{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T15:41:34Z","timestamp":1784907694507,"version":"3.55.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Maternal hypertensive disorders (MHD) are major causes of maternal mortality and perinatal complications worldwide, and their disability burden has risen with pronounced geographic disparities. Under global warming, heat stress is increasingly implicated in dysregulated blood pressure during pregnancy, yet robust global-scale evidence remains limited.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We combined age-standardized years lived with disability (AS-YLDs) from MHD for 204 countries (1990\u20132021) with wet-bulb globe temperature (WBGT). Restricted cubic splines were used to characterize nonlinear WBGT\u2013AS-YLDs associations. Analyses were stratified by five Sociodemographic Index (SDI) levels and adjusted for environmental and behavioral covariates (body-mass index, air pollution, tobacco use, alcohol consumption, iron deficiency) plus calendar-year fixed effects. Sensitivity analyses further stratified by climate zones.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Globally, WBGT showed a significant nonlinear association with MHD AS-YLDs, approximating a <jats:italic>U<\/jats:italic>-shaped curve. The lowest burden occurred near 11.7 \u00b0C, followed by increases beyond this point, a brief dip around 23.5 \u00b0C, and renewed rise above 27 \u00b0C. Similar <jats:italic>J<\/jats:italic>-\/<jats:italic>U<\/jats:italic>-shaped patterns appeared in low\u2013median, median, and high\u2013median SDI strata, with modest shifts in inflection temperatures; low-SDI countries showed a pronounced <jats:italic>J<\/jats:italic>-shape, whereas high-SDI countries exhibited no clear nonlinearity. WBGT and SDI displayed stronger associations with MHD burden than other covariates. Year fixed effects were generally small and often non-significant. Results were consistent across climate-zone strata.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study quantifies a global, nonlinear relationship between WBGT and the MHD disability burden, with heterogeneous effects across development levels. The findings highlight heat exposure as a potential threat to maternal health under climate change and support targeted mitigation and adaptation\u2014especially in low- and median-SDI settings.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1678469","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T05:30:15Z","timestamp":1760074215000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Nonlinear association between wet-bulb globe temperature and maternal hypertensive disorders burden: a global analysis from 1990 to 2021"],"prefix":"10.3389","volume":"13","author":[{"given":"Boya","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonghui","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhan","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Duan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiujie","family":"Dou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Senlin","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,10]]},"reference":[{"key":"B1","first-page":"251","article-title":"Hypertensive disorders of pregnancy","volume":"109","author":"Farahi","year":"2024","journal-title":"Am Fam Physician."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1513","DOI":"10.1038\/s41598-025-85819-0","article-title":"Trends in global and regional incidence and prevalence of hypertensive disordersin pregnancy (1990-2021): an age-period-cohort analysis","volume":"15","author":"Sun","year":"2025","journal-title":"Sci Rep"},{"key":"B3","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1016\/j.ajog.2023.03.034","article-title":"Hypertensive disorders of pregnancy and long-term risk of maternal stroke-a systematic review and meta-analysis","volume":"229","author":"Brohan","year":"2023","journal-title":"Am J Obstet Gynecol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1007\/s11906-014-0475-3","article-title":"Contag, maternal preeclampsia and risk for cardiovascular disease in offspring","volume":"16","author":"Herrera-Garcia","year":"2014","journal-title":"Curr Hypertens Rep."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1074","DOI":"10.1001\/jama.2023.16991","article-title":"Screening for hypertensive disorders of pregnancy: US preventive services task force final recommendation statement","volume":"330","author":"Barry","year":"2023","journal-title":"JAMA"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2288586","DOI":"10.1080\/10641955.2023.2288586","article-title":"Associations between extreme temperature exposure and hypertensive disorders in pregnancy: a systematic review and meta-analysis","volume":"42","author":"Mao","year":"2023","journal-title":"Hypertens Pregnancy"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e0003540","DOI":"10.1371\/journal.pgph.0003540","article-title":"Impact of climate change on maternal health outcomes: an evidence gap map review","volume":"4","author":"Meherali","year":"2024","journal-title":"PLOS Glob Public Health"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2925","DOI":"10.1038\/s41467-020-16775-8","article-title":"Association between ambient temperature and hypertensive disorders in pregnancy in China","volume":"11","author":"Xiong","year":"2020","journal-title":"Nat Commun"},{"key":"B9","doi-asserted-by":"publisher","first-page":"117107","DOI":"10.1016\/j.envres.2023.117107","article-title":"Ambient temperature and preeclampsia: a historical cohort study","volume":"238","author":"Youssim","year":"2023","journal-title":"Environ Res"},{"key":"B10","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1186\/s12884-024-06512-0","article-title":"Impacts of heat exposure in utero on long-term health and social outcomes: a systematic review","volume":"24","author":"Brink","year":"2024","journal-title":"BMC Pregnancy Childbirth"},{"key":"B11","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1016\/j.envint.2018.05.007","article-title":"Pregnancy exposure to atmospheric pollution and meteorological conditions and placental DNA methylation","volume":"118","author":"Abraham","year":"2018","journal-title":"Environ Int"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1365","DOI":"10.1289\/ehp.1206430","article-title":"Ambient air pollution and preeclampsia: a spatiotemporal analysis","volume":"121","author":"Dadvand","year":"2013","journal-title":"Environ Health