{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:13:03Z","timestamp":1793319183894,"version":"4.5.0"},"reference-count":66,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,10,9]],"date-time":"2023-10-09T00:00:00Z","timestamp":1696809600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001409","name":"Department of Science and Technology, Ministry of Science and Technology, India","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001409","id-type":"DOI","asserted-by":"publisher"}]}],"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:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore the relationship between occupational heat exposure, physiological heat strain indicators and adverse outcomes in pregnant women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Workplaces in Tamil Nadu, India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Sample<\/jats:title>\n                    <jats:p>A cohort of 800 pregnant women engaged in moderate to heavy physical work in 2017\u20132019 and 2021\u20132022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants were recruited at between 8 and 14\u2009weeks of gestation. Occupational heat exposure and heat strain indicators were captured each trimester. \u2018Heat exposed\u2019 was defined as heat stress exceeding the threshold limit value (TLV) for safe manual work (with maximum wet\u2010bulb globe temperatures of 27.5\u00b0C for a heavy workload and 28.0\u00b0C 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\u2010related health symptoms were captured using the modified HOTHAPS questionnaire.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u2009\u2265\u20091.020). Heat\u2010exposed women had a doubled risk of miscarriage (adjusted odds ratio, aOR\u20092.4; 95% confidence interval, 95%\u2009CI 1.0\u20135.7). High occupational heat exposure was associated with an increased risk of any adverse pregnancy and foetal outcome (aOR\u20092.3; 95%\u2009CI 1.4\u20133.8) and adverse outcome at birth (aOR\u20092.0; 95%\u2009CI 1.2\u20133.3).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>High occupational heat exposure is associated with HSIs and adverse pregnancy outcomes in India.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.17680","type":"journal-article","created":{"date-parts":[[2023,10,11]],"date-time":"2023-10-11T22:36:00Z","timestamp":1697063760000},"page":"612-622","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":53,"title":["Heat stress and adverse pregnancy outcome: Prospective cohort study"],"prefix":"10.1111","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6390-1162","authenticated-orcid":false,"given":"Shanmugam","family":"Rekha","sequence":"first","affiliation":[{"name":"Department of Environmental Health Engineering Sri Ramachandra Institute of Higher Education and Research  Tamil Nadu Chennai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1583-8001","authenticated-orcid":false,"given":"Sirala Jagadeesh","family":"Nalini","sequence":"additional","affiliation":[{"name":"Faculty of Nursing Sri Ramachandra Institute of Higher Education and Research  Tamil Nadu Chennai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2401-439X","authenticated-orcid":false,"given":"Srinivasan","family":"Bhuvana","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Sri Ramachandra Medical Centre  Tamil Nadu Chennai 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