Abstract
<title>Abstract</title> <p>Intrapartum-related asphyxia (IRA) is a major cause of neonatal mortality and long-term neurodevelopmental impairment, yet little is known about the role of environmental stressors. Using clinical cohort data from 13,803 births in The Gambia and Burkina Faso linked to ERA5 temperature data, we applied a time-stratified case-crossover design to investigate the short-term effects of heat exposure on IRA. Exposure to extreme daytime heat in the days preceding delivery was associated with increased odds of IRA, with stronger associations observed at higher temperature thresholds and longer exposure durations. Among live births, the most extreme multi-day heat events nearly doubled the odds of IRA. No associations were observed for minimum temperatures. These findings suggest that extreme heat may act as an acute trigger of intrapartum complications and highlight the need to strengthen maternal and newborn health systems in regions facing increasing heat exposure.</p>