The association of maternal exposure to ambient temperature with low birth weight in term pregnancies varies by location: In Brazil, positive associations may occur only in the Amazon region

Exposure to ambient temperature has been linked to adverse birth outcomes in several regions, including the USA, Australia, China, countries in the Middle East, and European countries. To date, no studies were performed in South America, a region with serious challenges related to climate change. Our investigation addresses this literature lack by examining the association between Low Birth Weight (LBW) and ambient temperature expo-sure in the largest county in South America, Brazil. We applied a nationwide case-control study design using a logistic regression model to estimate the odds ratio (OR) for LBW associated with ambient temperature during a specific trimester of pregnancy (1-3 trimester). Our sample size includes 5,790,713 birth records nationwide over 18 years (2001-2018), of which 264,967 infants were included in the model as cases of LBW, representing 4.6% of our total sample. We adjusted our model for several confounding variables, including weather factors, air pollution, seasonality, and SES variables at the individual level. Our findings indicate that North was the only region with positive and statistically significant associations in the primary analysis and most of the sensitivity analysis, which is the region where the Amazon is located. In this region, we estimated an increase of 5.16% (95%CI: 3.60; 6.74) in the odds of LBW per 1 ?C increase in apparent temperature when the exposure occurred in the second trimester. Our results may be explained by the climate conditions in the Amazon region in the past years. A large body of literature indicates that the Amazon region has been facing serious climate challenges including issues related to policy, governance, and deforestation. Specifically, regarding deforestation, it is suggested that land use change and deforestation is projected to increase heat stress in the Amazon region, because of Amazon savannization, increasing the risk of heat stress exposure in Northern Brazil. Our study can assist public sectors and clinicians in mitigating the risk and vulnerability of the Amazonian population.