Heat exposure and maternal and newborn health: a narrative review and multi-level adaptation framework

Population heat exposure is increasing in a warming climate, particularly affecting vulnerable populations such as pregnant individuals and newborns. However, a comprehensive overview of the impacts of ambient heat exposure on maternal and newborn health, together with a discussion of adaptation strategies and their development, is lacking. We searched for studies available in MEDLINE and Embase from database inception up to June 25, 2026. Of 6, 235 records initially identified, 192 studies from 60 countries met the eligibility criteria. In this narrative review, we summarised the current evidence on the maternal and newborn health risks from heat exposure, discussed the progress and challenges in current adaptation strategies, and proposed a structured multi-level adaptation framework. The literature consisted predominantly of cohort studies focusing on newborn health, mainly from China, the United States and Australia, limiting global understanding and the geographical representativeness of the evidence. Heat exposure definitions varied across studies. Overall, heat exposure was broadly associated with an increased risk of adverse maternal and newborn health outcomes. Reported differences in heat-related associations by maternal characteristics and social or environmental conditions were context-specific, with heterogeneous evidence of effect modification. Existing adaptation strategies often target broader populations or pregnant individuals in specific regions (e.g., Africa). Future research should improve understanding of heat impacts on maternal health, especially in low- and middle-income countries disproportionately burdened by heat. We proposed a structured multi-level adaptation framework tailored to pregnant individuals, encompassing individual, interpersonal and social support, healthcare provision, community, institutional and public policy, and environmental levels. This review integrates evidence synthesis with adaptation strategies to help translate research findings into practice.