Study protocol for the Bio-HEAT study: Investigating the Biological pathways from HEAT exposure to preterm birth and other adverse maternal and child health outcomes in South Africa [version 2; peer review: 2 approved, 1 approved with reservations]
Introduction Epidemiological evidence linking heat exposure to adverse maternal and child health outcomes is compelling. However, the biological and social mechanisms underlying these associations remain poorly understood. Understanding the pathways explaining these associations is important given r...
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Wellcome
2025-06-01
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| author | Lebohang Radebe Nicholas B. Brink Clive Gray Marié Landsberg Robyn Hetem G Justus Hofmeyr Phelelani T. Mpangase Sibusisiwe Makhanya Michael Urban Shane Norris Amy Wise Valerie Vannevel Karl-Gunter Technau Matthew F. Chersich Renate Strehlau Ijeoma Solarin Kimberly Mc Alpine Darshnika Pemi Lakhoo Admire Chikandiwa Howard Chang Margaret M. Brennan |
| author_facet | Lebohang Radebe Nicholas B. Brink Clive Gray Marié Landsberg Robyn Hetem G Justus Hofmeyr Phelelani T. Mpangase Sibusisiwe Makhanya Michael Urban Shane Norris Amy Wise Valerie Vannevel Karl-Gunter Technau Matthew F. Chersich Renate Strehlau Ijeoma Solarin Kimberly Mc Alpine Darshnika Pemi Lakhoo Admire Chikandiwa Howard Chang Margaret M. Brennan |
| author_sort | Lebohang Radebe |
| collection | DOAJ |
| description | Introduction Epidemiological evidence linking heat exposure to adverse maternal and child health outcomes is compelling. However, the biological and social mechanisms underlying these associations remain poorly understood. Understanding the pathways explaining these associations is important given rising global temperatures, and the urgent need for developing and testing adaptive interventions. Methods This transdisciplinary study in Johannesburg, South Africa, will monitor a cohort of 200 women from their second trimester until one-year postpartum, alongside their infants. Heat exposure and environmental factors will be tracked using personal, community and facility-level temperature monitors and geospatial data. Data will be collected on social conditions, medical and obstetric history, heat stress and adaptation, hydration, mental wellbeing, and sleep quality. Clinical data includes physical measurements, ultrasound, cardiotocography, and biological specimens (blood, urine, saliva) analysed for inflammatory markers, RNA, metabolic indicators, renal function and hormonal levels. Placental and cord blood analyses will assess foetal stress. Infant data will include medical history, hospital visits, neurodevelopment, anthropometric measurements, vital signs, and urine analysis. Three nested sub-studies (20–50 participants) will explore specific aspects: Sub-study 1 will use wearable devices to monitor sleep, activity, and heart rate in high-risk women; Sub-study 2 will involve qualitative interviews; and Sub-study 3 will assess breastmilk composition and volume. Planned analyses Our primary aim is to document linkages between heat exposure and inflammatory pathways that precede preterm birth. The hypothesis that heat exposure triggers maternal inflammation will be tested by analysing epigenetic changes associated with inflammatory cytokine protein and gene expression. We will investigate thermoregulation and hydration during labour. Using isotope techniques, we assess whether heat exposure alters breastmilk composition and volume. Conceptual frameworks and graphical causal models will be developed to delineate pathways of vulnerability and protective mechanisms. |
| format | Article |
| id | doaj-art-71097901b3b3480fa045757f587bdbe3 |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-06-01 |
| publisher | Wellcome |
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| series | Wellcome Open Research |
| spelling | doaj-art-71097901b3b3480fa045757f587bdbe32025-08-20T03:29:52ZengWellcomeWellcome Open Research2398-502X2025-06-011010.12688/wellcomeopenres.23616.226873Study protocol for the Bio-HEAT study: Investigating the Biological pathways from HEAT exposure to preterm birth and other adverse maternal and child health outcomes in South Africa [version 2; peer review: 2 approved, 1 approved with reservations]Lebohang Radebe0https://orcid.org/0000-0003-3184-9165Nicholas B. Brink1https://orcid.org/0000-0002-6843-6236Clive Gray2Marié Landsberg3Robyn Hetem4https://orcid.org/0000-0003-1953-3520G Justus Hofmeyr5https://orcid.org/0000-0002-3080-1007Phelelani T. Mpangase6https://orcid.org/0000-0001-8280-8940Sibusisiwe Makhanya7Michael Urban8Shane Norris9https://orcid.org/0000-0001-7124-3788Amy Wise10https://orcid.org/0000-0001-5182-9060Valerie Vannevel11Karl-Gunter Technau12Matthew F. Chersich13Renate Strehlau14https://orcid.org/0000-0001-9113-6584Ijeoma Solarin15https://orcid.org/0000-0002-2045-3053Kimberly Mc Alpine16Darshnika Pemi Lakhoo17Admire Chikandiwa18Howard Chang19Margaret M. Brennan20https://orcid.org/0000-0002-5390-8827Wits PHR, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, South AfricaWits PHR, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, South AfricaReproductive Immunology Research Consortium in Africa (RIRCA), Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, Western Cape, South AfricaWits PHR, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, South AfricaFaculty of Science, University of Canterbury School of Biological Sciences, Christchurch, Canterbury, New ZealandEffective Care Research Unit, University of the Witwatersrand Johannesburg School of Clinical Medicine, Johannesburg, Gauteng, 2000, South AfricaSydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, South AfricaIBM Research Africa, Johannesburg, Gauteng, South AfricaDivision of Human Genetics, National Health Laboratory Service and School of Pathology, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, South AfricaWits Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics