Assessing the effects of disasters and their aftermath on pregnancy and infant outcomes: A conceptual model

https://doi.org/10.1016/j.ijdrr.2021.102415Get rights and content

Abstract

Although many studies have examined broad patterns of effects on pregnancy and infant outcomes after disasters, the causes of adverse outcomes are not always clear. Disasters cause interrelated exposure to environmental pollutants, psychological stressors, and lack of health care, and interacts with other social determinants of health. This topical review examines the short- and long-term effects of disasters on pregnancy and how they are mediated by social, behavioral, and environmental effects. In the short term, disasters are associated with physical trauma, adverse environmental exposures, and unstable housing. In the longer term, disasters may lead to relocation, changes in family functioning, and negative economic effects. These aspects of disaster exposure, in turn, lead to lack of access to health care, increased stress and negative mental health outcomes, and negative behavioral changes, including smoking and substance use, poor nutrition, physical overexertion and limited activity, and reduction in breastfeeding. All of these factors interact with social determinants of health to worsen effects on the most vulnerable women, infants, and communities. Few interventions after disasters have been tested. With the increase in disasters due to climate change and the ongoing coronavirus pandemic, the models of effects of disasters and their human health consequences need increasing refinement, and, more importantly, should be applied to interventions that improve disaster prevention, mitigation, and response.

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)

  • A. Hasegawa et al.

    Emergency responses and health consequences after the fukushima accident; evacuation and relocation

    Clin. Oncol. (Res. Coll Radiol).

    (2016)
  • M.R. Haque et al.

    The effects of household's climate-related displacement on delivery and postnatal care service utilization in rural Bangladesh

    Soc. Sci. Med.

    (2020)
  • S. Subedi et al.

    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.

    (2020)
  • C.A. Chisholm et al.

    2nd. Intimate partner violence and pregnancy: epidemiology and impact

    Am. J. Obstet. Gynecol.

    (2017)
  • J.B. Kane et al.

    Intergenerational pathways linking maternal early life adversity to offspring birthweight

    Soc. Sci. Med.

    (2018)
  • M. Rosales-Rueda

    The impact of early life shocks on human capital formation: evidence from El Nino floods in Ecuador

    J. Health Econ.

    (2018)
  • K. Fiscella

    Does prenatal care improve birth outcomes? A critical review

    Obstet. Gynecol.

    (1995)
  • S.J. Schrag et al.

    Prenatal screening for infectious diseases and opportunities for prevention

    Obstet. Gynecol.

    (2003)
  • M. Lobel et al.

    Pregnancy and prenatal stress

  • P.M. Jayaram et al.

    Bacterial vaginosis in pregnancy - a storm in the cup of tea

    Eur. J. Obstet. Gynecol. Reprod. Biol.

    (2020)
  • P.J. Steer et al.

    Group B streptococcal disease in the mother and newborn-A review

    Eur. J. Obstet. Gynecol. Reprod. Biol.

    (2020)
  • E. Harville et al.

    Disasters and perinatal health:a systematic review

    Obstet Gynecol Surv.

    (2010)
  • World Health Organization. Humanitarian health action: definition: emergencies....
  • W.M. Callaghan et al.

    Health concerns of women and infants in times of natural disasters: lessons learned from Hurricane Katrina

    Matern. Child Health J.

    (2007)
  • M. Keren et al.

    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.

    (2006)
  • Division of Reproductive Health at National Center for Chronic Disease Prevention and Health Promotion

    Safety messages for pregnant, postpartum, and breastfeeding women during natural disasters and severe weather

    Centers Disease Contr. Prevent.

    (2020)
  • B. Cakmak et al.

    Postural balance and the risk of falling during pregnancy

    J. Matern. Fetal Neonatal Med.

    (2016)
  • A.P. Ribeiro et al.

    Static and dynamic biomechanical adaptations of the lower limbs and gait pattern changes during pregnancy

    Wom. Health

    (Jan 2013)
  • T.B. Erickson et al.

    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.

    (2019)
  • Baurick T, Mitchell D. Chemical fire in Lake Charles after Hurricane Laura landfall prompts shelter-in-place order....
  • Anonymous

    Public health response to Hurricanes Katrina and Rita

    MMWR Morb Mortal Wkly Rep

    (2005)
  • D.N. Barbeau et al.

    Mold exposure and health effects following hurricanes Katrina and Rita

    Annu. Rev. Publ. Health

    (2010)
  • M.J. Nieuwenhuijsen et al.

    Environmental risk factors of pregnancy outcomes: a summary of recent meta-analyses of epidemiological studies

    Environ. Health

    (2013)
  • A.H. Knap et al.

    Environmental exposures due to natural disasters

    Rev. Environ. Health

    (2016)
  • W. Kihal-Talantikite et al.

    Systematic literature review of reproductive outcome associated with residential proximity to polluted sites

    Int. J. Health Geogr.

    (2017)
  • M.J. Wilson et al.

    The environmental health and emergency preparedness impacts of Hurricane Katrina

    Am. J. Publ. Health

    (Oct 2020)
  • NHC GIS Archive - Tropical Cyclone Best...
  • US Environmental Protection Agency

    Geospatial Data Download Service

    (2018)
  • Florida Resources and Environmental Analysis Center. Data

  • Florida Fish and Wildlife Conservation Commission

    Recent Harmful Algal Bloom (HAB) Events

  • E.J. Phlips et al.

    Hurricanes, El Niño and harmful algal blooms in two sub-tropical Florida estuaries: direct and indirect impacts

    Sci Rep.

    (2020)
  • M.A. Friedman et al.

    Neurobehavioral effects of harmful algal bloom (HAB) toxins: a critical review

    J. Int. Neuropsychol. Soc.

    (2005)
  • J.M. Maucher et al.

    Maternal-fetal transfer of domoic acid in rats at two gestational time points

    Environ. Health Perspect.

    (2007)
  • A.M. Vicedo-Cabrera et al.

    Exposure to seasonal temperatures during the last month of gestation and the risk of preterm birth in Stockholm

    Int. J. Environ. Res. Publ. Health.

    (2015)
  • A. Ward et al.

    The impact of heat exposure on reduced gestational age in pregnant women in North Carolina, 2011-2015

    Int. J. Biometeorol.

    (2019)
  • W. Zhang et al.

    Projected changes in maternal heat exposure during early pregnancy and the associated congenital heart defect burden in the United States

    J. Am. Heart Assoc.

    (2019)
  • A. Soim et al.

    Population-based case-control study of the association between weather-related extreme heat events and neural tube defects

    Birth Defects Res.

    (2017)
  • B. Bekkar et al.

    Association of air pollution and heat exposure with preterm birth, low birth weight, and stillbirth in the US: a systematic review

    JAMA Netw Open

    (2020)
  • C.J. Gronlund et al.

    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.

    (2020)
  • Cited by (8)

    • Climate Change-Related Environmental Exposures and Perinatal and Maternal Health Outcomes in the U.S.

      2023, International Journal of Environmental Research and Public Health
    View all citing articles on Scopus
    View full text