Associations between prenatal heatwave exposure and child development and behavior and the mediating role of maternal depression in Brazil
- 1Insper, São Paulo, Brazil
- 2Ribeirão Preto Medical School, University of São Paulo. Ribeirão Preto, Brazil
- 3School of Economics, Business, and Accounting, University of São Paulo, São Paulo, Brazil
Abstract
Background:: Heatwaves are becoming more frequent and intense under climate change. Although prenatal heat exposure has been linked to adverse birth outcomes, its implications for early-childhood development and behavior remain poorly understood in tropical low- and middle-income settings. We examined whether prenatal heatwave exposure is associated with infant development and behavior, and whether current maternal depression mediates this association.
Methods:: We used data from the Brazilian Center for Early Child Development (CPAPI) birth cohort in Ribeirão Preto, São Paulo state, Brazil, comprising 946 infants born between July 2023 and March 2024. We assessed development and behavior at 6–10 months using the Survey of Well-being of Young Children and derived prenatal heatwave exposure from climate reanalysis data linked to maternal residential addresses. We estimated associations using a high-dimensional fixed-effects framework, adjusting for family, infant, and neighborhood characteristics, historical climate, and postnatal climate exposure, and decomposed these associations using a mediation analysis.
Results:: Prenatal heatwave exposure was not associated with developmental milestone scores. However, each additional heatwave day during pregnancy was associated with higher infant irritability, with a risk increase of approximately 13%. Prenatal exposure was also associated with increased maternal depressive symptoms, which accounted for 21%–22% of the associations with behavioral outcomes.
Conclusion:: Prenatal heatwave exposure was associated with early behavioral difficulties, suggesting that early behavioral regulation may be particularly sensitive to prenatal heat. Maternal mental health appears to be an important pathway, highlighting its relevance for climate adaptation and early-childhood health strategies.
Related
- The Mediating Role of Sleep Quality in Associations of Smartphone Addiction and Time-Specific Use With Prenatal Depression and Anxiety: Cross-Sectional Observational Study.
- Polygenic Prediction of Depression Liability Reveals Broad Genetic Associations Across Development, Families, and Populations
- Dyadic coping and factors associated with prenatal depression and anxiety profiles: a couple-level latent profile analysis study
- Prenatal cannabis use disorder and postpartum psychiatric emergency department visits: A retrospective cohort study of trends and associations in California, 2016–2021
- Infant hippocampal and amygdala volume in an observational follow-up from a randomized clinical trial for maternal prenatal depression
BibTeX
@article{komatsu2026associations,
title = {{Associations between prenatal heatwave exposure and child development and behavior and the mediating role of maternal depression in Brazil}},
author = {Bruno Kawaoka Komatsu and Maria Beatriz Martins Linhares and Naercio Menezes-Filho},
journal = {Environmental Epidemiology},
year = {2026},
month = nov,
doi = {10.1097/ee9.0000000000000546},
url = {https://doi.org/10.1097/ee9.0000000000000546},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Associations between prenatal heatwave exposure and child development and behavior and the mediating role of maternal depression in Brazil
AU - Bruno Kawaoka Komatsu
AU - Maria Beatriz Martins Linhares
AU - Naercio Menezes-Filho
PY - 2026
DA - 2026/11/06
JO - Environmental Epidemiology
DO - 10.1097/ee9.0000000000000546
UR - https://doi.org/10.1097/ee9.0000000000000546
AB - Background:: Heatwaves are becoming more frequent and intense under climate change. Although prenatal heat exposure has been linked to adverse birth outcomes, its implications for early-childhood development and behavior remain poorly understood in tropical low- and middle-income settings. We examined whether prenatal heatwave exposure is associated with infant development and behavior, and whether current maternal depression mediates this association. Methods:: We used data from the Brazilian Center for Early Child Development (CPAPI) birth cohort in Ribeirão Preto, São Paulo state, Brazil, comprising 946 infants born between July 2023 and March 2024. We assessed development and behavior at 6–10 months using the Survey of Well-being of Young Children and derived prenatal heatwave exposure from climate reanalysis data linked to maternal residential addresses. We estimated associations using a high-dimensional fixed-effects framework, adjusting for family, infant, and neighborhood characteristics, historical climate, and postnatal climate exposure, and decomposed these associations using a mediation analysis. Results:: Prenatal heatwave exposure was not associated with developmental milestone scores. However, each additional heatwave day during pregnancy was associated with higher infant irritability, with a risk increase of approximately 13%. Prenatal exposure was also associated with increased maternal depressive symptoms, which accounted for 21%–22% of the associations with behavioral outcomes. Conclusion:: Prenatal heatwave exposure was associated with early behavioral difficulties, suggesting that early behavioral regulation may be particularly sensitive to prenatal heat. Maternal mental health appears to be an important pathway, highlighting its relevance for climate adaptation and early-childhood health strategies.
SN - 2474-7882
ER -