*2.1. Increased Frequency of Extreme Heat Events and Rising Seasonal Temperatures*

Van Zutphen et al. (2012) was one of the first studies to address elevated temperature and its association with congenital disabilities. Rylander et al. (2013) also examined elevated temperatures and maternal health and found that the physical exchange of heat to maintain a stable core body temperature is approximately 37.8 degrees Celsius. Heat will be added to the body if the air is hotter than the body. An individual's capacity to reduce excessive heat by sweat evaporation to regulate core body temperature is influenced by the surrounding temperature, humidity, wind, and clothing. If the core body temperature continues to rise, heat exhaustion can occur. Persons can adjust by seeking shade, drinking more water, and swimming. However, with the increasing temperatures caused by climate change, the heat shock risk increases. Pregnant women are at risk of 'over-heating' because of their hormonal situation at all stages of pregnancy (Cunningham et al. 2010). This 'overheating' increases health risks for both the mother and foetus. Kuehn and McCormick (2017) add that dehydration in pregnancy results in decreased uterine blood flow and could lead to pre-term labour. Newborns can experience a too high or too low temperature as they possess limited temperature regulation capacity (Poursafa and Kelishadi 2011). Strand et al. (2011) reviewed the literature and suggested that the impact of seasonal patterns of prenatal exposure to extreme ambient temperature may be a factor for pre-term birth and stillbirth. Sheffield and Landrigan (2011) stated that heat-related effects may affect school performance and increase pregnancy challenges and renal effects. The influence of these outcomes would vary by region and socioeconomic status, fuelling health inequalities (Sheffield and Landrigan 2011).

According to Sorensen et al. (2018), extreme heat events and their consequences for maternal health and children are exacerbated by poor access to healthcare services and cooling facilities, and lack of transportation to access these healthcare services. Lack of communication and awareness by the populace, those in authority, decision makers, and healthcare professionals to the effects of extreme heat adds to the list. There is also a paucity of gender-disaggregated heat-related health data to assist in decision making. Religious and culturally heavy clothing add to the consequences of extreme heat events (Sorensen et al. 2018)
