Protecting pregnant women from extreme heat: A content analysis of heat health action plans

Extreme heat exposure increases maternal vulnerability to adverse health outcomes. Heat Health Action Plans (HHAPs) are crucial to risk reduction and adaptive strategies for this vulnerable population. This study analyses the content of HHAPs to assess the extent to which they recognise pregnant women as a heat-vulnerable population, identify any maternal heat-health interventions, and develop recommendations to enhance HHAPs from a maternal health perspective. The grey literature search combined three strategies: 1) Google advanced searches for all HHAPs, 2) customised searches for country-specific HHAPs, and (3) targeted website searches for well-known HHAPs. The search included two phases: Phase 1 identified HHAPs published until August 2023; Phase 2 verified updates to the Phase 1 plans and identified newly released HHAPs from September 2023 to June 2025. Our analysis identified 36 HHAPs across thirteen countries that acknowledged the heightened vulnerability of pregnant women to extreme heat. Among these, 36% (13/36) provided heat-health education interventions, 33% (12/36) offered heat-risk communication interventions, 31% (11/36) included support for health and social care and governance, while only 8% (3/36) focused on indoor heat reduction for pregnant women. No plans included early warning systems, long-term plans or real-time surveillance targeting pregnant women. Our findings highlight the need to strengthen maternal health resilience in HHAPs through targeted communication, education, integrated health and social care, and indoor heat reduction strategies, along with governance frameworks for early warning systems, long-term heat-health interventions, and real-time surveillance. • Extreme heat poses significant health risks for pregnant women • Most Heat Health Action Plans lack targeted interventions for pregnant women • Current plans offer education, communication, and social support for pregnant women • Early warnings, planning, and surveillance can strengthen maternal heat health