Climate change, women's health, and the role of obstetricians and gynecologists in leadership

A FRET probe based on flavonol-benzothiazole for the detection of viscosity and SO2 derivatives

Sulfur dioxide (SO2) and viscosity play important roles in living organisms, and abnormal levels of them are associated with many diseases. Hence, a bifunctional fluorescence probe (E)-3-(2-(4-(4-(4-(6-fluoro-3-hydroxy-4-oxo-4H-chromen-2-yl)benzoyl)piperazin-1-yl)styryl)benzo-[d]thiazol-3-ium-3-yl)propane-1-sulfonate (HFBT) with fluorescence resonance energy transfer (FRET) properties was successfully constructed by using 3-hydroxyflavonol as the energy donor and benzothiazole sulphonate derivatives as the energy acceptor, and it can be used for the detection of SO2 derivatives (HSO3-/HSO32-) and viscosity. HFBT exhibits a large Stokes shift (245 nm), high resonance energy transfer efficiency (95.56 %), and excellent selectivity, anti-interference and low limit of detection (LOD = 0.057 μM) for HSO3-. The fluorescence intensity of HFBT at 596 nm gradually increases with the increase of viscosity. Interestingly, a visual HSO3- detection platform was successfully constructed and applied to the quantitative detection of HSO3- in food. Additionally, HFBT was successfully applied to imaging endogenous and exogenous HSO3- in cells. The successful development of HFBT provides an effective tool for the detection and imaging of HSO3- in food and cells.

Exposure to drinking water pollutants and non-syndromic birth defects: a systematic review and meta-analysis synthesis

OBJECTIVES

To evaluate the association between drinking water pollutants and non-syndromic birth defects.

DESIGN

Systematic review and meta-analysis synthesis.

DATA SOURCES

A search of MEDLINE, EMBASE and Google Scholar was performed to review relevant citations reporting on birth defects in pregnancies exposed to water pollutants between January 1962 and April 2023.

ELIGIBILITY CRITERIA

Prospective or retrospective cohort, population studies and case-control studies that provided data on exposure to drinking water pollutants around conception or during pregnancy and non-syndromic birth defects. We included studies published in the English language after the Minamata Bay disaster to reflect on contemporary concerns about the effect of environmental pollution and obstetric outcomes.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently read the retrieved articles for content, data extraction and analysis. The methodological quality of studies was assessed using the Newcastle-Ottawa Scale. Included studies were assessed for comparability when considered for meta-analysis.

RESULTS

32 studies met inclusion criteria including 17 cohorts (6 389 097 participants) and 15 case-control studies (47 914 cases and 685 712 controls). The most common pollutants investigated were trihalomethanes (11 studies), arsenic (5 studies) and nitrates (4 studies). The studies varied in design with different estimates of exposure, different stages of gestation age and different durations of exposure to pollutants. 21 articles reported data on any birth defects in their population or study groups and the others on specific birth defects including congenital heart defects, neural tube defects, orofacial defects and hypospadias. An increased risk or higher incidence of overall birth defects was reported by 9 studies and for specific birth defects by 14 studies. Eight studies compared the risk or incidence of birth defects with exposure to different concentrations of the pollutants. The analysis showed an association between higher levels of trihalomethanes (TTMs) and arsenic increase in major birth defects (lower vs higher exposure (OR 0.76, 95% CI 0.65 to 0.89; p<0.001 and OR 0.56, 95% CI 0.39 to 0.82; p<0.005, respectively).

CONCLUSION

The evidence of an association between exposure to average levels of common drinking water chemical pollutants during pregnancy and an increased risk or incidence of birth defects is uncertain. Available evidence indicates that some common chemical pollutants currently found in drinking water may have a direct teratogenic effect at high maternal exposure, however, wide variation in methodology limits the interpretation of the results. Future prospective studies using standardised protocols comparing maternal levels during all three trimesters of pregnancy and cord blood levels at birth are needed to better understand the placental transfer of water pollutants and accurately evaluate individual fetal exposure to drinking water pollutants.

PROSPERO REGISTRATION NUMBER

CRD42018112524.

The impact of climate change anxiety on premenstrual syndrome: A cross-sectional study

OBJECTIVE

Climate change is thought to have possible effects on changes in the menstruation process, which covers an important period of time in women's lives. Our study aimed to determine the impact of climate change anxiety on premenstrual syndrome (PMS) in women of reproductive age.

METHODS

This is a cross-sectional study. The research was conducted online using various digital platforms between December 2023 and February 2024. This study was conducted on 456 women of reproductive age. The Personal Information Form, PMS Scale and Eco-Anxiety Scale were used for the data collection. The level of statistical significance was set at p < 0.05.

RESULTS

The prevalence of PMS was 44.7%. The average score for the Eco-Anxiety Scale was 27.28 ± 6.44. A significant majority of participants (81.4%) stated that climate change would affect women's health, and 81.1% thought that they were affected by climate change. The Eco-Anxiety Scale scores were higher in women with PMS (p < 0.05). The results of the binary logistic regression analysis showed that being affected by climate change (odds ratio [OR] = 2.109, 95% confidence interval [CI] = 1.045-4.259, p = 0.035), age at menarche (OR = 1.249, 95% Cl = 1.073-1.453, p = 0.004) and Eco-Anxiety Scale scores were significant predictors of PMS (OR = 0.828, 95% Cl = 0.791-0.867, p < 0.001).

CONCLUSION

The results of our study showed that women with PMS had higher Eco-Anxiety Scale scores. Given the global effects of climate change, it is important to investigate its effects as a risk factor for the emergence of PMS. Furthermore, women's healthcare providers play an important and beneficial role in adapting to a changing climate; these efforts will have long-term impacts.

Study on the Precise Evaluation of Environmental Impacts of Air Pollution in Cold Regions Using the Cost Control Method

Objective: With the acceleration of industrialization, air pollution has become a global environmental issue, particularly in cold regions where the unique climatic and geographical conditions give rise to distinctive types of air pollution and impacts. Considering the economic evaluation of environmental damage is crucial for effective pollution control policies, this study aims to provide a more precise environmental damage assessment method through the Improved Virtual Control Cost Method (IVCCM) to optimize air pollution governance strategies in cold regions. Method: This study utilizes a case study of a major company producing methanol and coal-based natural gas, where the emissions from the boiler exhaust exceeded the prescribed standards for particulate matter, sulfur dioxide, and nitrogen oxides during a specific period. By employing a segmented counting approach that accounts for downtime, precise calculations were conducted for the actual periods of excess emissions. Adjustments were made to the calculation coefficients within the Virtual Control Cost Method to more accurately reflect the ecological damage caused by air pollution. Results: The IVCCM calculations revealed that the total environmental loss caused by the company’s excessive air pollution emissions amounted to USD 1.6844 million, significantly lower than the original calculation method (USD 2.1885 million). Specifically, the environmental losses due to particulate matter, sulfur dioxide, and nitrogen oxides were USD 0.0032 million, USD 0.3600 million, and USD 1.3212 million, respectively. Conclusions: The IVCCM enables a more precise assessment and prediction of ecological environmental damage caused by air pollution in cold regions. Compared to traditional methods, it effectively reduces assessment costs, mitigates disputes arising from unclear parameter values and calculation methods, and facilitates the development of more rational environmental protection policies and measures.

