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Previous studies have established a correlation between heat exposure and adverse pregnancy outcomes, including preterm birth, stillbirth, and other maternal and fetal health complications. However, evidence on the physiological pathways underlying heat strain during pregnancy and on whether heat adaptation strategies can modify these responses remains limited, particularly in low-resource settings. This study aims to assess the effects of environmental heat exposure on maternal and fetal physiological responses among pregnant women exposed and unexposed to a heat adaptation strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Physio-HeMAB is an interventional, cluster-randomized study hosted by the Health and Demographic Surveillance System in Navrongo, Ghana. This study integrates: (i) high-resolution environmental monitoring including Wet-Bulb Globe Temperature at household level and Universal Thermal Climate Index environmental data at regional level; (ii) continuous maternal physiological assessment via wearable devices measuring heart rate, heart rate variability, core body temperature, physical activity, and sleep; and (iii) fetal health assessments, including fetal heart rate and Doppler indices. This multimodal framework supports detailed assessment of how varying levels of environmental heat exposure relate to maternal physiological changes and fetal health indicators. Descriptive and multivariable statistical methods will be used to analyze the data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>A better understanding of the physiological mechanisms of heat strain during pregnancy, and an evaluation of whether targeted adaptation strategies can mitigate its effects, are essential for protecting maternal and neonatal health. This Physio-HeMAB study integrates individual-level physiological responses to environmental heat exposure and heat adaptation strategies. This approach strengthens the evidence for developing context-specific and gender-responsive public health interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>This study was registered in the Pan African Clinical Trials Registry as PACTR202601761543866 on 05 January 2026.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12889-026-28030-8","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T14:28:31Z","timestamp":1783348111000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Investigating environmental heat exposure and its effects on maternal and fetal health in rural Northern Ghana (Physio-HeMAB Study): a study protocol for a cluster randomized trial"],"prefix":"10.1186","volume":"26","author":[{"given":"Rachel Sophie","family":"Zimmer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edmund","family":"Yeboah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lila Sax Dos Santos","family":"Gomes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Fiebig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Torres","family":"Reyes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"Hermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Kampim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Callistus Ireneous","family":"Nakpih","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalena","family":"Horst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Bergner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Riemer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Wallwiener","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilbert Abotisem","family":"Abiiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Akazili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan W.","family":"Kantelhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina Anna","family":"Maggioni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuela","family":"De Allegri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Azongo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva J.","family":"Kantelhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"issue":"9676","key":"28030_CR1","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1016\/S0140-6736(09)60935-1","volume":"373","author":"A Costello","year":"2009","unstructured":"Costello A, Abbas M, Allen A, Ball S, Bell S, Bellamy R, et al. 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Available from: URL: https:\/\/www.mindtecstore.com\/mediafiles\/Sonstiges\/Shop\/Greenteg\/CALERA%20Research_Manual%20EN.pdf?srsltid=AfmBOooUkxMjLWS_8wcjCP7F_t56cdRv7oNn2NdS8l9SJuRj6Tbqzd6f.\u00a0Cited 2025 Nov 14."}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12889-026-28030-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-026-28030-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-026-28030-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T14:43:09Z","timestamp":1783348989000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12889-026-28030-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,6]]},"references-count":51,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["28030"],"URL":"https:\/\/doi.org\/10.1186\/s12889-026-28030-8","relation":{},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,6]]},"assertion":[{"value":"9 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol has received ethical approval from the Review Board of the Ethics Committee of the Medical Faculty, Heidelberg University (S-042\/2025); and the Institutional Review Board of the Navrongo Health Research Centre (NHRCIRB). The study will be conducted in accordance with the principles of the Declaration of Helsinki. All personal data and responses from participants will be handled with medical confidentiality and managed in accordance with the General Data Protection Regulation (GDPR) and relevant national and federal data protection laws.Substantive protocol changes will be documented as formal amendments and submitted to the ethics committee for approval before implementation, as required. All amendments will be dated, version-controlled, archived, and communicated to the team, funders, and partners. Minor administrative changes that do not affect safety or study integrity will be noted but may not require formal ethics approval. Participants will be identified only by unique ID numbers in all data forms and databases. Identifiable data will not be shared or published. Written informed consent will be obtained from all study participants. For illiterate participants, consent will be recorded via thumbprint in the presence of an impartial witness.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent will obtained from the participants. The document is available upon request to the corresponding author.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"2056"}}