New research: Extreme heat doubling miscarriages, and flooding is causing 100,000 miscarriages

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Fig. 3: Odds ratios of pregnancy loss associated with gestational flood exposure, classified by socioeconomic factors, living conditions, and flood duration. from: He, C., Zhu, Y., Zhou, L. et al. Flood exposure and pregnancy loss in 33 developing countries. Nat Commun 15, 20 (2024). https://doi.org/10.1038/s41467-023-44508-0

The climate killer we ignore: Women are losing babies. I call it ‘maternalcide’

Nathalie Beasnael

November 17, 2024 the Age

Extreme temperatures are accelerating a global crisis of maternal mortality, doubling the rate of miscarriage in the hottest countries (below) while dramatically increasing the risk of still- or premature birth. More than 100,000 pregnancies are lost every year due to flooding alone, and that’s only in the 33 countries studied for a recent report in the journal Nature Communications (below).

This disturbing reality is deeply personal for me as the US diplomatic envoy for the Republic of Chad, a country that’s reeling from a cataclysmic flood affecting 1.7 million people. It is also suffering from a fivefold surge of mpox infections in Africa.

But this is just the tip of the rapidly melting iceberg. From Florida and Californiato Chad and Peru, soaring heat and compounding natural disasters are causing women to lose babies to heart-related illnesses, mosquito-borne viruses and other fetal abnormalities at record rates.

But as world leaders assemble at the COP29 climate summit, women and children are being ignored. Of the 119 countries that have submitted climate commitments to the UN, only 27 include any action relating to – what I am calling – a burgeoning “maternalcide”. Unless we act now, this decline in maternal and newborn health could fundamentally alter the very fabric of our society, catalysing a social, economic and health crisis unlike anything humanity has endured before.

More than half of the world’s countries are already enduring a dramatic fall in fertility rates, a trend that is destabilising economies and burdening healthcare systems. Japan’s population is shrinking by almost 100 people per hour, and even China, home to a sixth of the world’s population, is expected to lose half of its population by 2100.

This global demographic shift, accelerated by climate-related maternal mortality, risks triggering a permanent feedback loop of escalating vulnerability. As societies grow less stable, we become increasingly ill-equipped to tackle climate change, compounding relentless geopolitical turmoil and economic struggles of recent years. This decline in our resilience will inevitably push women’s health even further down the priority list, creating a self-destructive spiral.

And that is why leaders at this year’s COP must set a new mandate, obliging countries to include practical actions on maternal and reproductive health in their climate plans.

Options could include establishing climate-resilient maternal health zones, providing urgent medical care as well as hydration stations and cooling systems. Healthcare workers should be trained to recognise and respond to the kind of climate-related pregnancy risks that led to recent preventable deaths in the hurricane-struck US.

Technological solutions must be scaled up to reach those who need them the most. Imagine how many lives could be saved if, for example, NASA’s latest AI model for the prediction of extreme weather was available in remote parts of the Global South.

More importantly, we must empower women. This means funding climate education, which the UN champions as a way to make women and girls “agents of change” to usher in a new era of sustainable living. Companies such as Unilever, Mars and Nestle have been funding such programs for decades, recognising them as an important investment in their supply chains.

The global advocacy Women Deliver is funding grassroots projects that empower local groups and young leaders to take charge of sexual health, reproductive rights and climate justice. The Muslim World League’s coming conference in Pakistan will convene thousands of scholars and politicians, including the prime minister of Pakistan, to launch a new charter on girls’ education in Muslim communities across the Global South. This initiative will be spearheaded by the league’s secretary-general, Mohammad Al-Issa, who has argued women – and their right to education – are key to tackling the climate crisis in the Muslim world.

As COP29 proceeds, the stakes for women’s health could not be higher. Already Donald Trump’s election in the US has sent shockwaves through the summit: governments, businesses and civil society organisations have cut their delegations or skipped the UN summit altogether.

But we cannot be deterred. Delegates at COP29 must recognise that protecting mothers and children is not a side issue. It’s the heartbeat of humanity’s future.

Nathalie Beasnael is the founder of Health4Peace, which provides medical supplies to hospitals in Chad, Senegal, Ghana, South Africa and Nigeria. She is the diplomatic envoy for the Republic of Chad to the US and was a delegate at COP28.

Flood exposure and pregnancy loss in 33 developing countries

Nature Communications volume 15, Article number: 20 (2024) Cite this article

Abstract

Floods have affected billions worldwide. Yet, the indirect health impacts of floods on vulnerable groups, particularly women in the developing world, remain underexplored. Here, we evaluated the risk of pregnancy loss for women exposed to floods. We analyzed 90,465 individual pregnancy loss records from 33 developing countries, cross-referencing each with spatial-temporal flood databases. We found that gestational flood exposure is associated with increased pregnancy loss with an odds ratio of 1.08 (95% confidence interval: 1.04 – 1.11). This risk is pronounced for women outside the peak reproductive age range (<21 or >35) or during the mid and late-stage of pregnancy. The risk escalated for women dependent on surface water, with lower income or education levels. We estimated that, over the 2010s, gestational flood events might be responsible for approximately 107,888 (CIs: 53,944 – 148,345) excess pregnancy losses annually across 33 developing countries. Notably, there is a consistent upward trend in annual excess pregnancy losses from 2010 to 2020, and was more prominent over Central America, the Caribbean, South America, and South Asia. Our findings underscore the disparities in maternal and child health aggravated by flood events in an evolving climate.

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Heat stress and adverse pregnancy outcome: Prospective cohort study

Rekha S, Nalini SJ, Bhuvana S, Kanmani S, Hirst JE, Venugopal V. Heat stress and adverse pregnancy outcome: Prospective cohort study. BJOG. 2024; 131(5): 612–622.

Abstract

Objective

To explore the relationship between occupational heat exposure, physiological heat strain indicators and adverse outcomes in pregnant women.

Design

Prospective cohort.

Setting

Workplaces in Tamil Nadu, India.

Sample

A cohort of 800 pregnant women engaged in moderate to heavy physical work in 2017–2019 and 2021–2022.

Methods

Participants were recruited at between 8 and 14 weeks of gestation. Occupational heat exposure and heat strain indicators were captured each trimester. ‘Heat exposed’ was defined as heat stress exceeding the threshold limit value (TLV) for safe manual work (with maximum wet-bulb globe temperatures of 27.5°C for a heavy workload and 28.0°C for a moderate workload). Physiological heat strain indicators (HSIs) such as core body temperature (CBT) and urine specific gravity (USG) were measured before and after each shift. Heat-related health symptoms were captured using the modified HOTHAPS questionnaire.

Main outcome measures

The main outcome measures included (1) a composite measure of any adverse pregnancy outcome (APO) during pregnancy (including miscarriage, preterm birth, low birthweight, stillbirth, intrauterine growth restriction and birth defects), (2) a composite measure of adverse outcomes at birth (3) and miscarriage.

Results

Of the 800 participants, 47.3% had high occupational heat exposure. A rise in CBT was recorded in 17.4% of exposed workers, and 29.6% of workers experienced moderate dehydration (USG ≥ 1.020). Heat-exposed women had a doubled risk of miscarriage (adjusted odds ratio, aOR 2.4; 95% confidence interval, 95% CI 1.0–5.7). High occupational heat exposure was associated with an increased risk of any adverse pregnancy and foetal outcome (aOR 2.3; 95% CI 1.4–3.8) and adverse outcome at birth (aOR 2.0; 95% CI 1.2–3.3).

Conclusions

High occupational heat exposure is associated with HSIs and adverse pregnancy outcomes in India.

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