Review of sustainable practices for the gynecology operating room

PURPOSE OF REVIEW

Climate change has immediate impacts on women's health. Hospitals and operating rooms are large contributors to greenhouse gas (GHG) emissions and waste. This article will review current green initiatives designed to minimize environmental impact in the operating room and highlight areas for future improvement.

RECENT FINDINGS

From a materials perspective, reusable goods result in less GHG emissions while being just as efficacious, well tolerated, and easy to use. Materials should be opened judiciously, only as necessary. Processing regulated medical waste produces greater GHG emissions, so waste should be properly sorted, and items which are not biohazard waste should be processed separately. Choosing appropriate anesthesia and utilizing an 'off' setting, in which operating rooms are shut down when not in use, can also drastically decrease the environmental impact of surgery. Further research is needed to determine effective implementation in hospitals.

SUMMARY

This article summarizes current attempts to make operating rooms more sustainable. Many practices result in a decreased carbon footprint and cost savings without adversely affecting patient outcomes. Gynecologic surgeons and the hospitals in which they practice need to focus on implementing these changes in a timely fashion.

Impact of Climate Change on Reproductive Health and Pregnancy Outcomes: A Systematic Review

Climate change has emerged as a significant global health challenge, with growing evidence linking environmental factors to adverse reproductive health outcomes. The primary objective of this review is to assess the effects of climate change-driven environmental factors, such as air pollution and temperature extremes, on reproductive health outcomes, including fertility rates, miscarriage, preterm birth, and congenital anomalies. A comprehensive search of PubMed, Google Scholar, and Web of Science was conducted until July 2024. Studies included in the review were observational, experimental, and randomized controlled trials that reported quantitative data on reproductive outcomes in relation to climate-related environmental exposures. A total of 49 studies were selected for qualitative synthesis. The review found that increased exposure to particulate matter (PM2.5), extreme temperatures, and proximity to traffic were consistently associated with reduced fertility, increased risks of miscarriage, preterm birth, and low birth weight. Adverse effects were particularly pronounced among vulnerable populations, such as pregnant women of lower socioeconomic status and those living in disaster-prone areas. The studies also highlighted potential transgenerational effects, with prenatal exposure to environmental stressors influencing the long-term health of offspring. The findings underscore the urgent need for public health interventions and policies to mitigate environmental exposures that negatively impact reproductive health. Future research should focus on longitudinal and interventional studies to establish causal relationships and inform effective public health strategies.

Climate change and human health: a primer on what women's health physicians can do on behalf of their patients and communities

PURPOSE OF REVIEW

To describe the current state of knowledge on the impact on climate change on women's health and to highlight opportunities for healthcare providers to serve as advocates and subject matter experts.

RECENT FINDINGS

Healthcare providers are a uniquely respected voice in society but have not used this advantage to advocate for their communities and participate in mitigation, adaptation, and resiliency efforts on behalf of their patients and communities.

SUMMARY

Healthcare providers feel that climate change is real, is human caused, and is currently or will shortly negatively impact their patients. They feel unprepared to serve as leaders and advocates due to time limitations and a knowledge gap. Resources in the current climate movement can help close this gap.

Maternal exposure to bioclimatic stress and hypertensive disorders of pregnancy in Western Australia: identifying potential critical windows of susceptibility

The anthropogenic climate change may impact pregnancy outcomes. Rather than ambient temperature, we aimed to use a composite bioclimatic metric (Universal Thermal Climate Index, UTCI) to identify critical susceptible windows for the associations between bioclimatic exposure and hypertensive disorders of pregnancy (HDPs) risk. Daily UTCI exposure from 12 weeks of preconception through pregnancy was linked to 415,091 singleton pregnancies between 1st January 2000 and 31st December 2015 in Western Australia. Adjusted weekly-specific and cumulative odds ratios (ORs) and 95% confidence intervals (CIs) of gestational hypertension and preeclampsia were estimated with distributed lag non-linear and standard non-linear logistic regressions. Exposures from early pregnancy to week 30 were associated with greater odds of HDPs with critical susceptible windows, particularly elevated at the 1st (10.2 °C) and 99th (26.0 °C) exposure centiles as compared to the median (14.2 °C). The most elevated ORs were 1.07 (95% CI 1.06, 1.08) in weeks 8-18 for gestational hypertension and 1.10 (95% CI 1.08, 1.11) in weeks 11-16 for preeclampsia for the 99th exposure centile. Cumulative exposures associated with HDPs with relatively higher but less precise ORs. The effects of high exposure to HDPs indicated sociodemographic inequalities. The identified critical periods and subpopulations could benefit from climate-related interventions.

Health systems response to climate change adaptation: a scoping review of global evidence

BACKGROUND

The health system plays a critical role in safeguarding the well-being of communities in the face of health risks associated with climate change. This review maps evidence on health systems' adaptation to climate risk and barriers to effective adaptation.

METHODS

This review followed the recommendations by Arksey and O'Malley for conducting scoping review. Search for records was conducted in PubMed, Central, Web of Science, JSTOR, Google, and Google Scholar. Only peer-reviewed papers published in English language were included in this review. All the 63 included studies were critically appraise d.

RESULTS

We found that efforts are being made to create resilient health systems by incorporating climate change into health policies. Investments are being made in innovative technologies, climate-resilient health infrastructure, enhancing healthcare delivery, developing the capacity of climate specialists and agencies to provide high-quality evidence for resilient health systems. We also found that several obstacles prevent health system adaptation to climate risk, including poor policy implementation and evaluation. The obstacles are further exacerbated by financial constraints, including poverty, a lack of political commitment, inadequate data, and deficient healthcare systems, especially in developing countries. There is also a lack of integration of climate change into mental health actions and the health and safety of healthcare workers.

