{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T20:19:46Z","timestamp":1789417186331,"version":"build-2803163510"},"reference-count":89,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T00:00:00Z","timestamp":1690502400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Exposure to extreme heat in pregnancy increases the risk of stillbirth. Progress in reducing stillbirth rates has stalled, and populations are increasingly exposed to high temperatures and climate events that may further undermine health strategies. This narrative review summarises the current clinical and epidemiological evidence of the impact of maternal heat exposure on stillbirth risk. Out of 20 studies, 19 found an association between heat and stillbirth risk. Recent studies based in low\u2010 to middle\u2010income countries and tropical settings add to the existing literature to demonstrate that all populations are at risk. Additionally, both short\u2010term heat exposure and whole\u2010pregnancy heat exposure increase the risk of stillbirth. A definitive threshold of effect has not been identified, as most studies define exposure as above the 90th centile of the usual temperature for that population. Therefore, the association between heat and stillbirth has been found with exposures from as low as &gt;12.64\u00b0C up to &gt;46.4\u00b0C. The pathophysiological pathways by which maternal heat exposure may lead to stillbirth, based on human and animal studies, include both placental and embryonic or fetal impacts. Although evidence gaps remain and further research is needed to characterise these mechanistic pathways in more detail, preliminary evidence suggests epigenetic changes, alteration in imprinted genes, congenital abnormalities, reduction in placental blood flow, size and function all play a part. Finally, we explore this topic from a public health perspective; we discuss and evaluate the current public health guidance on minimising the risk of extreme heat in the community. There is limited pregnancy\u2010specific guidance within heatwave planning, and no evidence\u2010based interventions have been established to prevent poor pregnancy outcomes. We highlight priority research questions to move forward in the field and specifically note the urgent need for evidence\u2010based interventions that are sustainable.<\/jats:p>","DOI":"10.1111\/1471-0528.17622","type":"journal-article","created":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T03:46:16Z","timestamp":1690515976000},"page":"623-631","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":55,"title":["An expert review of environmental heat exposure and stillbirth in the face of climate change: Clinical implications and priority issues"],"prefix":"10.1111","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5981-762X","authenticated-orcid":false,"given":"Ana","family":"Bonell","sequence":"first","affiliation":[{"name":"Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine  Fajara The Gambia"},{"name":"Centre on Climate Change and Planetary Health London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cherie","family":"Part","sequence":"additional","affiliation":[{"name":"Centre on Climate Change and Planetary Health London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uduak","family":"Okomo","sequence":"additional","affiliation":[{"name":"Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine  Fajara The Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Cole","sequence":"additional","affiliation":[{"name":"Centre on Climate Change and Planetary Health London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shakoor","family":"Hajat","sequence":"additional","affiliation":[{"name":"Centre on Climate Change and Planetary Health London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sari","family":"Kovats","sequence":"additional","affiliation":[{"name":"Centre on Climate Change and Planetary Health London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda N.","family":"Sferruzzi\u2010Perri","sequence":"additional","affiliation":[{"name":"Department of Physiology, Development and Neuroscience, Centre for Trophoblast Research University of Cambridge  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0176-2651","authenticated-orcid":false,"given":"Jane E.","family":"Hirst","sequence":"additional","affiliation":[{"name":"Nuffield Department of Women's and Reproductive Health, University of Oxford  Oxford UK"},{"name":"The George Institute for Global Health Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,28]]},"reference":[{"key":"e_1_2_14_2_1","volume-title":"A neglected tragedy the global burden of stillbirths: report of the UN Inter\u2010Agency Group for Child Mortality Estimation, 2020","author":"Hug L","year":"2020"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00836-3"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00954-X"},{"key":"e_1_2_14_5_1","volume-title":"Every newborn progress report 2019","year":"2020"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)01112-0"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2022.101706"},{"key":"e_1_2_14_8_1","first-page":"37","volume-title":"Climate change 2022: impacts, adaptation and vulnerability","author":"P\u00f6rtner H\u2010O","year":"2022"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)61038-8"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(15)60901\u20101"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.14124"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1289\/EHP171"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/0265673021000039628"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2019.02.023"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1289\/EHP5117"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12397"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwy116"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwr404"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2021.111037"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m3811"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00484-017-1402-5"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2021.106902"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40201-020-00547-z"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-022-01344-7"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2023.115385"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2022.155750"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-23155-3"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2020.109958"},{"key":"e_1_2_14_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2019.105067"},{"key":"e_1_2_14_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2021.111262"},{"key":"e_1_2_14_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12940-022-00870-y"},{"key":"e_1_2_14_32_1","doi-asserted-by":"publisher","DOI":"10.1093\/biostatistics\/kxl013"},{"key":"e_1_2_14_33_1","volume-title":"Analysis of time\u2010stratified