Using wearable devices to measure personal heat exposure in a preconception cohort

Heat is a risk factor for several adverse pregnancy outcomes. Most epidemiologic studies use outdoor air temperature as a proxy for personal heat exposure, but outdoor measures may not reflect personally experienced temperature.

We conducted a personal heat monitoring sub-study within a preconception cohort to describe personal heat exposure, evaluate the correlation between personal and outdoor temperatures, and investigate factors that explain observed variation in correlations.

Pregnancy Study Online (PRESTO) is a web-based preconception cohort study of pregnancy planners. We used wearable monitors to collect up to 1 month of personal temperature and humidity data every 10 min from 152 participants living in the contiguous U.S. in May-October of 2021 and 2023. We calculated personal daily heat metrics, including temperature and heat index, to measure the intensity, frequency, and duration of heat exposure. We compared individual metrics to residence-based outdoor temperatures and estimated Spearman correlation coefficients across and within participants. Finally, we stratified distributions of within-person correlations by time spent outdoors, home air conditioning (AC) use, neighborhood median income, and climate region.

Participants resided in 40 states, and most (94%) had access to AC at home. The median daily personal mean temperature was 22.9 °C (IQR: 21.7-24.0). Four percent of participants' temperature readings exceeded a local extreme heat threshold (>90th county percentile). The correlation between daily mean personal and outdoor temperatures was low in the full cohort (r = 0.33), as was the median within-participant correlation (r = 0.34; IQR: 0.08-0.57). Time spent outdoors and AC use only modestly explained variability in these correlations.

In this U.S.-based pregnancy planning cohort, personal temperatures were generally moderate, although some participants experienced brief exposures to extreme heat. Personal and outdoor temperatures were not highly correlated, and variability in within-participant correlations was not appreciably explained by measured factors.

In this US-based preconception cohort, metrics of personal heat exposure were not highly correlated with heat exposure metrics derived from outdoor temperature at the residence. Although some participants experienced brief exposures to extreme heat, the results suggest that most participants achieved adequate climate control much of the time. Variation in the correlation between personal and outdoor temperatures was not appreciably explained by hypothesized factors. Even in a population with resources to mitigate heat exposure, some individuals still had short-duration exposures to extremely high temperatures.