Abstract
BACKGROUND AND AIM: Global heating will result in increased severity, duration and frequency of extreme heat in many parts of the world. Those at most risk of adverse health effects due to heat include infants, the elderly, pregnant women and outdoor labourers. In Sub-Saharan Africa women make up approximately 50% of the agricultural workforce and often work throughout pregnancy. The impact of heat on the physiology of pregnant women and fetal physiology are largely unknown. This study assessed the direct heat exposure of pregnant farmers in The Gambia, the rate of heat strain or heat illness symptoms and the impact on fetal distress by measuring placental blood flow and fetal heart rate. METHODS: This was an observational cohort study of pregnant subsistence farmers in rural Gambia who farmed during their pregnancy. Exposure was directly measured in the field. Participants wore an Equivital TM device that measured heart rate, skin temperature, respiratory rate and tri-axis accelerometry. In the field, fetal monitoring was achieved using a portable doppler device (UmbiFlow TM) and portable fetal heart rate monitor. RESULTS:92 participants competed at least one field visit prior to delivery. Mean age of participants was 30.0 years, median gravida was 4.5 (range 1-12) and median parity was 3 (range 0-10). Only 2/92 (2%) participants experienced a rise in core temperature to 38°C. 62/92 (67%) participants experienced at least one symptom of heat illness during their field visit. 6/92 (7%) participants demonstrated placental insufficiency at baseline according to UmbiFlow TM umbilical doppler scan, with 29/86 (33.7%) demonstrating acute fetal distress in the field. Development of placental insufficiency correlated with Wet Bulb Globe Temperature exposure. CONCLUSIONS:This study gives preliminary evidence of the impact of maternal heat exposure on placental blood flow. KEYWORDS: fetal distress, Temperature extremes, Pregnancy outcomes
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