Heat exposure and maternal stress: evidence from the GRAPHS pregnancy cohort in Ghana

Heat exposure has been linked to psychosocial stress, an established antecedent of perinatal depression; however, evidence on heat-related stress during pregnancy in sub-Saharan Africa remains limited. We analyzed psychosocial stress scores and covariate data from the Ghana Randomized Air Pollution and Health Study, linking daily maximum and minimum shaded wet bulb globe temperature (WBGT) metrics to participants' stress scores derived from the Crisis in Family Systems-Revised Life Events Questionnaire. We evaluated associations using ordinal logistic regression of pregnancy-average and trimester-average exposures and distributed lag non-linear models (DLNMs) to assess time-varying associations across gestation. Higher average maximum WBGT exposure across pregnancy was associated with increased odds of higher psychosocial stress; each 1 °C increase in maximum WBGT was associated with 64% higher odds of belonging to a higher stress category (OR = 1.64; 95% CI = 1.17-2.31; p = 0.0040). In trimester-average models, higher first-trimester maximum WBGT was also associated with higher stress (OR = 1.44; 95% CI = 1.15-1.81; p = 0.0014). DLNMs suggested that relatively cooler daily maximum WBGT values (25th percentile) were associated with decreased odds of stress in early pregnancy, whereas extreme daily maximum WBGT values (99th percentile) showed a pattern consistent with increased odds of stress in mid-to-late gestation. These findings highlight gestational windows in which heat exposure may influence stress, emphasizing the need for further research into underlying mechanisms and effective interventions to protect maternal mental health in heat-vulnerable settings.