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Associations between extreme temperature exposure and hypertensive disorders of pregnancy: A systematic review and
Yuetong Zheng1, Yinan Wang1, Yawei Zhu1
1Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200090, China.
Background:
Evidence linking extreme temperature exposure to hypertensive disorders of pregnancy (HDP) remains inconsistent, with limited synthesis on exposure timing and climatic vulnerability.
Objective:
To quantify associations of extreme heat, cold, and season-related exposures with HDP, preeclampsia (PE), and gestational hypertension (GH), and to identify critical windows and vulnerable climate zones.
Methods:
We systematically searched five databases up to February 2026. Observational studies (≥500 participants) reporting HDP outcomes with recognized diagnostic criteria were included. Random-effects meta-analyses were performed with subgroup analyses by exposure window, climate zone, and study period.
Results:
Twenty-eight studies (23,268,235 participants) were included. Heat exposure was significantly associated with increased HDP risk (pooled OR = 1.58, 95% CI: 1.31-1.90; I² = 98%), particularly for PE (OR = 2.01, 95% CI: 1.42-2.84; I² = 99%). Cold exposure showed no statistically significant pooled association. Stronger associations were observed in arid climates (PE: OR = 2.09, 95% CI: 1.19-3.66; I² = 40%) and during late gestation (≥28 weeks: OR = 1.23, 95% CI: 1.05-1.45; I² = 95%). Continuous temperature modeling revealed a linear exposure-response relationship (OR per 1 °C = 1.03, 95% CI: 1.02-1.04; I² = 48%).
Conclusion:
Maternal heat exposure is significantly associated with increased HDP risk, particularly preeclampsia, with pronounced effects in arid regions and late pregnancy. These findings support integrating climate-adaptive strategies into antenatal care.
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Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.