{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:40:21Z","timestamp":1787240421528,"version":"build-2736575974"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.23172.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T00:00:00Z","timestamp":1738886400000}}],"reference-count":38,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T00:00:00Z","timestamp":1738886400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["227176\/Z\/23\/Z"],"award-info":[{"award-number":["227176\/Z\/23\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns3:p>Climate change has resulted in an increase in heat exposure globally. There is strong evidence that this increased heat stress is associated with poor maternal and fetal outcomes, especially in vulnerable populations. However, there remains poor understanding of the biological pathways and mechanisms involved in the impact of heat in pregnancy. This observational cohort study of 764 pregnant participants based in sub-Saharan Africa, a geographical region at risk of extreme heat events, aims to evaluate the physiological and biochemical changes that occur in pregnancy due to heat stress. The key objectives of the study are to 1) map exposure to heat stress in the cohort and understand what environmental, social and community factors increase the risk of extreme heat exposure; 2) assess the impact of heat stress on maternal health, e.g. heat strain, subjective psychological well-being, sleep and activity level; 3) evaluate how heat stress impacts placenta structure and function; 4) determine how chronic heat exposure impacts birth outcomes; and 5) explore the epigenetic changes in the placenta and infant by heat stress exposure per trimester. Pregnant women will be recruited from two distinct regions in The Gambia to exploit the naturally occurring heat gradient across the country. Microclimate mapping of the area of recruitment will give detailed exposure measurements. Participants will be asked to wear a watch-style device at 28- and 35-weeks gestational age to evaluate maternal heart rate, activity and sleep. At the end of the week, an ultrasound scan will be performed to evaluate fetal size and placental blood flow. At delivery, birth outcomes will be recorded and maternal, placental and cord samples taken for epigenetic, biochemical and histological evaluation. Evaluation of neuro-behaviour and final infant samples will be taken at 1 month following birth.<\/ns3:p>","DOI":"10.12688\/wellcomeopenres.23172.2","type":"journal-article","created":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T11:35:28Z","timestamp":1738928128000},"page":"624","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Study protocol for an observational cohort study of heat stress impacts in pregnancy in The Gambia, West Africa"],"prefix":"10.12688","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5981-762X","authenticated-orcid":false,"given":"Ana","family":"Bonell","sequence":"first","affiliation":[{"name":"Banjul Banjul Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine"},{"name":"Centre on Climate Change and Planetary Health London England London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonidas","family":"G. Ioannou","sequence":"additional","affiliation":[{"name":"Department of Physical Education and Sport Science Thessaly FAME laboratory"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul","family":"Sesay","sequence":"additional","affiliation":[{"name":"Banjul Banjul Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kris","family":"A. Murray","sequence":"additional","affiliation":[{"name":"Banjul Banjul Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine"},{"name":"Centre on Climate Change and Planetary Health London England London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3318-6668","authenticated-orcid":false,"given":"Bubacarr","family":"Bah","sequence":"additional","affiliation":[{"name":"Banjul Banjul Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Jeffries","sequence":"additional","affiliation":[{"name":"Banjul Banjul Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1650-3238","authenticated-orcid":false,"given":"Sophie","family":"E. Moore","sequence":"additional","affiliation":[{"name":"Banjul Banjul Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine"},{"name":"London England King's College London Department of Women & Children's Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Vicero-Cabrera","sequence":"additional","affiliation":[{"name":"Institute of Social and Preventative Medicine Bern University of Bern"},{"name":"Bern Canton of Bern University of Bern Oeschger Centre for Climate Change Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"S Maxwell","sequence":"additional","affiliation":[{"name":"Environmental Extremes Laboratory Brighton England University of Brighton"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0176-2651","authenticated-orcid":false,"given":"Jane","family":"E Hirst","sequence":"additional","affiliation":[{"name":"Oxford 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status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/wellcomeopenres.26241.r118297, Caitlin Wyrwoll, School of Human Sciences, The University of Western Australia, Crawley, WA, 24 Feb 2025, version 2, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/9-624\/v2#referee-response-118297","order":0,"name":"referee-response-118297","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.25517.r112341, Pam Factor-Litvak, Columbia University,, New York, 07 Dec 2024, version 1, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/9-624\/v1#referee-response-112341","order":1,"name":"referee-response-112341","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Ana Bonell<\/b>; \n<i>Posted: 04 Feb 2025<\/i>; \n<b>Minor comments:<\/b>  1. Birth outcome assessments: please standardize the timing of collection because, for example, birth weight can vary between delivery and 72 hours after birth.&nbsp; Or, alternatively, collect these data at both times. &nbsp;  \n<b>Author response:&nbsp;<\/b>Thank you for this comment. We endeavour to capture all birth anthropometry at the time of delivery, but in some cases (if the delivery occurs outside of the hospitals we are working in or at home) then we may miss this. Only in those cases, do we then visit the participants to collect the anthropometry and birth details, and we have a window of 72 hours otherwise the data will be recorded as missing. All the anthropometric data is time and date stamped so we should be able to determine if there has been a delay in recording the data and manage the data accordingly. The following text has been changed to reflect this (section 3.9) &nbsp; Neonatal anthropometric measurements will be taken at birth, to include birth weight, birth length, head circumference and infant sex, as well as a final maternal blood sample. On the occasion where participants deliver outside of the study hospital or the study team are unable to attend the birth, neonatal anthropometry will be collected up to 72 hours of birth and otherwise will be coded as missing.  2. Will the newborn anthropometrics be collected at the time of the NBAS assessment and at the final assessment at 28 days? &nbsp;  \n<b>Author response:&nbsp;<\/b>The NBAS assessment will take place at around 28 days, along with a final review of the infant, a brief clinical exam and a short survey. The newborn anthropometry will be completed within 72 hours of delivery, but mostly at the time of delivery and only in exceptional circumstances will this be delayed to 72 hours. Please see changed to text (section 3.11) &nbsp; Each newborn will be assessed once at around 28 days using the NBAS Brazelton scale which includes 28 behavioral and 18 reflex responses. This assessment will be completed at the participant\u2019s home or the clinic, in a quiet and safe place, mid-way between feeds. Assessment usually takes 20-30 minutes and is an interactive assessment covering how the baby responds to light and sound when asleep and how they follow faces and objects when awake.  3. The fecal swab for microbiota at 28 days is important.&nbsp; Perhaps consider also getting a meconium swab as well.&nbsp; In that way you may be able to determine changes in the microbiota related to heat stress.&nbsp; &nbsp;  \n<b>Author response:&nbsp;<\/b>Thank you for this comment. As indicated this is an important study and would require several other samples to allow a detailed and comprehensive analysis. Therefore after careful consideration of budget and man-power constraints we have dropped this aspect of the study. We have removed this completely from the study protocol and will hope that a different cohort will have the capacity to focus on this.  4. I would suggest considering using distributed lag models to assess possible critical times of exposure to heat stress for the various outcomes. &nbsp;  \n<b>Author response:&nbsp;<\/b>Thank you for this comment. We will certainly consider a distributed lag model \u2013 we have added this to the data analysis plan in section 7.5, see below text: &nbsp; Linear, non-linear, non-linear distributed lag models and logistic regression models will be used for these analyses.","URL":"https:\/\/wellcomeopenresearch.org\/articles\/9-624\/v2#referee-comment-6025","order":2,"name":"referee-comment-6025","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.25517.r114245, Zhiwei Xu, Griffith University, Gold Coast, 16 Dec 2024, version 1, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/9-624\/v1#referee-response-114245","order":3,"name":"referee-response-114245","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This work was supported by Wellcome [227176\/Z\/23\/Z]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}