During the first trimester, the baby's neural tube — which develops into the brain and spinal cord — is forming. Research shows that sustained core body temperatures above 102.2°F (39°C) during this critical period are associated with an increased risk of neural tube defects such as spina bifida and anencephaly. This is the same reason high fevers in early pregnancy warrant treatment.
Hot tubs are typically set between 100-104°F and maintain that temperature continuously, unlike a bath where the water cools. In a hot tub, your core body temperature can rise to unsafe levels within 10-20 minutes. Your body's normal cooling mechanism (sweating) is less effective when you are immersed in hot water.
After the first trimester, the neural tube is fully formed, but overheating still poses risks: dehydration, dizziness, and drops in blood pressure that can reduce blood flow to the placenta. This is why ACOG recommends avoiding hot tubs throughout pregnancy, not just in the first trimester.