Perspect"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e000308","DOI":"10.1136\/bmjph-2023-000308","article-title":"A scoping review on heat indices used to measure the effects of heat on maternal and perinatal health","volume":"2","author":"Brimicombe","year":"2024","journal-title":"BMJ Public Health"},{"key":"B14","doi-asserted-by":"publisher","first-page":"2100","DOI":"10.1016\/S0140-6736(24)00367-2","volume":"403","year":"2024","journal-title":"Lancet"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e2022GH000701","DOI":"10.1029\/2022GH000701","article-title":"Wet bulb globe temperature: indicating extreme heat risk on a global grid","volume":"7","author":"Brimicombe","year":"2023","journal-title":"Geohealth"},{"key":"B16","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1038\/s41597-020-00643-7","article-title":"Development and validation of the CHIRTS-daily quasi-global high-resolution daily temperature data set","volume":"7","author":"Verdin","year":"2020","journal-title":"Sci Data"},{"key":"B17","doi-asserted-by":"publisher","first-page":"161470","DOI":"10.1016\/j.scitotenv.2023.161470","article-title":"Spatiotemporal evolution of global long-term patterns of soil moisture","volume":"867","author":"Lal","year":"2023","journal-title":"Sci Total Environ"},{"key":"B18","doi-asserted-by":"publisher","first-page":"6938","DOI":"10.1175\/JCLI-D-14-00754.1","article-title":"Bias correction of GCM precipitation by quantile mapping: how well do methods preserve changes in quantiles and extremes?","volume":"28","author":"Cannon","year":"2015","journal-title":"J Clim."},{"key":"B19","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1002\/joc.7238","article-title":"Evaluation of quantile delta mapping as a bias-correction method in maximum rainfall dataset from downscaled models in S\u00e3o Paulo state (Brazil)","volume":"42","author":"Xavier","year":"2022","journal-title":"Int J Climatol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"2276","DOI":"10.1186\/s12889-025-23528-z","article-title":"Global, regional, and national burden of maternal hypertensive disorder: 1990-2021 analysis and future projections","volume":"25","author":"Hu","year":"2025","journal-title":"BMC Public Health."},{"key":"B21","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1002\/sim.4780030207","article-title":"Regression modelling strategies for improved prognostic prediction","volume":"3","author":"Harrell","year":"1984","journal-title":"Stat Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1093\/aje\/kwp353","article-title":"Longitudinal data analysis for generalized linear models under participant-driven informative follow-up: an application in maternal health epidemiology","volume":"171","author":"Buzkov\u00e1","year":"2010","journal-title":"Am J Epidemiol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"927","DOI":"10.2307\/2532214","article-title":"Application of generalized estimating equations to a study of in vitro radiation sensitivity","volume":"49","author":"Cologne","year":"1993","journal-title":"Biometrics"},{"key":"B24","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1038\/s41409-019-0679-x","article-title":"Cubic splines to model relationships between continuous variables and outcomes: a guide for clinicians","volume":"55","author":"Gauthier","year":"2020","journal-title":"Bone Marrow Transplant."},{"key":"B25","doi-asserted-by":"publisher","first-page":"302","DOI":"10.21236\/AD0099920","article-title":"Minard, control of heat casualties at military training centers","volume":"16","author":"Yaglou","year":"1957","journal-title":"AMA Arch Ind Health."},{"key":"B26","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1038\/s41591-024-03395-8","article-title":"A systematic review and meta-analysis of heat exposure impacts on maternal, fetal and neonatal health","volume":"31","author":"Lakhoo","year":"2025","journal-title":"Nat Med"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1149284","DOI":"10.3389\/fendo.2023.1149284","article-title":"Climate change and pregnancy complications: from hormones to the immune response","volume":"14","author":"Y\u00fczen","year":"2023","journal-title":"Front Endocrinol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1186\/s12884-025-07766-y","article-title":"Global burden of maternal hypertensive disorders (1990-2045): trends, regional disparities, and causal links to occupational exposures","volume":"25","author":"Xiong","year":"2025","journal-title":"BMC Pregnancy Childbirth"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e00035","DOI":"10.1097\/PN9.0000000000000035","article-title":"Addressing the smoking-hypertension paradox in pregnancy: insight from a multiethnic US birth cohort","volume":"2","author":"Garrison-Desany","year":"2023","journal-title":"Precis Nutr"},{"key":"B30","doi-asserted-by":"publisher","first-page":"e1004395","DOI":"10.1371\/journal.pmed.1004395","article-title":"Association between particulate air pollution and hypertensive disorders in pregnancy: a retrospective cohort study","volume":"21","author":"Sun","year":"2024","journal-title":"PLoS Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"52279","DOI":"10.1007\/s11356-024-34689-6","article-title":"Maternal exposure to bioclimatic stress and hypertensive disorders of pregnancy in Western Australia: identifying potential critical windows of susceptibility","volume":"31","author":"Gebremedhin","year":"2024","journal-title":"Environ Sci Pollut Res Int"},{"key":"B32","doi-asserted-by":"publisher","first-page":"108646","DOI":"10.1016\/j.envint.2024.108646","article-title":"Association of air temperature exposure during pregnancy with risk of preeclampsia in Guangzhou, China","volume":"186","author":"Zeng","year":"2024","journal-title":"Environ Int"},{"key":"B33","doi-asserted-by":"publisher","first-page":"113596","DOI":"10.1016\/j.envres.2022.113596","article-title":"Ambient temperature during pregnancy and risk of maternal hypertensive disorders: a time-to-event study in Johannesburg, South Africa","volume":"212","author":"Part","year":"2022","journal-title":"Environ Res"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1678469\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T05:30:16Z","timestamp":1760074216000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1678469\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,10]]},"references-count":33,"alternative-id":["10.3389\/fpubh.2025.1678469"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1678469","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,10]]},"article-number":"1678469"}}