CONCLUSION

Efforts to develop resilient health systems against climate risks are underway, but persistent obstacles, including inadequate policy implementation, resource limitations, and a lack of integration of climate change into critical health domains, hinder comprehensive adaptation measures, particularly in developing nations.

Educating Pregnant Women About the Dangers of Extreme Heat and Air Pollution

Climate change poses a serious threat to the health and well-being of pregnant women and their developing fetuses. Certain populations are at greater risk of adverse outcomes from air pollution, a contributing factor to climate change. In addition, heightened exposure to extreme heat, a consequence of climate change, exacerbates the existing health care inequities in the United States. Nurses, midwives, and other health care clinicians are uniquely positioned to reduce the harmful effects of climate change by educating pregnant women and their families and advocating for systems and policies that can decelerate climate change. The purpose of this article is to provide resources for clinicians to use in educating pregnant women about the risks of extreme heat and air pollution, their potential effects on pregnancy and neonatal outcomes, and strategies to help mitigate risk. We conclude with implications for practice, opportunities for advocacy, and areas for future research.

Pathomorphological characteristics of heat stress in the experiment

AIM

The purpose of this research was to explore some morphological, physiological, and biochemical changes in female and fetal Wistar rats under heat stress.

METHODS

The experiment involved 30 animals, including two experimental groups (pregnant and nonpregnant females) kept under heat stress at 32°C and one control group consisting of healthy individuals kept in standard vivarium conditions. After dissection, fixation, dehydration, and primary processing, tissue samples were embedded in a mixture of paraffin and lanolin to obtain material for sections. Sections were made using a freezing and angular microtome and stained with hematoxylin and fuchsine solutions. Changes in morphology were assessed by microscopy using a Leitz DIAPLAN system.

RESULTS

As a result of heat stress, an increase in linear cell size, capillary network area, and adrenal mass was observed; adipocytes lost lipid vacuoles; prismatic thyroid cells were replaced by flat cells; hypothyroidism; an increase in the number of osteocyte lacunae; and increased osteoclast activity in bone tissue; interstitial and intracellular oedema and caryopycnosis of ventricular cardiomyocytes; reduction in the diameter of skeletal muscle fibers and replacement of tissue with collagen fibers; water loss in the structure of myofibrils; destructive local changes, hyperchromatosis and caryopycnosis of the hippocampus.

CONCLUSIONS

The data obtained allows predicting the possible consequences of prolonged overheating of tissues of other vertebrates and the human body.

Climate change, air pollution and maternal and newborn health: An overview of reviews of health outcomes

Background

Climate change represents a fundamental threat to human health, with pregnant women and newborns being more susceptible than other populations. In this review, we aimed to describe the current landscape of available epidemiological evidence on key climate risks on maternal and newborn health (MNH).

Methods

We sought to identify published systematic and scoping reviews investigating the impact of different climate hazards and air pollution on MNH outcomes. With this in mind, we developed a systematic search strategy based on the concepts of 'climate/air pollution hazards, 'maternal health,' and 'newborn health,' with restrictions to reviews published between 1 January 2010 and 6 February 2023, but without geographical or language restriction. Following full text screening and data extraction, we synthesised the results using narrative synthesis.

Results

We found 79 reviews investigating the effects of climate hazards on MNH, mainly focussing on outdoor air pollution (n = 47, 59%), heat (n = 24, 30%), and flood/storm disasters (n = 7, 9%). Most were published after 2015 (n = 60, 76%). These reviews had consistent findings regarding the positive association of exposure to heat and to air pollution with adverse birth outcomes, particularly preterm birth. We found limited evidence for impacts of climate-related food and water security on MNH and did not identify any reviews on climate-sensitive infectious diseases and MNH.

Conclusions

Climate change could undermine recent improvements in maternal and newborn health. Our review provides an overview of key climate risks to MNH. It could therefore be useful to the MNH community to better understand the MNH needs for each climate hazard and to strengthen discussions on evidence and research gaps and potential actions. Despite the lack of comprehensive evidence for some climate hazards and for many maternal, perinatal, and newborn outcomes, we observed repeated findings of the impact of heat and air pollutants on birth outcomes, particularly preterm birth. It is time for policy dialogue to follow to specifically design climate policy and actions to protect the needs of MNH.

Environmental sustainability in obstetrics and gynaecology: A systematic review

BACKGROUND

The healthcare sector is responsible for 4%-10% of global greenhouse gas emissions. Considering the broad range of care that obstetricians and gynaecologists provide, mitigation strategies within this specialty could result in significant reductions of the environmental footprint across the whole healthcare industry.

OBJECTIVES

The aim of this review was to identify for what services, procedures and products within obstetric and gynaecological care the environmental impact has been studied, to assess the magnitude of such impact and to identify mitigation strategies to diminish it.

SEARCH STRATEGY

The search strategy combined terms related to environmental impact, sustainability, climate change or carbon footprint, with the field of obstetrics and gynaecology.

SELECTION CRITERIA

Articles reporting on the environmental impact of any service, procedure or product within the field of obstetrics and gynaecology were included. Included outcomes covered midpoint impact categories, CO2 emissions, waste generation and energy consumption.

DATA COLLECTION AND ANALYSIS

A systematic literature search was conducted in the databases of MEDLINE (Ovid), Embase (Ovid) and Scopus, and a grey literature search was performed on Google Scholar and two websites of gynaecological associations.

MAIN RESULTS

The scope of the investigated studies encompassed vaginal births, obstetric and gynaecological surgical procedures, menstrual products, vaginal specula and transportation to gynaecological oncologic consultations. Among the highest yielding mitigation strategies were displacing disposable with reusable materials and minimising content of surgical custom packs. The lowest yielding mitigation strategy was waste optimisation, including recycling.

CONCLUSIONS

This systematic review highlights opportunities for obstetricians and gynaecologists to decrease their environmental footprint in many ways. More high-quality studies are needed to investigate the environmental impact of other aspects of women's and reproductive health care.

Obstetric care for environmental migrants

BACKGROUND

Migration due to environmental factors is an international crisis affecting many nations globally. Pregnant people are a vulnerable subgroup of migrants.

AIM

This article explores the potential effects of environmental migration on pregnancy and aims to draw attention to this rising concern.

METHODS

Based on the study aim, a semi-structured literature review was performed. The following databases were searched: MEDLine (PubMed) and Google Scholar. The search was originally conducted on 31st January 2021 and repeated on 22nd September 2022.

RESULTS

Pregnant migrants are at increased risk of mental health disorders, congenital anomalies, preterm birth, and maternal mortality. Pregnancies exposed to natural disasters are at risk of low birth weight, preterm birth, hypertensive disorders, gestational diabetes, and mental health morbidity. Along with the health risks, there are additional complex social factors affecting healthcare engagement in this population.

