Prenatal exposure to heat and humidity and infant birth size in Ghana.

Previous studies - primarily in high income countries - have shown that high prenatal temperatures are associated with adverse birth outcomes. However, these studies are mostly focused on average exposure across the full gestational period or short-term exposure immediately prior to delivery and may miss important sensitive windows of exposure in utero. Further, nearly all use ambient air temperature data, which neglect physiologically important interactions between air temperature and humidity. The Ghana Randomized Air Pollution and Health Study (GRAPHS) recruited pregnant individuals from 2013 to 2015 from communities in the Kintampo North Municipality and Kintampo South District of Ghana. We estimated daily maximum shaded wet bulb globe temperature (WBGTmax) and heat index (HImax) during pregnancy and examined associations with birth weight, birth length, head circumference, and incidence of low birth weight, preterm birth, and small for gestational age. Using linear regression analyses, trimester average models identified that higher WBGTmax in the first trimester was associated with larger head circumference; second trimester was associated with shorter birth length, lower birth weight and higher odds of preterm birth, and third trimester was associated with shorter gestational age and larger head circumference. Time-varying analyses using distributed lag nonlinear models find that, compared to the median, lower WBGTmax and HImax (25th percentile) during the first half of pregnancy was associated with higher birth weight and longer birth length. Compared to the median, lower WBGTmax and HImax (25th percentile) in the second half of pregnancy was associated with smaller head circumference while higher wet bulb globe temperature (75th percentile) was associated with larger head circumference. Overall, our study identified that higher WBGTmax and HImax are associated with pregnancy duration and newborn size. Given the overall trend in our study area of rising temperatures, these data suggest that adaptation strategies are urgently needed to protect child health.