Maternal And preGnancy hEalth aNd elevaTed heAt (MAGENTA): protocol for a novel data linkage study exploring the association between temperature and pregnancy outcomes in Wales and London, UK

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There is growing evidence on the adverse health impacts of global warming, particularly amongst more vulnerable populations such as pregnant women and their newborns. However, evidence on the impacts of heat on maternal and neonatal health in the UK remains limited. The MAGENTA project aims to close this gap by assessing the effects, modifiers, and biological mechanisms of heat exposure during pregnancy in Wales and London. To examine the relationship between heat during pregnancy and pregnancy outcomes in the UK, MAGENTA will conduct a retrospective data linkage and cohort study in Wales and London, alongside a prospective bio-sampling study with a consented cohort of pregnant women in Swansea, UK. Daily, household-level temperatures during pregnancy will be linked to women’s electronic health records in the Secure Anonymised Information Linkage (SAIL) databank in Wales and the Kids’ Environment and Health Cohort (KEHC) within ONS Secure Research Service (ONS) in London. In Swansea, UK, biological samples and personal monitoring measures will be collected from participants before, during and after a local heatwave and at equivalent gestations in cooler months, to explore responses to heat in pregnancy. All pregnancies resulting in a live birth or stillbirth (≥24 weeks) in Wales or London from 2010 to 2023 will be included. The association between elevated or prolonged heat during pregnancy and the following outcomes will be explored: gestational age, birth weight, stillbirth, maternal length of stay and neonatal mortality. Future impact of global warming on pregnancy outcomes and health resource use will be projected using Bayesian models informed by the Intergovernmental Panel on Climate Change scenarios. MAGENTA will provide the most comprehensive evidence to date on the potential effects of heat on pregnancy in the UK, to inform policies and interventions designed to protect future maternal and neonatal health in a warming world.

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