CONCLUSION

Maternity healthcare providers are likely to provide care for environmental migrants over the coming years. Environmental disasters and migration as individual factors have complex effects on perinatal health, and environmental migrants may be at risk of specific perinatal complications. Obstetricians and maternity healthcare workers should be aware of these challenges and appreciate the individualised and specialised care that these patients require.

FIGO Preconception Checklist: Preconception care for mother and baby

The preconception period is a unique and opportunistic time in a woman's life when she is motivated to adopt healthy behaviors that will benefit her and her child, making this time period a critical "window of opportunity" to improve short- and long-term health. Improving preconception health can ultimately improve both fetal and maternal outcomes. Promoting health before conception has several beneficial effects, including an increase in seeking antenatal care and a reduction in neonatal mortality. Preconception health is a broad concept that encompasses the management of chronic diseases, including optimal nutrition, adequate consumption of folic acid, control of body weight, adoption of healthy lifestyles, and receipt of appropriate vaccinations. Use of the FIGO Preconception Checklist, which includes the key elements of optimal preconception care, will empower women and their healthcare providers to better prepare women and their families for pregnancy.

Maternal exposure to ambient air temperature and adverse birth outcomes: An umbrella review of systematic reviews and meta-analyses

BACKGROUND

Multiple systematic reviews on prenatal ambient temperature and adverse birth outcomes exist, but the overall epidemiological evidence and the appropriate metric for thermal stress remain unclear. An umbrella review was performed to summarise and appraise the evidence with recommendations.

METHODS

Systematic reviews and meta-analyses on the associations between ambient temperature and adverse birth outcomes (preterm birth, stillbirth, birth weight, low birth weight, and small for gestational age) up to December 20, 2023, were synthesised according to a published protocol. Databases PubMed, CINAHL, Scopus, MEDLINE/Ovid, EMBASE/Ovid, Web of Science Core Collection, systematic reviews repositories, electronic grey literature, and references were searched. Risk of bias was assessed using Joanna Briggs Institute's critical appraisal tool.

RESULTS

Eleven systematic reviews, including two meta-analyses, were included. This comprised 90 distinct observational studies that employed multiple temperature assessment metrics with a very high overlap of primary studies. Primary studies were mostly from the United States while both Africa and South Asia contributed only three studies. A majority (7 out of 11) of the systematic reviews were rated as moderate risk of bias. All systematic reviews indicated that maternal exposures to both extremely high and low temperatures, particularly during late gestation are associated with increased risks of preterm birth, stillbirth, and reduced fetal growth. However, due to great differences in the exposure assessments, high heterogeneity, imprecision, and methodological limitations of the included systematic reviews, the overall epidemiological evidence was classified as probable evidence of causation. No study assessed biothermal metrics for thermal stress.

CONCLUSIONS

Despite the notable methodological differences, prenatal exposure to extreme ambient temperatures, particularly during late pregnancy, was associated with adverse birth outcomes. Adhering to the appropriate systematic review guidelines for environmental health research, incorporating biothermal metrics into exposure assessment, evidence from broader geodemographic settings, and interventions are recommended in future studies.

Carrara V, Meeyai A, Aderoba AK, Nosten F, Gross MM, McGready R. Antenatal corticosteroids reduce neonatal mortality in settings without assisted ventilatory support: a retrospective cohort study of early preterm births on the Thailand-Myanmar border

Background

Prematurity is the highest risk for under-five mortality globally. The aim of the study was to assess the effect of antenatal dexamethasone on neonatal mortality in early preterm in a resource-constrained setting without assisted ventilation.

Methods

This retrospective (2008-2013) cohort study in clinics for refugees/migrants on the Thai-Myanmar border included infants born <34 weeks gestation at home, in, or on the way to the clinic. Dexamethasone, 24 mg (three 8 mg intramuscular doses, every 8 hours), was prescribed to women at risk of preterm birth (28 to <34 weeks). Appropriate newborn care was available: including oxygen but not assisted ventilation. Mortality and maternal fever were compared by the number of doses (complete: three, incomplete (one or two), or no dose). A sub-cohort participated in neurodevelopmental testing at one year.

Results

Of 15,285 singleton births, 240 were included: 96 did not receive dexamethasone and 144 received one, two or three doses (56, 13 and 75, respectively). Of live-born infants followed to day 28, (n=168), early neonatal and neonatal mortality/1,000 livebirths (95%CI) with complete dosing was 217 (121-358) and 304 (190-449); compared to 394 (289-511) and 521 (407-633) with no dose. Compared to complete dosing, both incomplete and no dexamethasone were associated with elevated adjusted ORs 4.09 (1.39 to 12.00) and 3.13 (1.14 to 8.63), for early neonatal death. By contrast, for neonatal death, while there was clear evidence that no dosing was associated with higher mortality, adjusted OR 3.82 (1.42 to 10.27), the benefit of incomplete dosing was uncertain adjusted OR 1.75 (0.63 to 4.81). No adverse impact of dexamethasone on infant neurodevelopmental scores (12 months) or maternal fever was observed.

Conclusions

Neonatal mortality reduction is possible with complete dexamethasone dosing in pregnancies at risk of preterm birth in settings without capacity to provide assisted ventilation.

Global Warming and Endocrinology: The Hyderabad Declaration of the South Asian Federation of Endocrine Societies

Global warming and endocrine disorders are intertwined issues posing significant challenges. Greenhouse gases emanating from human activities drive global warming, leading to temperature rise and altered weather patterns. South Asia has experienced a noticeable temperature surge over the past century. The sizable population residing in the region heightens the susceptibility to the impact of global warming. In addition to affecting agriculture, water resources, and livelihood, environmental changes interfere with endocrine functioning. Resulting lifestyle changes increase the risk of metabolic and endocrine disorders. Individuals with diabetes face heightened vulnerability to extreme weather due to impaired thermoregulation. A high ambient temperature predisposes to heat-related illnesses, infertility, and nephropathy. Additionally, essential endocrine drugs and medical devices are susceptible to temperature fluctuations. The South Asian Federation of Endocrine Societies (SAFES) calls for collaboration among stakeholders to combat climate change and promote healthy living. Comprehensive approaches, including the establishment of sustainable food systems, promotion of physical activity, and raising awareness about environmental impacts, are imperative. SAFES recommends strategies such as prioritizing plant-based diets, reducing meat consumption, optimizing medical device usage, and enhancing accessibility to endocrine care. Raising awareness and educating caregivers and people living with diabetes on necessary precautions during extreme weather conditions are paramount. The heat sensitivity of insulin, blood glucose monitoring devices, and insulin pumps necessitates proper storage and consideration of environmental conditions for optimal efficacy. The inter-connectedness of global warming and endocrine disorders underscores the necessity of international collaboration guided by national endocrine societies. SAFES urges all stakeholders to actively implement sustainable practices to improve endocrine health in the face of climate change.

