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Researchers are studying how exposure to high environmental temperatures during pregnancy affects the health of pregnant women and their babies in rural Sindh, Pakistan. The study aims to understand how heat stress impacts pregnancy complications and birth outcomes like early birth or low birth weight. It also explores biological pathways through which heat affects maternal, fetal, and infant health, considering factors such as socio-demographics and nutrition. This observational study enrolls pregnant women in their first trimester under 14 weeks and follows them through pregnancy and up to 12 months after birth. Participants wear devices measuring temperature and humidity, and some wear additional sensors to track skin temperature, heart rate, physical activity, and sleep. Researchers perform ultrasounds, collect blood and urine samples, and use questionnaires about heat exposure and coping strategies. After delivery, data on newborn size, birth timing, and complications are collected, along with placental and breastmilk samples for a subset. During the study, women attend clinic visits in the second and third trimesters for ongoing assessments. Researchers monitor heat exposure, physiological stress, hydration, and pregnancy progress through repeated ultrasounds and lab tests. The mother-infant pairs are followed monthly for a year to track health, growth, feeding, immunization, and development. The primary outcomes include low birth weight and small vulnerable newborns, with safety monitored throughout. This research will help inform protections for pregnant women and infants against climate-related heat risks in low-resource settings.