Assessing the effects of disasters and their aftermath on pregnancy and infant outcomes: A conceptual model
Introduction
The natural world and human influences work together to create the devastation that follows a major disaster such as a hurricane. Although many studies have examined broad patterns of effects on pregnancy outcomes after disasters [1], the causes of adverse outcomes are not always clear, as there are interrelated environmental pollutant exposures, psychological stressors, lack of health care, all moderated by social determinants of health. Without understanding which aspects of disaster exposure are the most meaningful contributors to adverse outcomes, it will not be possible to establish proactive disaster responses that efficiently target the most important factors and protect pregnant women. This topical review examines the traditionally expected short-term disaster exposures such as storm damage, health care closures as well as environmental and longer-term effects on pregnancy-related outcomes. In this review, we follow the World Health Organization's definition of disaster, “A serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources,” [2] with a particular focus on the short- and longer term effects of natural and technological disasters.
Several possible downstream effects of disaster exposure on pregnant women have been identified, including adverse birth outcomes, pregnancy loss, birth defects, and adverse child development, all of which have potential long-term or lifelong effects [3,4]. Surveillance after Hurricane Katrina found that 3% of evacuees had an emergency room visit for obstetric reasons and 13–15% of evacuees had a need for WIC (Special Supplemental Nutrition Program for Women, Infants and Children) services or birth control [5], suggesting this is not a small population of public health concern. Fig. 1 depicts the multidimensional nature of the impact of disasters on pregnant women and infants. The conceptual model demonstrates the complex interactions among physical, chemical, and non-chemical stressors and the impacts on prenatal and perinatal health. Furthermore, the model takes into account the short-term, often more identified effects, as well as the more protracted long-term consequences closely connected to existing burdens of health- and socio-economic disparities.
Section snippets
Physical trauma
Disasters bring several inherent risks, such as those associated with structural damage and vegetation collapse, involving increased risk of injury for anyone directly exposed. Pregnant women are less likely to be injured than some groups as they are more likely to limit their exposure and are not likely to be called upon for physical labor if others are available [6]. Still, reduced mobility and changed reflexes and balance associated with pregnancy may create vulnerability to hazards that
Effects of disasters on maternal and infant outcomes
We have explored the multiple pathways of effects of disasters, which converge on worsened outcomes for mother and infant in the short and long term. Major drivers of maternal morbidity and mortality include pregnancy complications such as hypertensive disorders and gestational diabetes; complications of labor; and cardiovascular conditions. The degree to which these conditions and complications cause sickness and death is strongly predicted by access to quality care. Disasters limit this care
Funding
This project was funded by National Institute of Environmental Health Sciences grant R21ES031020.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
References (133)
- et al.
Housing conditions and birth outcomes: the National Child Development Study
Environ Res.
(2018) - et al.
Persisting behavioral consequences of prenatal domoic acid exposure in rats
Neurotoxicol. Teratol.
(2005) - et al.
Neurobehavioral assessment of mice following repeated oral exposures to domoic acid during prenatal development
Neurotoxicol. Teratol.
(2017) - et al.
Domoic acid: neurobehavioral consequences of exposure to a prevalent marine biotoxin
Neurotoxicol. Teratol.
(2010) - et al.
Heat and pregnancy-related emergencies: risk of placental abruption during hot weather
Environ. Int.
(2018) - et al.
Temperature exposure during pregnancy and birth outcomes: an updated systematic review of epidemiological evidence
Environ. Pollut.
(2017) - et al.
Cold ambient temperature in utero and birth outcomes in Uppsala, Sweden, 1915-1929
Ann. Epidemiol.
(2014) - et al.
Effect of the 2008 cold spell on preterm births in two subtropical cities of Guangdong Province, Southern China
Sci. Total Environ.
(2018) - et al.
Extreme winter temperature and birth defects: a population-based case-control study
Environ. Res.
(2014) Carbon monoxide pollution and neurodevelopment: a public health concern
Neurotoxicol. Teratol.
(2015)
Emergency responses and health consequences after the fukushima accident; evacuation and relocation
Clin. Oncol. (Res. Coll Radiol).
The effects of household's climate-related displacement on delivery and postnatal care service utilization in rural Bangladesh
Soc. Sci. Med.