Impact of Climate Change, Environmental Toxins and Pollution on the AOFOG region: What can OBGYNs do?

Climate change is occurring rapidly, and this crisis should now be recognized as a "global emergency". It is one of the major global health threats brought about by global warming, resulting from human activity due in large part to increasing levels of greenhouse gases. The ongoing climate crisis poses significant risks to women, pregnant mothers, unborn fetuses and offspring, who were exposed in-utero to climate stressors, especially those in marginalized communities where effects are magnified. A focus on education, research, and advocacy in responding to changing health consequences and global awareness are key to educating our professional healthcare providers, patients, the lay public, key personnel in the government and other leaders, and by making the changes necessary to address this crisis. Building on the pillars that FIGO has identified (advocacy, research interpretation, capacity building, and education), and following the footsteps of the FIGO Committee on "Climate Change and Toxic Environmental Exposures", the baby steps yet focussed efforts taken by AOFOG through its recently formed "Climate Change & Pollution Working Group" will be highlighted in this review article. After all, investing in the health of women is investing in the health of current and future generations, and we, as healthcare providers along with health professional organizations should be in the forefront of environmental health advocacy to save the present generation and future generations through engagement as public opinion leaders.

Transformative strategies for enhancing women's resilience to climate change: A policy perspective for low- and middle-income countries

This policy paper advocates for a transformative strategy to address the disproportionate impact of climate change on women in low- and middle-income countries (LMICs), emphasizing the need to integrate gender considerations into climate resilience initiatives. Recognizing the multifaceted nature of women's vulnerabilities, the paper calls for the dismantling of discriminatory socio-cultural norms and the enhancement of women's capacities through digital health literacy, political empowerment, and the protection of sexual and reproductive health rights. Focusing on the health implications of climate change, particularly for pregnant women and newborns, the paper promotes a multi-sectoral approach that strengthens health systems and encourages community-based interventions. It underscores the importance of incorporating gender perspectives into climate adaptation and mitigation strategies, advocating for tailored health services in LMICs, and promoting women's active involvement in climate-related decision-making processes. The methodology involves a qualitative, expert, and narrative synthesis of existing literature and policy analysis. The paper synthesizes existing research and policy recommendations to argue for a comprehensive policy framework and backs it with case studies from LMICs. This framework recognizes the complex interplay between women's vulnerabilities and climate change, advocating for women's empowerment as central to climate resilience efforts in LMICs. By integrating gender perspectives, enhancing health services for women, and fostering international collaboration, it proposes a holistic approach to mitigate the adverse effects of climate change on women's health and well-being. This approach not only acknowledges the specific challenges faced by women but also leverages their unique insights and experiences, positioning them as pivotal contributors to global climate resilience and sustainability efforts.

Planetary health: an imperative for pediatric radiology

The global temperature has been increasing resulting in climate change. This negatively impacts planetary health that disproportionately affects the most vulnerable among us, especially children. Extreme weather events, such as hurricanes, tornadoes, wildfires, flooding, and heatwaves, are becoming more frequent and severe, posing a significant threat to our patients' health, safety, and security. Concurrently, shifts in environmental exposures, including air pollution, allergens, pathogenic vectors, and microplastics, further exacerbate the risks faced by children. In this paper, we provide an overview of pediatric illnesses that are becoming more prevalent and severe because of extreme weather events, global temperature increases, and shifts in environmental exposures. As members of pediatric health care teams, it is crucial for pediatric radiologists to be knowledgeable about the impacts of climate change on our patients, and continue to advocate for safe, healthier environments for our patients.

Understanding the connections between climate change, air pollution, and human health in Africa: Insights from a literature review

Climate change and air pollution are two interconnected global challenges that have profound impacts on human health. In Africa, a continent known for its rich biodiversity and diverse ecosystems, the adverse effects of climate change and air pollution are particularly concerning. This review study examines the implications of air pollution and climate change for human health and well-being in Africa. It explores the intersection of these two factors and their impact on various health outcomes, including cardiovascular disease, respiratory disorders, mental health, and vulnerable populations such as children and the elderly. The study highlights the disproportionate effects of air pollution on vulnerable groups and emphasizes the need for targeted interventions and policies to protect their health. Furthermore, it discusses the role of climate change in exacerbating air pollution and the potential long-term consequences for public health in Africa. The review also addresses the importance of considering temperature and precipitation changes as modifiers of the health effects of air pollution. By synthesizing existing research, this study aims to shed light on complex relationships and highlight the key findings, knowledge gaps, and potential solutions for mitigating the impacts of climate change and air pollution on human health in the region. The insights gained from this review can inform evidence-based policies and interventions to mitigate the adverse effects on human health and promote sustainable development in Africa.

Climate change: Overview of risks to pregnant persons and their offspring

Climate change is one of the greatest challenges confronting humanity. Pregnant persons, their unborn children, and offspring are particularly vulnerable, as evidenced by adverse perinatal outcomes and increased rates of childhood illnesses. Environmental inequities compound the problem of maternal health inequities, and have given rise to the environmental justice movement.  The International Federation of Gynecology and Obstetrics and other major medical societies have worked to heighten awareness and address the deleterious health effects of climate change and toxic environmental exposures. As part of routine prenatal, neonatal, and pediatric care, neonatal-perinatal care providers should incorporate discussions with their patients and families on potential harms and also identify actions to mitigate climate change effects on their health. This article provides clinicians with an overview of how climate change affects their patients, practical guidance in caring for them, and a frame setting of the articles to follow. Clinicians have a critical role to play, and the time to act is now.

Critical Windows of Maternal Exposure to Biothermal Stress and Birth Weight for Gestational Age in Western Australia

BACKGROUND

There is limited and inconsistent evidence on the risk of ambient temperature on small for gestational age (SGA) and there are no known related studies for large for gestational age (LGA). In addition, previous studies used temperature rather than a biothermal metric.

OBJECTIVES

Our aim was to examine the associations and critical susceptible windows of maternal exposure to a biothermal metric [Universal Thermal Climate Index (UTCI)] and the hazards of SGA and LGA.