and Child Health, School of Clinical Medicine, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, South AfricaDept of Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand Johannesburg School of Clinical Medicine, Johannesburg, Gauteng, South AfricaDept of Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand Johannesburg School of Clinical Medicine, Johannesburg, Gauteng, South AfricaEmpilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, 2093, South AfricaWits PHR, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, South AfricaWITS VIDA, Nkanyezi Research Unit, Department of Paediatrics, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, 2093, South AfricaWits PHR, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, South AfricaWits PHR, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, South AfricaWits PHR, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, South AfricaWits PHR, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, South AfricaDepartment of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia, 30329, USAWits PHR, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, South AfricaIntroduction Epidemiological evidence linking heat exposure to adverse maternal and child health outcomes is compelling. However, the biological and social mechanisms underlying these associations remain poorly understood. Understanding the pathways explaining these associations is important given rising global temperatures, and the urgent need for developing and testing adaptive interventions. Methods This transdisciplinary study in Johannesburg, South Africa, will monitor a cohort of 200 women from their second trimester until one-year postpartum, alongside their infants. Heat exposure and environmental factors will be tracked using personal, community and facility-level temperature monitors and geospatial data. Data will be collected on social conditions, medical and obstetric history, heat stress and adaptation, hydration, mental wellbeing, and sleep quality. Clinical data includes physical measurements, ultrasound, cardiotocography, and biological specimens (blood, urine, saliva) analysed for inflammatory markers, RNA, metabolic indicators, renal function and hormonal levels. Placental and cord blood analyses will assess foetal stress. Infant data will include medical history, hospital visits, neurodevelopment, anthropometric measurements, vital signs, and urine analysis. Three nested sub-studies (20–50 participants) will explore specific aspects: Sub-study 1 will use wearable devices to monitor sleep, activity, and heart rate in high-risk women; Sub-study 2 will involve qualitative interviews; and Sub-study 3 will assess breastmilk composition and volume. Planned analyses Our primary aim is to document linkages between heat exposure and inflammatory pathways that precede preterm birth. The hypothesis that heat exposure triggers maternal inflammation will be tested by analysing epigenetic changes associated with inflammatory cytokine protein and gene expression. We will investigate thermoregulation and hydration during labour. Using isotope techniques, we assess whether heat exposure alters breastmilk composition and volume. Conceptual frameworks and graphical causal models will be developed to delineate pathways of vulnerability and protective mechanisms.https://wellcomeopenresearch.org/articles/10-121/v2Hot Temperature Inflammation Pregnancy Premature birth Maternal health Breastfeedingeng |
| spellingShingle | Lebohang Radebe Nicholas B. Brink Clive Gray Marié Landsberg Robyn Hetem G Justus Hofmeyr Phelelani T. Mpangase Sibusisiwe Makhanya Michael Urban Shane Norris Amy Wise Valerie Vannevel Karl-Gunter Technau Matthew F. Chersich Renate Strehlau Ijeoma Solarin Kimberly Mc Alpine Darshnika Pemi Lakhoo Admire Chikandiwa Howard Chang Margaret M. Brennan Study protocol for the Bio-HEAT study: Investigating the Biological pathways from HEAT exposure to preterm birth and other adverse maternal and child health outcomes in South Africa [version 2; peer review: 2 approved, 1 approved with reservations] Wellcome Open Research Hot Temperature Inflammation Pregnancy Premature birth Maternal health Breastfeeding eng |
| title | Study protocol for the Bio-HEAT study: Investigating the Biological pathways from HEAT exposure to preterm birth and other adverse maternal and child health outcomes in South Africa [version 2; peer review: 2 approved, 1 approved with reservations] |
| title_full | Study protocol for the Bio-HEAT study: Investigating the Biological pathways from HEAT exposure to preterm birth and other adverse maternal and child health outcomes in South Africa [version 2; peer review: 2 approved, 1 approved with reservations] |
| title_fullStr | Study protocol for the Bio-HEAT study: Investigating the Biological pathways from HEAT exposure to preterm birth and other adverse maternal and child health outcomes in South Africa [version 2; peer review: 2 approved, 1 approved with reservations] |
| title_full_unstemmed | Study protocol for the Bio-HEAT study: Investigating the Biological pathways from HEAT exposure to preterm birth and other adverse maternal and child health outcomes in South Africa [version 2; peer review: 2 approved, 1 approved with reservations] |
| title_short | Study protocol for the Bio-HEAT study: Investigating the Biological pathways from HEAT exposure to preterm birth and other adverse maternal and child health outcomes in South Africa [version 2; peer review: 2 approved, 1 approved with reservations] |
| title_sort | study protocol for the bio heat study investigating the biological pathways from heat exposure to preterm birth and other adverse maternal and child health outcomes in south africa version 2 peer review 2 approved 1 approved with reservations |
| topic | Hot Temperature Inflammation Pregnancy Premature birth Maternal health Breastfeeding eng |
| url | https://wellcomeopenresearch.org/articles/10-121/v2 |
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