case\u2010crossover studies in environmental epidemiology using Stata","author":"Tobias A","year":"2014"},{"issue":"1","key":"e_1_2_14_34_1","first-page":"200","article-title":"Elevated outdoor temperatures and risk of stillbirth","volume":"46","author":"Auger N","year":"2017","journal-title":"Int J Epidemiol"},{"key":"e_1_2_14_35_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwv295"},{"key":"e_1_2_14_36_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-81496-x"},{"key":"e_1_2_14_37_1","doi-asserted-by":"publisher","DOI":"10.12688\/wellcomeopenres.15731.1"},{"key":"e_1_2_14_38_1","doi-asserted-by":"publisher","DOI":"10.1152\/advan.00126.2014"},{"key":"e_1_2_14_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.recesp.2011.07.009"},{"key":"e_1_2_14_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00484-022-02301-6"},{"key":"e_1_2_14_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-021-01504-y"},{"key":"e_1_2_14_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtherbio.2021.103011"},{"key":"e_1_2_14_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(20)30343-0"},{"key":"e_1_2_14_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12633"},{"key":"e_1_2_14_45_1","doi-asserted-by":"publisher","DOI":"10.1002\/tcm.1770060610"},{"key":"e_1_2_14_46_1","doi-asserted-by":"publisher","DOI":"10.21451\/1984-3143-AR2019-0063"},{"key":"e_1_2_14_47_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-032476"},{"key":"e_1_2_14_48_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-999422"},{"key":"e_1_2_14_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(22)00242-X"},{"key":"e_1_2_14_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2020.105682"},{"key":"e_1_2_14_51_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.14480"},{"key":"e_1_2_14_52_1","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.1003241"},{"issue":"1","key":"e_1_2_14_53_1","first-page":"17","article-title":"Some aspects of placental function in chronically heat\u2010stressed ewes","volume":"9","author":"Bell AW","year":"1987","journal-title":"J Dev Physiol"},{"key":"e_1_2_14_54_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1986.60.5.1759"},{"key":"e_1_2_14_55_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22084147"},{"key":"e_1_2_14_56_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdrb.20254"},{"issue":"1","key":"e_1_2_14_57_1","first-page":"71","article-title":"Mechanisms involved in exercise\u2010induced cardioprotection: a systematic review","volume":"105","author":"Borges JP","year":"2015","journal-title":"Arq Bras Cardiol"},{"key":"e_1_2_14_58_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-016-0538-5"},{"key":"e_1_2_14_59_1","doi-asserted-by":"publisher","DOI":"10.1113\/EP088563"},{"key":"e_1_2_14_60_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/6.2.149"},{"key":"e_1_2_14_61_1","doi-asserted-by":"publisher","DOI":"10.1159\/000334408"},{"key":"e_1_2_14_62_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2013.795535"},{"key":"e_1_2_14_63_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-96374-9"},{"key":"e_1_2_14_64_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1098-0997(1999)7:4<180::AID-IDOG3>3.0.CO;2-7"},{"key":"e_1_2_14_65_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.1998.tb08327.x"},{"key":"e_1_2_14_66_1","doi-asserted-by":"publisher","DOI":"10.1186\/1476-069X-9-42"},{"key":"e_1_2_14_67_1","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.1307986"},{"key":"e_1_2_14_68_1","doi-asserted-by":"publisher","DOI":"10.1189\/jlb.3MR0615-272RR"},{"key":"e_1_2_14_69_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jri.2016.11.008"},{"key":"e_1_2_14_70_1","doi-asserted-by":"publisher","DOI":"10.1111\/aji.13017"},{"key":"e_1_2_14_71_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2017.11.004"},{"key":"e_1_2_14_72_1","doi-asserted-by":"publisher","DOI":"10.1093\/pnasnexus\/pgac309"},{"key":"e_1_2_14_73_1","doi-asserted-by":"publisher","DOI":"10.2353\/ajpath.2008.071193"},{"key":"e_1_2_14_74_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1907548116"},{"key":"e_1_2_14_75_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrg.2016.59"},{"key":"e_1_2_14_76_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms19113425"},{"key":"e_1_2_14_77_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yfrne.2019.100773"},{"key":"e_1_2_14_78_1","doi-asserted-by":"publisher","DOI":"10.2337\/db10-0979"},{"key":"e_1_2_14_79_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1016-8478(23)17572-8"},{"key":"e_1_2_14_80_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12192-019-01002-1"},{"key":"e_1_2_14_81_1","doi-asserted-by":"publisher","DOI":"10.1002\/mrd.23040"},{"key":"e_1_2_14_82_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-32975-1"},{"key":"e_1_2_14_83_1","doi-asserted-by":"publisher","DOI":"10.1111\/jnc.14014"},{"key":"e_1_2_14_84_1","volume-title":"Protecting children from heat stress. A technical note","author":"UNICEF","year":"2023"},{"key":"e_1_2_14_85_1","unstructured":"Committee FR.Climate crisis and health.2020[cited 2023 May 5]. Available from:https:\/\/www.figo.org\/news\/statement\u2010climate\u2010crisis\u2010and\u2010health"},{"key":"e_1_2_14_86_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)01209-5"},{"key":"e_1_2_14_87_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-14-1112"},{"issue":"1","key":"e_1_2_14_88_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2021-006845","article-title":"Impact of community education on heat\u2010related health outcomes and heat literacy among low\u2010income communities in Karachi, Pakistan: a randomised controlled trial","volume":"7","author":"Junaid Abdul R","year":"2022","journal-title":"BMJ Glob Health"},{"key":"e_1_2_14_89_1","doi-asserted-by":"publisher","DOI":"10.3390\/urbansci4040053"},{"key":"e_1_2_14_90_1","unstructured":"Wellcome Trust.Biological vulnerability to extreme heat in maternal and child health.2022[cited 2023 Jun 13]. Available from:https:\/\/wellcome.org\/grant\u2010funding\/schemes\/biological\u2010vulnerability\u2010extreme\u2010heat\u2010maternal\u2010and\u2010child\u2010health"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.17622","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T04:12:34Z","timestamp":1710735154000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.17622"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,28]]},"references-count":89,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["10.1111\/1471-0528.17622"],"URL":"https:\/\/doi.org\/10.1111\/1471-0528.17622","archive":["Portico"],"relation":{"has-preprint":[{"id-type":"doi","id":"10.22541\/au.168682920.05412223\/v1","asserted-by":"object"}]},"ISSN":["1470-0328","1471-0528"],"issn-type":[{"value":"1470-0328","type":"print"},{"value":"1471-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,28]]},"assertion":[{"value":"2023-06-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-28","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}