METHODS

We linked 385,337 singleton term births between 1 January 2000 and 31 December 2015 in Western Australia to daily spatiotemporal UTCI. Distributed lag nonlinear models with Cox regression and multiple models were used to investigate maternal exposure to UTCI from 12 weeks preconception to birth and the adjusted hazard ratios (HRs) of SGA and LGA.

RESULTS

Relative to the median exposure, weekly and monthly specific exposures showed potential critical windows of susceptibility for SGA and LGA at extreme exposures, especially during late gestational periods. Monthly exposure showed strong positive associations from the 6th to the 10th gestational months with the highest hazard of 13% for SGA (HR = 1.13 ; 95% CI: 1.10, 1.14) and 7% for LGA (HR = 1.07 ; 95% CI: 1.03, 1.11) at the 10th month for the 1st UTCI centile. Entire pregnancy exposures showed the strongest hazards of 11% for SGA (HR = 1.11 ; 95% CI: 1.04, 1.18) and 3% for LGA (HR = 1.03 ; 95% CI: 0.95, 1.11) at the 99th UTCI centile. By trimesters, the highest hazards were found during the second and first trimesters for SGA and LGA, respectively, at the 99th UTCI centile. Based on estimated interaction effects, male births, mothers who were non-Caucasian, smokers, ≥ 35 years of age, and rural residents were most vulnerable.

CONCLUSIONS

Both weekly and monthly specific extreme biothermal stress exposures showed potential critical susceptible windows of SGA and LGA during late gestational periods with disproportionate sociodemographic vulnerabilities. https://doi.org/10.1289/EHP12660.

Impact of climate and environmental change on the menopause

The huge impact of climate change on humankind is multidimensional, and includes direct and indirect challenges to the physical, psychological and socio-cultural wellbeing. Women may be more vulnerable to climate-sensitive diseases, but little attention has been paid to specific needs and challenges associated with the menopause transition. The increase in average and extreme temperatures may modulate the manifestation of vasomotor symptoms; in particular, environmental temperature and seasonality may affect hot flushes and night sweats. However, more research is needed to define the impact of climate-related factors among the determinants influencing the individual experience of menopause. In addition, increased exposure to environmental pollution and toxins may also have a role in the modulation of ovarian aging mechanisms, possibly influencing timing of menopause. Finally, both air pollution and menopause transition are associated with unfavorable modifications of cardio-metabolic, bone and cognitive health, and account should be taken of these in the evaluation of the individual woman's health vulnerabilities. Overall, the evidence reported in this narrative review supports the need for specific strategies aimed at reducing the burden of climate and environmental change on menopausal women. Healthcare providers should promote behavioral measures that reduce anthropogenic climate change and at the same time have a beneficial role on several domains of physical and psychological wellbeing. From this perspective, menopause represents a golden moment to implement virtuous behaviors that will benefit at the same time women's longevity and the planet.

Ambient temperature, heat stress and fetal growth: A review of placenta-mediated mechanisms

Pregnancy is increasingly considered a period of vulnerability for extreme heat exposure. Multiple lines of evidence support that heat stress is associated with placental insufficiency, poor fetal growth and decreased birth weight. In this narrative review, we first summarize evidence linking ambient temperature or experimentally-induced heat stress with fetal and placental growth outcomes in humans, ruminants and murine species. We then synthesize the literature on putative underlying biological pathways with a focus on the placenta. Reviewed mechanisms include: reduced uterine-placental blood flow, impaired supply of metabolic substrates to the fetus, activation of the maternal stress-response system, and disruption of other endocrine and immune system endpoints. Taken together, this body of evidence supports that exposure to extreme ambient heat likely has adverse consequences for placental development and function. However, research investigating placenta-mediated pathophysiological mechanisms in humans remains extremely limited.

Going green in gynecology: a call to action

The climate change crisis poses a central threat to public health. The health outcomes of this crisis are well known, but lesser known to medical professionals is the role that healthcare delivery plays in worsening this crisis. The United States healthcare system is responsible for producing 10% of the total greenhouse gases. The adverse health outcomes caused by the overall healthcare system emissions in the United States is estimated to be 470,000 disability-adjusted life years lost, which is commensurate with the 44,000 to 98,000 people who die in hospitals each year in the United States as a consequence of preventable medical errors. Factors that contribute to healthcare greenhouse gas emissions include emissions from our facilities and from the purchase, transport, and use of supplies and waste. In the purview of obstetrics and gynecology, providers should minimize their use of disposable supplies, replace single-use specula with stainless steel specula, and educate themselves and operating room staff about best waste disposal practices. In addition, they can use their individual and collective voice to advocate for sustainable energy and supply practices. A transformation in the way we supply and power our hospitals is needed, and providers should be early adopters of this transformational change. Physician buy-in is essential to decrease the carbon footprint of our care. This narrative is a call to action for obstetricians and gynecologists to reduce our carbon footprint as a public health measure to uphold the quality of care we provide to women.

Impact of ambient temperature on adverse pregnancy outcomes: a birth cohort study in Fuzhou, China

Background

Previous studies have identified a series of specific adverse pregnancy outcomes (APOs) linked with temperature extremes. Most of them focus on preterm birth, low birth weight, and stillbirth. Other possible adverse outcomes were under-researched. This study aimed to investigate the impact of ambient temperature on maternal complications, white blood cell count (WBC), newborn hearing, and neonatal jaundice.

Methods

A total of 418 participants were recruited from Fuzhou Maternity & Child Healthcare Hospital in 2016. Participants were invited to fill out a structured questionnaire. The gridded near-surface air temperatures at a resolution of 0.1°* 0.1° for Fuzhou were extracted from a published dataset. Meteorological data and PM2.5 were extracted based on participants' residential addresses using R packages "ncdf4" and "raster." Multivariate logistic regression models were used to quantify the effects of ambient temperature on APOs after controlling for confounders.

Results

Overall, there were 107 APOs, accounting for 25.6% of all participants. Every 1°C increase in mean temperature was associated with a 10.0% increase in APOs (aOR = 1.100, 95%CI 1.006-1.203) during the period of early pregnancy. However, negative associations were observed in the middle pregnancy period, and a 1°C increase in mean temperature was associated 8.8% decrease in APOs (aOR = 0.912, 95%CI 0.846-0.982). Diurnal temperature variation had a significant impact on APOs in the third trimester. Infant jaundice was negatively associated with temperature exposure in the middle and late pregnancy periods. The risk of neonatal jaundice increased at lag weeks 2-9 in the first trimester, with the greatest lagged effect (aOR = 1.201, 95%CI 1.020-1.413) observed at lag week 3. A 1°C increase in mean temperature led to a 29.6% (aOR = 1.296, 95%CI 1.019-1.649) increase in high WBC. A 1°C increase in temperature variation was associated with more than two times (aOR = 2.469, 95%CI 1.001-6.089) increase of high WBC in the first trimester and about five times (aOR = 4.724, 95%CI 1.548-14.409) increase in the third trimester.

