Published Aug 02, 2026 | 10:27 AM ⚊ Updated Aug 02, 2026 | 10:27 AM
Rural women also experienced substantially higher levels of dehydration and urogenital problems such as burning sensation.
Synopsis: Pregnant women in rural areas face significantly greater risks of heat-related illness and adverse pregnancy outcomes than their urban counterparts because of harsher working conditions, poorer living environments and limited access to essential services, according to a new study. The researchers found that rural women were more likely to experience heat strain, dehydration and pregnancy complications, with excessive heat during the first trimester.
Pregnant women in rural Tamil Nadu face significantly greater risks of heat-related illnesses and adverse pregnancy outcomes than their urban counterparts because of a combination of environmental and socio-economic factors, according to an exploratory cohort study published in BMC Pregnancy and Childbirth.
The study was conducted by Rekha Shanmugam and Vidhya Venugopal of the Sri Ramachandra Institute of Higher Education and Research.
The researchers found that pregnant women in rural areas are more likely to spend long hours working outdoors without adequate shade, cooling facilities or rest breaks.
Limited access to safe drinking water, healthcare services, electricity and proper ventilation, coupled with lower incomes and limited awareness of heat-related health risks, further heighten their vulnerability, making climate change a disproportionate threat to maternal health in rural communities.
The study warns that the disparity is likely to widen as climate change drives more frequent and intense heatwaves. It calls for the introduction of heat-risk screening during pregnancy, workplace protections and targeted public health interventions to reduce risks to mothers and newborns.
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Researchers followed 680 pregnant women between 2018 and 2021 across six districts of Tamil Nadu.
Of the participants, 429 women were from the rural districts of Tiruvannamalai, Salem, Nagapattinam and Tiruvallur, while 251 were from Chennai and Kancheepuram.
The women were monitored from the first trimester until delivery. Researchers assessed heat exposure at homes and workplaces using the internationally accepted Wet Bulb Globe Temperature (WBGT) index and recorded physiological indicators, including dehydration and core body temperature.
Although average temperatures in rural and urban locations were nearly identical, the study found that 55 percent of rural pregnant women were exposed to heat levels exceeding recommended safety limits, compared with 45 percent of urban women.
Researchers say the difference lies in prolonged outdoor exposure, physically demanding work, poor housing conditions and inadequate access to cooling facilities rather than temperature alone.
Nearly half of the rural participants belonged to lower socioeconomic households, and almost 48 percent performed heavy manual work in occupations such as agriculture, brick kilns and salt pans.
Urban women were more commonly employed in domestic work, the textile industry and clerical jobs, with comparatively better access to healthcare, water and cooling infrastructure.
The health impacts were evident throughout pregnancy. Eighty-four per cent of rural women reported symptoms including excessive sweating, thirst, fatigue, dizziness and headaches, compared with 71 percent of urban women.
Rural women also experienced substantially higher levels of dehydration and urogenital problems such as burning sensation, itching and changes in urine colour and volume.
Objective physiological measurements supported these findings. Around 31 percent of rural women showed signs of heat strain, including elevated core body temperature and dehydration, compared with 22 percent of urban women.
Even after adjusting for age, education, body mass index, anaemia, occupation and socioeconomic status, heat-exposed rural women remained more than three times as likely to experience physiological heat strain.
The study found that heat exposure was associated with significantly poorer pregnancy outcomes among rural women.
After adjusting for multiple confounding factors, heat-exposed rural women were 2.5 times more likely to experience adverse pregnancy outcomes, including miscarriage, preterm birth, stillbirth, intrauterine growth restriction (IUGR), low birth weight and birth defects. They were also 3.2 times more likely to experience adverse birth outcomes than urban women.
One of the most striking findings was that women exposed to excessive heat during the first trimester faced more than four times the risk of miscarriage, suggesting early pregnancy is particularly vulnerable to rising temperatures.
The researchers also found that the impact of heat varied across pregnancy.
During the first trimester, excessive heat may interfere with fetal organ development, increasing the risk of miscarriage and congenital abnormalities.
Exposure during the second trimester was associated with impaired fetal growth, while prolonged heat exposure during the third trimester increased the likelihood of preterm birth, stillbirth and low birth weight.
Maternal dehydration and elevated body temperature may impair fetal development, although the exact biological mechanisms remain unclear and require further research.
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The study recommends integrating heat-risk screening into routine antenatal care, particularly during the summer months.
It also calls for ensuring access to safe drinking water and shaded rest areas, introducing modified work-rest schedules for pregnant women engaged in outdoor occupations, and conducting community-level awareness campaigns on heat-related risks.
The authors further recommend strengthening primary health centres to identify and manage heat-related illnesses early, introducing occupational safety guidelines for pregnant workers based on internationally accepted Wet Bulb Globe Temperature (WBGT) standards, and conducting larger longitudinal studies to develop location-specific adaptation strategies.
