Temperature at conception and pregnancy loss in rural KwaZulu-Natal Province, South Africa: Implications for climate change policy in sub-Saharan African settings

BackgroundGlobal warming is projected to cause a substantial rise in temperatures with serious health implications across sub-Saharan Africa. Although South African policy makers have drafted a climate change adaptation plan, potential health threats posed by increasing temperatures on womens reproductive health are overlooked due to the lack of local population-based evidence. We sought to address the gap in the evidence around global warming and womens reproductive health in sub-Saharan Africa by using one of the continents largest prospective cohorts from rural KwaZulu-Natal Province, South Africa to investigate the relationship between temperature at conception and pregnancy loss. MethodsOur study sample consisted of 36341 pregnancies from 16765 women from the uMkhanyakude District of KwaZulu-Natal, South Africa between 2000-2017. Average monthly temperatures for the study locale during the study period were obtained from the South African Weather Services. An adjusted logistic regression model was used to investigate the relationship between temperature at conception and pregnancy loss (miscarriage or stillbirth). ResultsThe rate of pregnancy loss in the study sample was 1.9 (95% Confidence interval [CI]: 1.7-2.0) per 100 pregnancies. We observed a 4% higher odds of pregnancy loss for each 1{degrees}C increase in temperature (Adjusted Odds Ratio: 1.04, 95% CI: 1.01-1.08). ConclusionThere is a clear relationship between temperature and pregnancy loss in our sub-Saharan African setting. The effects of global warming will likely exacerbate the existing challenges for womens reproductive health in this region. Pregnancy outcomes should be given adequate attention when sub-Saharan African governments draft policies in response to global warming.