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

Extreme weather events and maternal health in low-income and middle-income countries: a scoping review

BACKGROUND

Despite global efforts to improve maternal health and healthcare, women throughout the world endure poor health during pregnancy. Extreme weather events (EWE) disrupt infrastructure and access to medical services, however little is known about their impact on the health of women during pregnancy in resource-poor settings.

OBJECTIVES

This review aims to examine the current literature on the impact of EWE on maternal health to identify the pathways between EWE and maternal health in low-income and middle-income countries to identify gaps.

ELIGIBILITY CRITERIA

Studies were eligible for inclusion if they were published before 15 December 2022 and the population of the studies included pregnant and postpartum women (defined at up to 6 weeks postpartum) who were living in low-income and middle-income countries. The exposure of the included study must be related to EWE and the result to maternal health outcomes.

SOURCES OF EVIDENCE

We searched the literature using five databases, Medline, Global Health, Embase, Web of Science and CINAHL in December 2022. We assessed the results using predetermined criteria that defined the scope of the population, exposures and outcomes. In total, 15 studies were included.

CHARTING METHODS

We identified studies that fit the criteria and extracted key themes. We extracted population demographics and sampling methodologies, assessed the quality of the studies and conducted a narrative synthesis to summarise the key findings.

RESULTS

Fifteen studies met the inclusion criteria. The quantitative studies (n=4) and qualitative (n=11) demonstrated an association between EWE and malnutrition, mental health, mortality and access to maternal health services.

CONCLUSION

EWE negatively impact maternal health through various mechanisms including access to services, stress and mortality. The results have demonstrated concerning effects, but there is also limited evidence surrounding these broad topics in low-resource settings. Research is necessary to determine the mechanisms by which EWE affect maternal health.

PROSPERO REGISTRATION NUMBER

CRD42022352915.

Climate change, air pollution and maternal and newborn health: An overview of reviews of health outcomes

Background

Climate change represents a fundamental threat to human health, with pregnant women and newborns being more susceptible than other populations. In this review, we aimed to describe the current landscape of available epidemiological evidence on key climate risks on maternal and newborn health (MNH).

Methods

We sought to identify published systematic and scoping reviews investigating the impact of different climate hazards and air pollution on MNH outcomes. With this in mind, we developed a systematic search strategy based on the concepts of 'climate/air pollution hazards, 'maternal health,' and 'newborn health,' with restrictions to reviews published between 1 January 2010 and 6 February 2023, but without geographical or language restriction. Following full text screening and data extraction, we synthesised the results using narrative synthesis.

Results

We found 79 reviews investigating the effects of climate hazards on MNH, mainly focussing on outdoor air pollution (n = 47, 59%), heat (n = 24, 30%), and flood/storm disasters (n = 7, 9%). Most were published after 2015 (n = 60, 76%). These reviews had consistent findings regarding the positive association of exposure to heat and to air pollution with adverse birth outcomes, particularly preterm birth. We found limited evidence for impacts of climate-related food and water security on MNH and did not identify any reviews on climate-sensitive infectious diseases and MNH.

Conclusions

Climate change could undermine recent improvements in maternal and newborn health. Our review provides an overview of key climate risks to MNH. It could therefore be useful to the MNH community to better understand the MNH needs for each climate hazard and to strengthen discussions on evidence and research gaps and potential actions. Despite the lack of comprehensive evidence for some climate hazards and for many maternal, perinatal, and newborn outcomes, we observed repeated findings of the impact of heat and air pollutants on birth outcomes, particularly preterm birth. It is time for policy dialogue to follow to specifically design climate policy and actions to protect the needs of MNH.

The impacts of climate migration on perinatal health and opportunities to safeguard perinatal well-being

The disparate health consequences of climate change and migration have been separately explored, and the gendered impacts of climate change have been previously established. Nonetheless, there is limited research on the specific nexus of climate change-migration-sexual and reproductive health (SRH). This chapter reviews specific vulnerabilities faced by women and infants throughout the perinatal period, and how these are affected by climate change-induced migration in different migratory contexts. The available literature refers to antenatal and postnatal care utilization, access to water, sanitation, and hygiene facilities, childbirth and delivery challenges, and infant feeding barriers, amongst other concerns. The discussion explored in this chapter highlights the need to develop disaster frameworks that reflect the heterogeneity of outcomes related to specific and unique climate migration contexts.