Conclusion

Ambient temperature affects neonatal jaundice, newborn hearing loss, and infections during pregnancy. In addition to the identified epidemiologic link and susceptible exposure windows, there is a need to understand the underlying biological mechanisms for better recommendations for climate change adaptation policies.

Climate and Environmental Change: A Generation at Risk

ABSTRACT

Climate and environmental changes have been described as the biggest global health threat of the 21st century, with the potential to cause immediate harm in early life with important lifelong effects, and important consequences for future generations. Pregnant women and children are increasingly being recognized as vulnerable populations in the context of climate change. The effects can be direct or indirect through heat stress, extreme weather events, and air pollution, potentially affecting both the immediate and long-term health of pregnant women and newborns through a broad range of mechanisms. Climate and environmental changes have wide-ranging effects on a woman's reproductive life including sexual maturation and fertility, pregnancy outcomes, lactation, breastfeeding, and menopause. A comprehensive overview of these impacts is presented as well as opportunities for interventions for nurses practicing in perinatal, neonatal, midwifery, and pediatric specialties.

Increased late preterm birth risk and altered uterine blood flow upon exposure to heat stress

BACKGROUND

Climate change, in particular the exposure to heat, impacts on human health and can trigger diseases. Pregnant people are considered a vulnerable group given the physiological changes during pregnancy and the potentially long-lasting consequences for the offspring. Evidence published to date on higher risk of pregnancy complications upon heat stress exposure are from geographical areas with high ambient temperatures. Studies from geographic regions with temperate climates are sparse; however, these areas are critical since individuals may be less equipped to adapt to heat stress. This study addresses a significant gap in knowledge due to the temperature increase documented globally.

METHODS

Birth data of singleton pregnancies (n = 42,905) from a tertiary care centre in Hamburg, Germany, between 1999 and 2021 were retrospectively obtained and matched with climate data from the warmer season (March to September) provided by the adjacent federal meteorological station of the German National Meteorological Service to calculate the relative risk of heat-associated preterm birth. Heat events were defined by ascending temperature percentiles in combination with humidity over exposure periods of up to 5 days. Further, ultrasound data documented in a longitudinal prospective pregnancy cohort study (n = 612) since 2012 were used to identify pathophysiological causes of heat-induced preterm birth.

FINDINGS

Both extreme heat and prolonged periods of heat exposure increased the relative risk of preterm birth (RR: 1.59; 95% CI: 1.01-2.43; p = 0.045; RR: 1.20; 95% CI: 1.02-1.40; p = 0.025). We identified a critical period of heat exposure during gestational ages 34-37 weeks that resulted in increased risk of late preterm birth (RR: 1.67; 95% CI: 1.14-1.43; p = 0.009). Pregnancies with a female fetus were more prone to heat stress-associated preterm birth. We found heat exposure was associated with altered vascular resistance within the uterine artery.

INTERPRETATION

Heat stress caused by high ambient temperatures increases the risk of preterm birth in a geographical region with temperate climate. Prenatal routine care should be revised in such regions to provide active surveillance for women at risk.

FUNDING

Found in acknowledgements.

Screening for Heat Related Illness in Pregnant People: Sample Case Study for Clinician Education

Climate change has significant implications for pregnant people. The Heat-Related Illness Screening Tool was developed by faculty in the nurse-led Center for Climate Change, Climate Justice, and Health at the MGH Institute of Health Professions. In an effort to integrate content on the health effects of climate change on pregnant people, faculty in the Women's Health/Gender-Related Nurse Practitioner program in the School of Nursing developed a case study that incorporated heat and environmental exposures in pregnancy into an existing module on preterm birth. The case study aims to increase awareness about the intersections between climate change, social determinants of health, structural racism, and potential adverse pregnancy outcomes. Together this case study and screening tool for heat-related illness represent innovations for health professions educators and clinicians to detect intensifying risks to already vulnerable people who are pregnant.

Development of a screening tool for assessment of climate change-related heat illness in the clinical setting

ABSTRACT

Extreme heat contributes to heat-related illnesses resulting from heat intolerance, which is the inability to maintain a thermal balance to tolerate heat stress. In the United States, heat-related mortality for older persons has almost doubled in the past 20 years. Other populations at risk for heat-related illness (HRI) include children, pregnant people, those who work outside, young people participating in outdoor sports, and at-risk populations such as Black, indigenous, and populations of color. The classic heat tolerance test used for decades monitoring physiological responses to repetitive motions is impractical across large and potentially health challenged populations and does not identify environmental or social factors or specific vulnerable populations. To address this issue, we developed a heat-related illness screening tool (HIST) to identify individuals at risk for HRI morbidity and mortality based on their physical, environmental, and social vulnerabilities with an emphasis on populations of concern. The HIST has the potential to be used as routine clinical screening in the same way as other commonly used screening tools. Heat intolerance affects patient outcomes and quality of life; therefore, early screening with a simple, easy-to-administer screening tool such as the HIST can identify people at risk and refer them to services that address heat exposure and/or create safety nets to prevent heat-related illnesses.

Effects of Climate Change and Air Pollution on Perinatal Health

Climate change is often framed as an environmental concern; however, the burning of fossil fuels both directly and indirectly impacts air quality and, thus, human health. Gas byproducts of combustion lead to increased levels of atmospheric ozone and carbon dioxide, which in turn elevate surface temperatures of the earth. This process exposes individuals to respiratory irritants and contributes to increased frequency of natural disasters such as wildfires, negatively impacting respiratory health. Normal physiologic changes in the respiratory system make pregnant people particularly vulnerable to the effects of air pollution. Asthma and allergic rhinitis are 2 common respiratory diseases that can be triggered by poor air quality. Solutions to limit the impact of climate change on respiratory disease include risk mitigation and reduction of fossil fuel consumption on individual, organization, and community levels. Midwives are well positioned as clinicians to educate people about individual strategies to reduce environmental exposure to respiratory irritants and advocate for policy changes to limit future health effects of climate change.

