Ambient air temperature exposure and foetal size and growth in three European birth cohorts

Publication authors

Esmée Essers, Laura Granés, Scott Delaney, Joan Ballester, Susana Santos, Sami Petricola, Tiffany C Yang, Ana Fernández-Somoano, Ainhoa Bereziartua, Ferran Ballester, Adonina Tardón, Martine Vrijheid, Aitana Lertxundi, Rosemary R.C. McEachan, Hanan El Marroun, Henning Tiemeier, Carmen Iñiguez, Mònica Guxens



Ambient air temperature may affect birth outcomes adversely, but little is known about their impact on foetal growth throughout pregnancy. We evaluated the association between temperature exposure during pregnancy and foetal size and growth in three European birth cohorts.


We studied 23,408 pregnant women from the English Born in Bradford cohort, Dutch Generation R Study, and Spanish INMA Project. Using the UrbClimTM model, weekly ambient air temperature exposure at 100x100m resolution at the mothers’ residences during pregnancy was calculated. Estimated foetal weight, head circumference, and femur length at mid and late pregnancy and weight, head circumference, and length at birth were converted into standard deviation scores (SDS). Foetal growth from mid to late pregnancy was calculated (grams or centimetres/week). Cohort/region-specific distributed lag non-linear models were combined using a random-effects meta-analysis and results presented in reference to the median percentile of temperature (14 °C).


Weekly temperatures ranged from −5.6 (Bradford) to 30.3 °C (INMA-Sabadell). Cold and heat exposure during weeks 1–28 were associated with a smaller and larger head circumference in late pregnancy, respectively (e.g., for 9.5 °C: −1.6 SDS [95 %CI −2.0; −0.4] and for 20.0 °C: 1.8 SDS [0.7; 2.9]). A susceptibility period from weeks 1–7 was identified for cold exposure and a smaller head circumference at late pregnancy. Cold exposure was associated with a slower head circumference growth from mid to late pregnancy (for 5.5 °C: −0.1 cm/week [-0.2; −0.04]), with a susceptibility period from weeks 4–12. No associations that survived multiple testing correction were found for other foetal or any birth outcomes.


Cumulative exposure to cold and heat during pregnancy was associated with changes in foetal head circumference throughout gestation, with susceptibility periods for cold during the first pregnancy trimester. No associations were found at birth, suggesting potential recovery. Future research should replicate this study across different climatic regions including varying temperature profiles.