**5. Climate change and maternal/prenatal health outcomes**

The alarming statistics that define maternal and neonatal health problems in Nigeria will most likely continue to grow as the effect of climate change increases. There is evidence that extreme temperatures and air pollution lead to adverse birth outcomes, including gestational age, birth weight, stillbirth, and neonatal stress from unusually hot temperature exposures [9, 44–46].

#### **5.1 Increasing temperatures**

According to Intergovernmental Panel on Climate Change (IPCC), the increasing global temperature and its detrimental influences on neonatal and maternal health have led them to strong concerns about the negative effects of climate change on the growth and development of babies both before (pre-natal) and after (postnatal) birth. However, climate change-related health issues will adversely affect developing nations—like Nigeria—already dealing with many public health issues such as malaria, diarrheal diseases, diabetes, and tuberculosis [4, 5].

Molina and Saldarriaga [47] have identified five pathways through which climate change temperature can affect the growth and development of a healthy fetus which includes exposure to extreme temperatures, maternal infection by a temperature-sensitive disease (e.g., respiratory infections) or by a biological vectorborne disease, maternal mental illnesses, and food insecurity brought about by less predictable growing conditions.

Temperature rises will extend the habitats of vectors diseases such as malaria that significantly harm children's health. Pregnant women are vulnerable to extreme temperatures and are especially susceptible to dehydration, which releases laborinducing hormones [48]. Newborns are especially sensitive to ambient temperature extremes because their capacity for regulating body temperature is limited.

Extreme heat waves related to climate change may result in adverse pregnancy outcomes including but not limited to preterm births, still births, miscarriages, low birth weight, neonatal deaths, preeclampsia and eclampsia.

A study carried out to determine whether there is a seasonal variation in preeclamptic presentation undergoing cesarean delivery in a tropical rainforest belt in Nigeria showed seasonal variation in the cesarean delivery required for preeclampsia/eclampsia [12]. In an older retrospective report of eclampsia's meteorological relations in Lagos—the busiest city in Nigeria—the study showed that the incidence of this condition varies significantly with weather changes [14].

Droughts and flooding, where sanitary infrastructure is inadequate, will result in increased frequency of epidemics and enteric diseases, with maternal and neonatal health being the most vulnerable in developing nations [49, 50]. Furthermore, drought and flood reduce pregnant women's access to safe food and water, resulting in adverse psychological stress and disrupted health care, and increasing their vulnerability to dehydration (leading to pre-term labor), infectious agents and increased risk of exposure to environmental toxins.
