Lucknow: Uttar Pradesh is projected to face the highest number of climate-related premature births in India by the middle of this century, with nearly 4,500 additional preterm deliveries in the state during an average April, according to a new analysis by Zero Carbon Analytics (ZCA).
The study warns that rising temperatures could push the number of excess preterm births in India to around 15,300 during a typical April by 2041-2060, exceeding the estimated burden recorded during the exceptionally hot April of 2024.
The projections indicate that Uttar Pradesh will account for the largest share of the additional premature births, followed by Bihar and Rajasthan. Under the moderate emissions scenario, UP could record 4,376 excess preterm births, while the figure could rise to 4,521 under a higher emissions scenario.
Study Examines Heat Impact On Pregnancy
The analysis, titled 'Climate change is already driving preterm births in Asia, and the toll is set to rise', examines the impact of extreme heat on pregnancy outcomes in India, Bangladesh and the Philippines.
It estimates that the prolonged heat event in April 2024 was associated with 16,150 excess preterm births across the three countries compared with a typical April. India accounted for 10,050 of these cases, Bangladesh 5,515 and the Philippines 585.
The researchers separately estimated that around 10,573 preterm births across the three countries would not have occurred without the additional warming caused by human-induced climate change.
Climate Change Intensifies Extreme Heat Risks
The April 2024 heat event, which lasted nearly a month in India and Bangladesh, was made around 45 times more likely by human-induced climate change, according to findings by World Weather Attribution cited in the briefing.
In India, Uttar Pradesh, Bihar, West Bengal and Jharkhand together accounted for 65 per cent of the estimated excess premature births during the 2024 heat event. While the risk of preterm birth in UP increased by around three per cent, Bihar and West Bengal witnessed increases of seven and 10 per cent respectively.
The study attributes the higher number of cases in UP partly to its large population, while states such as Bihar and West Bengal faced the combined impact of population size and unusually high temperatures.
Extreme Heat Threatens Maternal Health
The researchers warn that pregnant women are particularly vulnerable to extreme heat because of physiological stress during pregnancy. Dehydration, reduced blood flow to the placenta, inflammation and the activation of biological pathways that trigger labour are among the possible mechanisms linking high temperatures with premature delivery.
A preterm birth is defined as a delivery before 37 completed weeks of pregnancy. It is the leading cause of neonatal mortality globally and can have long-term physical, developmental and socioeconomic consequences for children.
Dr Madhu Gupta, a former lawmaker and gynaecologist, said: "Extreme heat can cause dehydration, increase physiological stress during pregnancy and affect blood circulation to the placenta, potentially triggering premature labour."
She further said that pregnant women, particularly those who work outdoors, suffer from anaemia or do not have access to adequate healthcare and cooling facilities, are especially vulnerable. “We are increasingly required to look at heat exposure as an important factor during antenatal care. Pregnant women should stay hydrated, avoid strenuous outdoor activities during peak heat hours and seek medical attention if they experience unusual discomfort, contractions or other warning signs,” she said.
Economically Vulnerable Women Face Greater Risks
The report also highlights the vulnerability of women from economically weaker households, particularly those engaged in strenuous physical work or living in poorly ventilated houses without affordable access to cooling facilities. Poor nutrition, anaemia and inadequate antenatal care can further aggravate the risks.
Despite growing evidence of the impact of extreme heat on pregnancy, existing maternal healthcare programmes and heat action plans do not adequately address the specific needs of pregnant women.
Heat Action Plans Lack Pregnancy Safeguards
India has introduced guidelines on heat and pregnancy for healthcare professionals and community health workers. However, a review of 35 state and Union Territory-level heat action and climate change plans found that 12 had no recommendations for pregnant or lactating women. Of the 23 plans that mentioned them, only 40 of the 214 listed strategies specifically targeted this group.
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A September 2026 survey by the Wellcome Trust of 1,000 maternal healthcare professionals across five countries, including India, found that 73 per cent had noticed an increase in heat-related cases or complications among pregnant women over the preceding five years. As many as 92 per cent said they needed more training and resources to protect them.
Researchers Call For Stronger Maternal Protection
The study calls for heat protection to become an integral part of antenatal care, community-level maternal health services and health-system preparedness. It recommends better early warning systems, targeted outreach to pregnant women and cooling facilities at healthcare centres.
The researchers caution that these measures could prevent some, but not all, of the additional premature births associated with climate change.
