Effects of Heat Exposure on Maternal and Pregnancy Health: Understanding the Role of Social Determinants and Adaptive Behaviors - ABSTRACT Climate change, exacerbated by urbanization, is escalating extreme heat globally, posing significant threats to human health, particularly among vulnerable demographic groups. This study addresses critical gaps in understanding daily heat exposure of vulnerable urban residents, specifically pregnant women. While previous research has linked increased temperatures to adverse pregnancy outcomes, this study aims to extend that work in order to unravel complex interactions between hyperlocal (neighborhood) heat exposure, social determinants of health (SDoH), and adaptive behaviors among pregnant women in Miami, Florida. Epidemiological evidence underscores associations between extreme heat exposure and negative pregnancy-related outcomes. Census data, typically used in existing studies, overlooks hyperlocal heat conditions such as indoor/outdoor home temperatures and neighborhood temperature. Miami's temperatures often exceed official National Weather Service measurements. Leveraging hyperlocal assessments, this study investigates the effects of this extreme heat on maternal and pregnancy health outcomes. The proposed longitudinal pilot study, embedded in an established pregnancy cohort, aims to achieve two specific aims. The first aim seeks to examine the moderating role of SDoH (e.g., neighborhood/housing quality, and economic hardship) on the interactions between heat exposure and maternal/pregnancy health outcomes (psychological stress, low birth weight, and preterm birth.) The hypothesis posits that higher hyperlocal heat exposure will be associated with poorer neighborhood/housing quality and greater economic hardship and will negatively affect maternal and pregnancy health outcomes. The second aim focuses on identifying heat adaptive behaviors (e.g. HVAC usage, decreased step count) adopted by pregnant women to mitigate the risks of heat exposure in context of SDoH. The hypothesis suggests that heat adaptive behaviors, such as reduced step count in warmer months and increased air-conditioning use, will mitigate the risks of heat exposure. This study contributes to the understanding of local heat exposure effects on pregnancy, emphasizing the need for effective and equitable adaptations. By aligning with the Social Determinants of Health framework and the National Institute of Nursing Research's strategic plan, this research aims to inform future interventions and policies. The proposed F31 award provides the researcher with opportunity to develop essential skills in both maternal health and climate health research, paving the way for future postdoctoral opportunities and a career as an independent nurse researcher.
