aims

Heat-Preg aims to provide insights into the physiological mechanisms linking heat exposure during pregnancy to adverse maternal and child health outcomes, identify vulnerable populations, and create a national information system for ongoing surveillance and policy development. Heat-Preg hypotheses that investigating precise clinical definitions of pregnancy complications and outcomes using population data from over 7 million births in France will provide insights into mechanisms and vulnerability to heat exposure’s towards adverse birth outcomes.
Specifically, Heat-Preg will:

  • Develop a national information database including maternal pregnancy complications and neonatal health outcomes as a proof of concept that will be used for the Heat-Preg project and then available for ongoing surveillance and research
  • Create an inventory of heat exposures during pregnancy and the perinatal period
  • Identify pathophysiological mechanisms linking heat and cold exposure to maternal and child outcomes
  • Determine social and clinical factors moderating/exacerbating the impact of temperature exposure

| Methods

Heat-Preg will use hospital discharge and insurance data from the French National System of Health on births from 2014 onwards (7 million births), which includes information on maternal and child health outcomes, morbidity data, and residential address at delivery at the commune level. For each participant, the address will be geocoded to match the socioeconomic context and daily exposure to temperature (and co-exposures) during pregnancy. Various definitions of heat stress will be tested. Combined with the innovative highly resolved temperature exposure data (200m, daily), advanced statistical methods including distributed lag models and regression-based mediation methods, will allow to jointly explore acute (days before events) and chronic (weeks from conception to perinatal period) exposure windows, considering potential confounders and moderators.

| Perspectives

This research project innovatively combines comprehensive and extensive clinical data, high-resolution exposure data and advanced methodologies to fill critical knowledge gaps which will ultimately improve our understanding of the pathophysiological mechanisms linking heat to adverse maternal and child perinatal outcomes in order to improve public health recommendations and interventions in the context of climate change. The project will yield three scientific publications and a database integrating routine pregnancy and perinatal data with environmental exposures. It will also serve as a foundation for a national information system to continuously monitor heat-related health effects during pregnancy, and for an expansion to postnatal outcomes and overseas territories.