The contribution of quasi-experimental studies to causal knowledge of climate-related exposures and adverse maternal and perinatal outcomes. A systematic review. — The Association Specialists
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  3. The contribution of quasi-experimental studies to causal knowledge of climate-related exposures and adverse maternal and perinatal outcomes. A systematic review.

The contribution of quasi-experimental studies to causal knowledge of climate-related exposures and adverse maternal and perinatal outcomes. A systematic review. (23954)

Anna-Lisa Baker 1 , Getaneh B Mulu 1 2 , Tomas Y Ferede 1 3 , Kendalem A Atalell 1 , Sylvester D Nyadanu 1 , Gavin Pereira 1 4 5 6 7
  1. Curtin University School of Population Health, Perth, WESTERN AUSTRALIA, Australia
  2. Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
  3. School of Nursing, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
  4. WHO Collaborating Centre for Climate Change and Health Impact Assessment, Perth, Western Australia, Australia
  5. enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
  6. Faculty of Medicine, Universitas Negeri Malang, Malang, East Java, Indonesia
  7. Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia

Background: Climate change poses significant threats to maternal and fetal health. While observational studies demonstrate associations between heat, ambient air pollution and wildfires and adverse outcomes, residual confounding, heterogeneity and inconsistent findings limit causal conclusions. Quasi-experimental designs (QEDs) leverage exogenous variation in exposure to strengthen causal inference, but this body of evidence has not been comprehensively evaluated in the perinatal context.

 

Objective: To systematically evaluate QEDs examining associations between temperature, air pollutants and fires and adverse maternal-perinatal outcomes (hypertensive disorders, gestational diabetes, birth weight, small for gestational age, fetal growth restriction, preterm birth, stillbirth, and neonatal death).

 

Methods: A systematic review following a published protocol and using Navigation Guide (NG) methodology is in progress. Eligible study designs include natural experiments, difference-in-differences (DiD), instrumental variables, regression discontinuity, interrupted time-series, controlled before-after, synthetic controls, within-family, and fixed effects analyses exploiting exogenous shocks. PubMed, EMBASE, Web of Science, Scopus, Google Scholar and references were searched to 18th February, 2026. Risk of bias including assessment of QED-specific assumptions, and grading of the strength and quality of the evidence will be conducted according to NG principles.

 

Preliminary results: 2081 titles and abstracts were screened, with 154 studies progressing to full-text review and 57 included. Fixed effects analyses exploiting exogenous shocks (74%), natural experiments (35%), and DiD designs (23%) were most used, often in combination. Air pollutants (65%) were most studied.  Few studies utilised instrumental variables, synthetic controls, interrupted time-series, or regression discontinuity designs.  Most examined high- or upper-middle income settings.

 

Conclusion: This review will provide a comprehensive synthesis of quasi-experimental evidence on climate-related exposures and maternal-perinatal outcomes, identifying where the evidence supports causal effects and where research gaps remain. Preliminary findings suggest QED with potential for robust causal inference are currently underutilised and the populations most impacted by climate-related exposures remain understudied.