Association between natural hazards and postnatal care among the neonates in India: a step towards full coverage using geospatial approach

BACKGROUND

Postnatal care is crucial to prevent the child mortality. Despite the improvement in the PNC coverage for the neonates, it is still far away from the universal health coverage. Along with, some specific regions mostly are natural hazard prone areas of India show very under coverage of PNC for the neonates. Considering the substantial spatial variation of PNC coverage and natural hazard prevalence, present study aimed to examine spatial variation of PNC coverage and its association with natural hazard at the district level.

METHODS

The cross-sectional exploratory study utilized National Family Health Survey, 2019-21, which included 1,76,843 children using multistage stratified sampling method to examine postnatal care within 42 days for neonates born within five years prior to the survey. Additionally, the study utilized Vulnerability Atlas of India,2019 maps to categorize regions into hazardous (flood, earthquake, and landslide) and non-hazardous areas. Spatial univariate and bivariate analyses, logistic and geographically weighted regressions were conducted using ArcGIS Pro, GeoDa, and Stata 16.0 software to identify associations between PNC coverage, hazard exposure, and spatial variation.

RESULTS

The univariate spatial analysis showed some specific regions such as north, east, and north-east region of India had a high concentration of natural hazard and low access of PNC coverage. Bivariate analysis also showed that PNC coverage was low in flood (75.9%), earthquake (68.3%), and landslide (80.6%) effected areas. Compared to the national PNC coverage (81.1%), all these natural hazards effected areas showed low coverage. Further, logic regression showed that these hazard prone areas were less (OR:0.85 for flood, 0.77 for earthquake, and 0.77 for landslide) likely to get PNC coverage than their counterparts. LISA cluster maps significantly showed low PNC and high disaster concentration in these disaster-prone areas. Geographic weighted regression results also showed similar result.

CONCLUSIONS

The present study elucidates notable heterogeneity in the coverage of postnatal care (PNC) services, with lower concentrations observed in disaster-prone areas. In order to enhance the accessibility and quality of PNC services in these areas, targeted interventions such as the deployment of mobile health services and fortification of health systems are recommended.

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

PURPOSE

Climate change poses one of the greatest risks to human health as air pollution increases, surface temperatures rise, and extreme weather events become more frequent. Environmental exposures related to climate change have a disproportionate effect on pregnant women through influencing food and water security, civil conflicts, extreme weather events, and the spread of disease. Our research team sought to identify the current peer-reviewed research on the effects of climate change-related environmental exposures on perinatal and maternal health in the United States.

DESIGN AND METHODS

A systematic literature review of publications identified through a comprehensive search of the PubMed and Web of Science databases was conducted using a modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. The initial search across both databases identified a combined total of 768 publications. We removed 126 duplicates and 1 quadruplet, and the remaining 639 publications were subjected to our pre-set inclusion and exclusion criteria. We excluded studies outside of the United States. A total of 39 studies met our inclusion criteria and were retained for thematic analysis.

FINDINGS

A total of 19 studies investigated the effect of either hot or cold temperature exposure on perinatal and maternal health outcomes. The effect of air pollution on perinatal outcomes was examined in five studies. A total of 19 studies evaluated the association between natural disasters (hurricanes, flash floods, and tropical cyclones) and perinatal and maternal health outcomes. High and low temperature extremes were found to negatively influence neonate and maternal health. Significant associations were found between air pollutant exposure and adverse pregnancy outcomes. Adverse pregnancy outcomes were linked to hurricanes, tropical cyclones, and flash floods.

CONCLUSIONS

This systematic review suggests that climate change-related environmental exposures, including extreme temperatures, air pollution, and natural disasters, are significantly associated with adverse perinatal and maternal health outcomes across the United States.

