Heat, lactation, and the medical curriculum: a global call to teach the health costs of a warming world

Abstract

Extreme heat is rapidly becoming a routine clinical stressor that influences presentation patterns, health system capacity, and health inequities worldwide. Yet many medical curricula still treat climate-related health as peripheral, leaving trainees underprepared to recognize and prevent heat-associated harms. This commentary argues that pregnancy and lactation should be taught as core climate-health content because they represent universal, high-stakes physiologic windows where anticipatory guidance and timely clinical action can reduce morbidity for both parent and infant. Drawing on physiologic principles and an expanding body of observational and synthesis evidence, the article highlights how real-world heat exposure interacts with pregnancy thermoregulation, cardiovascular and fluid demands, and fetal vulnerability, particularly in settings marked by humidity, exertion, limited shade, and constrained access to safe water and cooling. It further emphasizes that lactation and early infant feeding are climate-relevant clinical domains: heat can destabilize postpartum routines, heighten dehydration risk, and amplify misinformation, including persistent advice to supplement exclusively breastfed infants with water despite lack of supportive evidence. The commentary proposes a feasible, competency-based blueprint for curricular integration across preclinical teaching, clinical skills training, and clerkships, coupled with assessment strategies such as case-based exams and OSCEs. A final focus is global equity, calling for co-developed, locally adaptable teaching that aligns clinical practice with heat preparedness and public health systems.