Analysis of the relationship between earthquake-related losses and the frequency of child-directed emotional, physical, and severe physical abuse in Haiti
Child Abuse Negl.
2nd. Intimate partner violence and pregnancy: epidemiology and impact
Am. J. Obstet. Gynecol.
Intergenerational pathways linking maternal early life adversity to offspring birthweight
Soc. Sci. Med.
The impact of early life shocks on human capital formation: evidence from El Nino floods in Ecuador
J. Health Econ.
Does prenatal care improve birth outcomes? A critical review
Obstet. Gynecol.
Prenatal screening for infectious diseases and opportunities for prevention
Obstet. Gynecol.
Pregnancy and prenatal stress
Bacterial vaginosis in pregnancy - a storm in the cup of tea
Eur. J. Obstet. Gynecol. Reprod. Biol.
Group B streptococcal disease in the mother and newborn-A review
Eur. J. Obstet. Gynecol. Reprod. Biol.
Disasters and perinatal health:a systematic review
Obstet Gynecol Surv.
Health concerns of women and infants in times of natural disasters: lessons learned from Hurricane Katrina
Matern. Child Health J.
The impact of trauma on the fetus, the infant, and the child
Illness surveillance and rapid needs assessment among Hurricane Katrina evacuees--Colorado, September 1-23, 2005
MMWR Morb Mortal Wkly Rep.
Safety messages for pregnant, postpartum, and breastfeeding women during natural disasters and severe weather
Centers Disease Contr. Prevent.
Postural balance and the risk of falling during pregnancy
J. Matern. Fetal Neonatal Med.
Static and dynamic biomechanical adaptations of the lower limbs and gait pattern changes during pregnancy
Wom. Health
Environmental health effects attributed to toxic and infectious agents following hurricanes, cyclones, flash floods and major hydrometeorological events
J. Toxicol. Environ. Health B Crit. Rev.
Public health response to Hurricanes Katrina and Rita
MMWR Morb Mortal Wkly Rep
Mold exposure and health effects following hurricanes Katrina and Rita
Annu. Rev. Publ. Health
Environmental risk factors of pregnancy outcomes: a summary of recent meta-analyses of epidemiological studies
Environ. Health
Environmental exposures due to natural disasters
Rev. Environ. Health
Systematic literature review of reproductive outcome associated with residential proximity to polluted sites
Int. J. Health Geogr.
The environmental health and emergency preparedness impacts of Hurricane Katrina
Am. J. Publ. Health
Geospatial Data Download Service
Florida Resources and Environmental Analysis Center. Data
Recent Harmful Algal Bloom (HAB) Events
Hurricanes, El Niño and harmful algal blooms in two sub-tropical Florida estuaries: direct and indirect impacts
Sci Rep.
Neurobehavioral effects of harmful algal bloom (HAB) toxins: a critical review
J. Int. Neuropsychol. Soc.
Maternal-fetal transfer of domoic acid in rats at two gestational time points
Environ. Health Perspect.
Exposure to seasonal temperatures during the last month of gestation and the risk of preterm birth in Stockholm
Int. J. Environ. Res. Publ. Health.
The impact of heat exposure on reduced gestational age in pregnant women in North Carolina, 2011-2015
Int. J. Biometeorol.
Projected changes in maternal heat exposure during early pregnancy and the associated congenital heart defect burden in the United States
J. Am. Heart Assoc.
Population-based case-control study of the association between weather-related extreme heat events and neural tube defects
Birth Defects Res.
Association of air pollution and heat exposure with preterm birth, low birth weight, and stillbirth in the US: a systematic review
JAMA Netw Open
Modeling and comparing central and room air conditioning ownership and cold-season in-home thermal comfort using the American Housing Survey
J. Expo. Sci. Environ. Epidemiol.
Cited by (8)
The impacts of climate migration on perinatal health and opportunities to safeguard perinatal well-being
2023, Seminars in PerinatologyFactors influencing perceived stress in pregnant women during cyclones in Queensland, Australia
2023, Current Research in Ecological and Social PsychologyMaternal Self-Efficacy Buffers the Effects of COVID-19–Related Experiences on Postpartum Parenting Stress
2022, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal NursingClimate Change-Related Environmental Exposures and Perinatal and Maternal Health Outcomes in the U.S.
2023, International Journal of Environmental Research and Public Health