Prenatal exposure to long-term heat stress and stillbirth in Ghana: A within-space time-series analysis

INTRODUCTION

Few studies examined the association between prenatal long-term ambient temperature exposure and stillbirth and fewer still from developing countries. Rather than ambient temperature, we used a human thermophysiological index, Universal Thermal Climate Index (UTCI) to investigate the role of long-term heat stress exposure on stillbirth in Ghana.

METHODS

District-level monthly UTCI was linked with 90,532 stillbirths of 5,961,328 births across all 260 local districts between 1^st January 2012 and 31^st December 2020. A within-space time-series design was applied with distributed lag nonlinear models and conditional quasi-Poisson regression.

RESULTS

The mean (28.5 ± 2.1 °C) and median UTCI (28.8 °C) indicated moderate heat stress. The Relative Risks (RRs) and 95% Confidence Intervals (CIs) for exposure to lower-moderate heat (1st to 25th percentiles of UTCI) and strong heat (99th percentile) stresses showed lower risks, relative to the median UTCI. The higher-moderate heat stress exposures (75th and 90th percentiles) showed greater risks which increased with the duration of heat stress exposures and were stronger in the 90th percentile. The risk ranged from 2% (RR = 1.02, 95% CI 0.99, 1.05) to 18% (RR = 1.18, 95% CI 1.02, 1.36) for the 90th percentile, relative to the median UTCI. Assuming causality, 19 (95% CI 3, 37) and 27 (95% CI 3, 54) excess stillbirths per 10,000 births were attributable to long-term exposure to the 90th percentile relative to median UTCI for the past six and nine months, respectively. Districts with low population density, low gross domestic product, and low air pollution which collectively defined rural districts were at higher risk as compared to those in the high level (urban districts).

DISCUSSION

Maternal exposure to long-term heat stress was associated with a greater risk of stillbirth. Climate change-resilient interventional measures to reduce maternal exposure to heat stress, particularly in rural areas may help lower the risk of stillbirth.

Anticipated impacts of climate change on women's health: A background primer

Due to human activities, atmospheric greenhouse gas levels have increased dramatically, leading to an increase in the global mean surface temperature by 1.1° Celsius. Unless we can achieve a significant reduction in emissions, the global mean surface temperature will continue to rise to a dangerous level. Adverse outcomes of this warming will include extreme weather events, a deterioration of food, water and air quality, decreased food security, and an increase in vector-borne infectious disease. Political and economic instability as well as mass population migration will result in reduced access to healthcare resources. Mitigation of and adaptation to climate change will be key determinants of humanity's survival in the face of this existential crisis. Women will be more adversely affected by climate change than men, and pregnant persons will be particularly vulnerable. Particular differential impacts on women include higher heat and particulate-related morbidity and mortality; pregnancy risks including preterm birth, fetal growth lag, hypertensive disorders; and mental health impacts. To prepare for the climate crisis, it  is imperative for women's healthcare providers to assist their patients through political advocacy, provide family planning services, and focus on nutrition and lifestyle counseling.

Climate change and women's health: Turning leadership into action

Climate change is considered the greatest long-term challenge we face, and it comes with a direct impact on women's health and pregnancy outcomes. There are many balances that physicians make in deciding elements of care, but environmental impact has not been a consideration. Health care leaders must recognize the impact of their decisions on carbon footprints and creatively look towards changes that will improve global conditions.

Airway pollution and smoking in reproductive health

Environmental exposure refers to contact with chemical, biological, or physical substances found in air, water, food, or soil that may have a harmful effect on a person's health. Almost all of the global population (99%) breathe air that contains high levels of pollutants. Smoking is one of the most common forms of recreational drug use and is the leading preventable cause of morbidity and mortality worldwide. The small particles from either ambient (outdoor) pollution or cigarette smoke are inhaled to the lungs and quickly absorbed into the bloodstream. These substances can affect virtually every organ in our body and have been associated with various respiratory, cardiovascular, endocrine, and also reproductive morbidities, including decreased fertility, adverse pregnancy outcomes, and offspring long-term morbidity. This review summarizes the latest literature reporting the reproductive consequences of women exposed to ambient (outdoor) air pollution and cigarette smoking.

Reproductive Intentions Affected by Perceptions of Climate Change and Attitudes toward Death

Adverse climate change poses a threat to the health of pregnant women and unborn children and has a negative impact on the quality of life. Additionally, individuals with a high awareness of the consequences of climate change may be accompanied by a fear of the inevitable end, such as a fear of death. This, in turn, may discourage planning for offspring. Thus, both the perception of climate change and fear of death can have implications for reproductive intentions. Only a few studies to date indicate that concerns about climate change, especially when combined with attitudes towards death, may influence the formation of attitudes and reproductive plans. Thus, current research is aimed at looking at reproductive intentions from the perspective of both climate change concerns and the fear of death. This study was conducted from December 2020 to February 2021. A total of 177 childless males and females (58.8%) took part in the study. The Death Anxiety and Fascination Scale (DAFS) and Climate Change Perception Questionnaire (CCPQ) were completed online. Overall, 63.8% of respondents displayed a positive reproductive intention. Multivariable logistic regression analysis found that, in addition to the young age of respondents, the likelihood of positive reproductive intentions increases with death anxiety and decreases with death fascination and with climate health concerns. The results indicate that both climate change concerns and the fear of death are relevant to reproductive plans-positive reproductive intentions increase with death anxiety and decrease with death fascination and with climate health concerns. The results fill the gap in the existing research on predictors of reproductive intentions and can be used for further scientific exploration and practical activities addressing the issues of the determinants of decisions about having children. The individual consequences of climate change are clearly taken into account in the context of offspring planning and, therefore, should be considered in the design of social and environmental actions.

Design a protocol to investigate the effects of climate change in vivo

Climate change has a variety of effects on communities and the environment, most of which have been directly addressed, such as floods, droughts, and fires. To date, the impacts of climate change on health in in vivo conditions have not been assessed, and no protocol has been developed in this regard. Therefore, the purpose of the current study is to develop a protocol as well as design and build a pilot to deal with climate change in vivo to show the direct effects of climate change on health. For this purpose, twenty specialists, comprising ten experts active in field climate and 10 experts in field medicine and anatomy, have been consulted to design the proposed exposure protocol using the Delphi method. According to the prepared protocol, an exposure pilot was then designed and built, which provides the climatic conditions for animal exposure with a fully automatic HMI-PLC system. The results showed the average 12:12-h day/night temperature, humidity, and circadian cycle for three consecutive ten-year periods selected for exposure of 1-month-old male rats. The duration of the exposure period is four months, which is equivalent to a ten-year climatic period. This study is a framework and a starting point for examining the effects of climate change on in vivo conditions that have not yet been considered.