The Effects of Maternal Disaster Exposure on Adolescent Mental Health 12 Years Later

Natural disasters adversely impact children's mental health, with increased parent or child exposure and subsequent parental distress predicting poorer outcomes. It remains unknown, however, whether the psychological consequences of disasters for children persist long-term, and if so, why and for whom. We therefore examined the effects of mothers' exposure to Hurricane Katrina on adolescent children's mental health 12 years later, distinguishing between direct effects of disaster exposure and effects mediated by maternal distress, and evaluating moderation by child age and gender. Data were from a 2003-2018 study of young, low-income, primarily African American mothers living in New Orleans when Hurricane Katrina occurred in 2005 (n = 328). Mothers rated their mental health about one year pre-Katrina and one, four, and 12 years afterwards. They reported on an adolescent child's (ages 10-17, mean = 14.46) internalizing and externalizing symptoms 12 years post-Katrina using the Strengths and Difficulties Questionnaire. Path analytic models adjusting for mothers' pre-disaster distress showed that, whereas the direct effects of maternal hurricane exposures on child mental health were not significant, the indirect effects were. Specifically, mothers who experienced more Katrina-related stressors had higher distress thereafter, which predicted poorer child outcomes. Results did not differ significantly by child age. Gender differences are discussed. Findings suggest that disasters can affect child mental health for many years, even for those who were very young or not yet born at the time, due to parents' disaster-related distress. Addressing parents' mental health needs in the aftermath of disasters may improve child well-being long-term.

Association between severe cyclone events and birth outcomes in Queensland, Australia, 2008-2018: a population based retrospective cohort study

OBJECTIVE

Investigate an association between severe tropical cyclones (TCs) and birth outcomes in an Australian population.

METHODS

We analysed over 600,000 singleton livebirths collected through the Queensland Perinatal Data Collection between 2008 and 2018. We estimated the odds ratios (ORs) of adverse birth outcomes using logistic multi-level modelling.

RESULTS

Exposure to TCs in early pregnancy was associated with significantly higher odds of preterm births in affected compared to unaffected areas during the TC year [OR=1.28, 95%CI=1.11, 1.49, p=0.001] and slightly significant higher odds in affected areas during TC years compared to non-TC years. Significantly higher odds of low birthweight births were associated with mid-pregnancy exposure to cyclone Marcia [OR=1.62, 95%CI=1.00, 2.40, p=0.016] .

CONCLUSIONS

Findings aligned with studies demonstrating an association between exposure to environmental stressors in early to mid-pregnancy and adverse birth outcomes.

IMPLICATIONS FOR PUBLIC HEALTH

There is limited research into TCs and perinatal health in Australia despite most of the population residing along coastlines and TCs presenting one of the nation's most devastating weather events. This study will inform public health practice and contribute to further research into mitigating environmental risks faced by pregnant women.

Maternal Self-Efficacy Buffers the Effects of COVID-19-Related Experiences on Postpartum Parenting Stress

OBJECTIVE

To examine the associations of maternal self-efficacy (MSE) and perceived social support with parenting stress during the postpartum period during the COVID-19 pandemic and whether these two psychosocial factors account for variance in parenting stress in addition to the effects of COVID-19-related experiences and sociodemographic factors.

DESIGN

Cross-sectional survey.

SETTING

Online survey, the Perinatal Experiences and COVID-19 Effects (PEACE) study, launched in May 2020.

PARTICIPANTS

Participants included 310 women who gave birth in the past 24 weeks.

METHODS

The survey included self-report quantitative measures of MSE, social support, COVID-19-related experiences, parenting stress, symptoms of depression and anxiety, and a range of sociodemographic factors.

RESULTS

Hierarchical multiple regression analysis indicated that MSE and social support were negatively associated with postpartum parenting stress in addition to the effects of COVID-19-related experiences, maternal symptoms of depression and anxiety, and a range of demographic factors. Furthermore, MSE interacted with COVID-19-related experiences such that higher levels of MSE mitigated the effects of COVID-19-related experiences on parenting stress.

CONCLUSION

Our findings underscore the importance of protective factors at the individual and interpersonal levels and provide insights for prevention and intervention programs aimed at mitigating postpartum parenting stress during a wide-scale disaster such as the COVID-19 pandemic.