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Research problem and specific questionsNon-optimal or extreme temperatures negatively affect public health and well-being. Their detrimental impacts are unevenly distributed, with pregnant women and infants bearing a disproportionate burden. Moreover, both the occurrence of temperature extremes, notably heatwaves, and their impacts are projected to increase under future climate change.Taking Sweden as a case-in-point, this project aims:to study the vulnerability to non-optimal and extreme temperatures in pregnant women and infants in Sweden

to study the role of adaptation to non-optimal and extreme temperatures on maternal and infant health

to develop scenarios of maternal and infant related health outcomes from plausible future extreme temperatures in Sweden accounting for socio-political dimensions of adaptation processes.Data and methodAccessing novel data resources from Sweden (DOHaD), we will quantify the excess risk of maternal and infant related health outcomes attributed to non-optimal and extreme temperatures. We will include an analysis of historical trends and drivers of the adaptation comparing Sweden with England and Italy-Lombardy Region, a temperate oceanic and a Mediterranean climate country. Leveraging available climate projections, we will also develop scenarios of maternal and infant related health outcomes of plausible future temperature extremes using storylines.Societal relevance and utilisationThis effort is timely: anthropogenically-driven global warming has led to an increased frequency, duration and intensity of heatwaves, a trend that is foreseen to continue in the coming decades. Concurrently, cold spells in several mid-latitude regions continue to be the norm, in part due to enhanced temperature variability. This points to the urgency of reducing the impacts on the most vulnerable, such as pregnant women and infants, by leveraging early-warning systems, and developing new recommendations and long-term adaptation strategies.Plan for project realisationThe project will last 3 years (overall cost 4 999 613 SEK) and consists of 3 WPs. Costs cover salaries (3 675 334 SEK), and communication, travel and overhead (1 324 279 SEK). Raffetti with expertise in public health and epidemiology will lead the project in collaboration with experts in ̽»¨¾«Ñ¡, physical and critical social sciences.The project will be part of the Swedish Center for Impacts of Climate Extremes.

Climate extremes have multifarious socio-economic impacts. Gaining a detailed understanding of these is essential for building a resilient society, yet is not easily realized. Limitations in impact databases and the complex socio-physical feedbacks underlying the genesis of impacts pose a formidable challenge to current analysis techniques.The Centre of excellence on Impacts of Climate Extremes under global change (ICE) commits to overcoming this challenge. ICE will build a new interdisciplinary research field bridging the physical, ̽»¨¾«Ñ¡, social and engineering sciences, provide training opportunities and support societal response to climate extremes. ICE focuses on three overarching themes over a 5-year period: improving databases of impacts of climate extremes

using these to better understand the physical and societal interplays determining the impacts of an extreme

and building policy-actionable scenarios of impacts of future extremes.ICE promotes excellence in science by seamlessly combining interdisciplinary methodological and conceptual inno vations and coordinating an international exchange program. These will boost Sweden’s visibility and competitiveness in the study of impacts of climate extremes. Excellence in training is pursued by a synergistic offer of master´s courses and a doctoral graduate school. Excellence in supporting societal response is promoted through policy-actionable research outputs developed together with public and industry stakeholders.

The COVID-19 pandemic has raised significant concerns about the potential long-term effects on women and infants exposed to SARS-CoV-2 infection during pregnancy. This points to the urgency of developing balanced policy responses during COVID-19 epidemic phases and future pandemics.Taking Sweden and England as a case-in-point, this project aims to address the following questions: 1) What are the adverse health outcomes after the delivery associated with SARS-CoV-2 infection during pregnancy? 2) What are the adverse health outcomes associated with intrauterine exposure to SARS-CoV-2 infection in infants? 3) How can preventive strategies mitigate the impacts on women and infant health of a potential future respiratory virus-related pandemic?Accessing novel data resources from Sweden and England, we will quantify the excess risk of 2-year post-delivery adverse health outcomes in women and offspring exposed to SARS-CoV-2 infection during pregnancy and compare with influenza (as a positive control). We will then develop future pandemic scenarios using ‘storylines’.This effort is timely: 1) to reduce the impact of SARS-CoV-2 infection during pregnancy on women and infant health

2) to support better-informed prevention strategies (e.g. targeted vaccination campaigns, early monitoring) for high-risk individuals

3) to reduce the impacts of future pandemics on the most vulnerable, such as pregnant women and offspring (e.g. new recommendations and long-term contingency plans).

Temporally compound hydroclimate extremes, such as drought-to-flood and heatwave-drought transitions, are consecutive and/or partially overlapping events. Anthropogenic climate change exacerbates their frequency and intensity, making them the norm in many regions. Lack of impact databases and the complex socio-physical feedbacks underlying the genesis of such extremes pose a formidable challenge to sustainable transformation.This project aims to enhance understanding of temporally compound hydroclimate extremes and identify adaptation actions that promote sustainable transformation. Specific aims include: 1) developing a multi-sectoral impact database of such extremes in Europe since 1940

2) analyzing (un)sustainable transformation following extreme events through two case studies

3) proposing a novel system dynamics modelling framework for a system view, and 4) developing scenarios to evaluate public health and societal impacts of future extremes under different development pathways.A thorough understanding of such extremes is crucial for developing a sustainable society, as their impact is likely to disproportionately affect vulnerable groups. In addition, societal responses after an extreme may exacerbate inequalities and contribute to the genesis of successive extremes. This makes the planned research highly timely.The project will engage with stakeholders and end-users to ensure their needs are met in achieving a fair and effective response to climate change.

Temperature extremes negatively affect public health and well-being. These detrimental impacts are unevenly distributed, and affect most those who are already vulnerable. Moreover, they are projected to increase under future climate change.Taking Sweden as a case-in-point, this project aims to address the following questions, of key relevance for ensuring a socially just adaptation to future temperatures: (1) which groups are most vulnerable to non-optimal and extreme temperatures? (2) what is the interplay between environmental drivers, societal processes, adaptation strategies and the resulting health impacts? and (3) how can adaptation strategies mitigate the health impacts of plausible future temperatures?These questions will be addressed by quantifying the excess risk of adverse health outcomes related to exposure to non-optimal and extreme temperatures including an analysis of historical trends and drivers of the adaptation process. Leveraging available climate projections, we will also develop scenarios of health impacts of future temperatures incorporating different adaptation strategies.This effort is timely, as the expectation of continued large impacts of temperature extremes points to the urgency of reducing their uneven distribution and designing a long-term adaptation process. Sweden offers highly spatially and temporally resolved registers of health data, unique in the international context, that can be rapidly and effectively leveraged towards this goal.