Objective <p>Heat wave exposure significantly impacts human health. Nevertheless, studies on the long-term effects of heat wave exposure during adolescence on adverse pregnancy outcomes (APOs) are rare. This study aimed to investigate the relationship between the long-term effects of heat wave exposure during adolescence and APOs.</p> Methods <p>We analyzed data from 3,376 female and 3,013 male participants across 31 provinces in China. All adolescents (10–19 years old), early adolescents (10–14), and late adolescents (15–19) were chosen as exposure windows. Heat waves were defined as periods lasting 2‒4 consecutive days with the daily temperature exceeding the 75th, 90th, and 92.5th percentiles. We employed multivariate logistic regression models to assess the associations between exposure to heat waves during adolescence and APOs.</p> Results <p>The results revealed significant associations between male exposure to heat wave events during late adolescence and spontaneous abortion (<i>P</i> &lt; 0.05), which was more pronounced in South China. In contrast, no statistically significant associations were detected between males’ exposure to heat wave events during adolescence and their partners’ preterm birth (<i>P</i> &gt; 0.05 for all comparisons). The exposure of females to heat waves during adolescence was not significantly associated with subsequent spontaneous abortion or preterm birth (<i>P</i> &gt; 0.05 for all comparisons).</p> Conclusions <p>This study demonstrates that spontaneous abortion in females is associated with heat wave exposure in their male partner during adolescence.</p>