Pregnant women in England are more likely to give birth early or develop gestational diabetes during heatwaves, but no official guidance tells them or their doctors how to stay safe. This matters because global temperatures are rising, and England is seeing more frequent and intense hot spells. While the 2024 heatwave plans for England finally recognised pregnant women as a vulnerable group, no specific advice exists for them. The international evidence on heat and pregnancy does not necessarily apply to England, where populations, housing, and healthcare systems differ. This study will link NHS maternity records with hospital and mortality data to quantify how high temperatures affect preterm birth, stillbirth, and gestational diabetes across England. It will also survey pregnant women, partners, and healthcare staff to understand what they know about heat risks and what actions they already take. If successful, the project will produce co-designed, evidence-based guidance for the NHS, policymakers, and the public. This could change how maternity care is delivered during hot weather—for instance, by triggering earlier monitoring or issuing specific cooling advice—without waiting for a national heatwave emergency to act.
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Background: Global average temperatures are increasing due to anthropogenic climate change, including in England, with increased intensity, frequency, and duration of extreme heat (such as heatwaves) being recorded. Growing epidemiological evidence suggests that pregnant women are a vulnerable group to the effects of high ambient temperatures. Pregnant women have only been recognised as such in the 2024's heatwave plans for England, but no specific guidance exists for this group. In England, the quantitative and qualitative evidence on the impact of high ambient temperatures on pregnancy and neonatal health is limited. The international evidence lacks generalisability to England as people adapt to their local climate with differences in populations and healthcare systems. It is important to understand the impacts of heat on pregnancy and neonatal health in England, including stakeholders' perceptions, to enable development of specific guidance. Aim: To improve understanding regarding the impacts of high ambient temperatures, including heatwaves, on pregnancy and neonatal health in England and use a consensus approach to agree evidence-based guidance and recommendations to reduce the impacts. Objectives: Quantify the impact of high ambient temperatures on selected pregnancy and neonatal outcomes in England. Explore the perceptions and understanding of the impacts of high ambient temperatures on pregnancy and neonatal health from a diverse cohort of stakeholders (including pregnant women, healthcare staff and policymakers) using a population-based survey and focus groups. Integrate Phase 1's and 2's findings to provide evidence-based guidance/recommendations for policy and practice around reducing the impacts with organisational or system response. Methods: This multi-methods study consists of three phases: Phase 1: will provide an epidemiological quantification regarding the impact of high ambient temperatures on selected pregnancy and neonatal outcomes in England using data linkage of Maternity Services Data Set (MSDS), a comprehensive national dataset of all NHS booked pregnancies, with Hospital Episodes Statistics (HES) and Office for National Statistics (ONS) mortality data. The outcomes will include preterm birth, stillbirth, and gestational diabetes. Phase 2: will explore pregnant, or recently pregnant, women's and partners' perceptions of the impact of high ambient temperatures on pregnancy and neonatal health using a survey and qualitative exploration of professionals' and women's (pregnant or recently pregnant) views of the impacts and possible actions to reduce them. Phase 3: will integrate Phase 1 and 2's findings with development of co-designed consensus guidance/recommendations. Timelines: Phase 1: data application/ethics (will start prior to the Fellowship with data acquisition months 6-8), linking exposure data (months 8-11), analysis (months 11-27). Phase 2: design (months 1-17), data collection (survey: months 11-15; focus groups: months 19-26), analysis (months 16-29). Phase 3: integrate findings (months 28-32), consensus work (months 34-38), further analysis/write-up: thesis and publications (months 36-45), dissemination (months 40-45). Anticipated impact and dissemination: I will share policy briefs for the relevant professional stakeholders as the project progresses. The research findings will be shared with decision makers, healthcare professionals and the public as evidence-based co-designed guidance and recommendations to reduce the impacts of heat on pregnancy and neonatal health.
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