Psychiatric morbidity and pregnancy outcome in a disaster area of Taiwan 921 earthquake

Maternal anxiety, depression and posttraumatic stress disorder (PTSD) after natural disasters: a systematic review

OBJECTIVE

To measure the prevalence of maternal anxiety, depression and posttraumatic stress disorder (PTSD) in those exposed to natural disasters.

METHODS

A literature search of the PubMed database and www.clinicaltrials.gov from January 1990 through June 2020 was conducted. A PRISMA review of the available literature regarding the incidence and prevalence of maternal anxiety, depression and posttraumatic stress disorder (PTSD) following natural disasters was performed. A natural disaster was defined as one of the following: pandemic, hurricane, earthquake and post-political conflict/displacement of people. Studies were selected that were population-based, prospective or retrospective. Case reports and case series were not used. The primary outcome was the prevalence of maternal anxiety, depression and PTSD in the post-disaster setting. Two independent extractors (I.F. & H.G.) assessed study quality using an adapted version of the Effective Public Health Practice Project Quality Assessment tool. Given the small number of studies that met inclusion criteria, all 22 studies were included, regardless of rating. Data were extracted and aggregate rates of depression, anxiety, and PTSD were calculated to provide synthesized rates of maternal mental health conditions among participants.

RESULTS

Twenty-two studies met the inclusion criteria. A total of 8357 pregnant or birthing persons in the antepartum and postpartum periods were studied. The prevalence of post-pandemic anxiety, depression and PTSD were calculated to be 48.2%, 27.3%, and 22.9%. Post-earthquake depression and PTSD rates were 38.8% and 22.4%. The prevalence of post-hurricane anxiety, depression and PTSD were 17.4%, 22.5%, and 8.2%. The rates of post-political conflict anxiety, depression and PTSD were 48.8%, 31.6% and 18.5%.

CONCLUSION

Given the high rates of anxiety, depression and PTSD among pregnant and birthing persons living through the challenges of natural disasters, obstetrician-gynecologists must be able to recognize this group of patients, and provide a greater degree of psychosocial support.

Eight-Year Trends in the Effect of the Great East Japan Earthquake on Obstetrics Outcomes: A Study from the Fukushima Health Management Survey

Information regarding the longitudinal effects of natural/environmental disasters on obstetrics outcomes is limited. This study aimed to analyze the longitudinal changes in obstetrics outcomes over 8 years after the Great East Japan Earthquake and the Fukushima power plant accident. We used data from the first 8 years of the Pregnancy and Birth Survey by the Fukushima prefectural government, launched in 2011. We compared data on obstetrics outcomes by year and divided Fukushima Prefecture into six districts based on administrative districts. Longitudinal changes in the occurrence of preterm birth before 37 gestational weeks, low birth weight, and anomalies in newborns were accessed using the Mantel-Haenszel test for trends in all six districts. Overall, 57,537 participants were included. In 8 years, maternal age, conception rate after sterility treatment, and cesarean section delivery incidence increased. Although significant differences were observed in preterm birth and low birth weight occurrence among districts, there was no significant trend in the occurrence of preterm birth, low birth weight, and anomalies in newborns in all six districts of Fukushima Prefecture. The Great East Japan Earthquake and Fukushima power plant accident were associated with increased cesarean section delivery incidence but had no significant adverse effects on obstetrics outcomes.

The impact of flood on pregnancy outcomes: A review article

Flood is one of the natural disasters with high prevalence in the world. The aim of this research was to investigate the effect of flood on pregnancy outcome and pregnancy complication such as preterm birth, LBW, SGA, stillbirth, spontaneous abortion, preeclampsia and eclampsia. This is a systematic review based on the PRISMA model that examines pregnancy disorder, pregnancy complication, and reproductive outcomes in floods. For fulfilling of the objectives of the research, related keywords were identified using Mesh and Emtree databases. Then the search was done in the electronic database of Medline, Web of Science, Embase, scopus until 2021.2.10. The search strategy in the Medline database. Database searches resulted in 823 non-duplicate records. After reading the abstracts, 808 articles were excluded. 15 abstracts were eligible for the study, which their full texts were provided. Finally based on inclusion and exclusion criteria 7 articles were included in this study. After flood, the rate of LBW birth and gestational hypertension increases. However, there is no significant difference in preterm birth rates. Pregnancy complications can be reduced or prevented by starting prenatal care early and also by controlling risk factors such as reducing smoking and alcohol consumption.

The Effects of the Great East Japan Earthquake on Perinatal Outcomes: Results of the Pregnancy and Birth Survey in the Fukushima Health Management Survey

There are limited studies on the long-term effects of natural/environmental disasters, especially nuclear disasters, on obstetric outcomes. This study aimed to review the results of perinatal outcomes immediately after the Great East Japan Earthquake (GEJE) and the Fukushima Daiichi Nuclear Power Plant accident, as well as their long-term trends over 8 years, in the Fukushima Health Management Survey. The annual population-based Pregnancy and Birth Survey is conducted as part of the Fukushima Health Management Survey. The Fukushima Prefecture government launched it to assess the health conditions of pregnant women and their neonates after the GEJE. The self-reported questionnaire was sent to 115,976 pregnant women by mail from January 2012, with 58,344 women responding to the questionnaire (50.3% response rate). Pregnancy complications, such as gestational hypertension, respiratory diseases, and mental disorders, increased in some women who were pregnant at the time of the earthquake and immediately after the earthquake. However, the direct effects on newborns, such as preterm birth, low birth weight, and congenital anomalies, were not immediately clear after the earthquake. Although there were significant differences in the occurrence of preterm birth and low birth weight among the districts, there was no change in the occurrences of preterm birth, low birth weight, or anomalies in newborns in Fukushima Prefecture from the fiscal year 2011 to the fiscal year 2018. Therefore, the long-term effects of the post-disaster radiation accident on perinatal outcomes are considered to be very small.

The prevalence of psychological distress during pregnancy in Miyagi Prefecture for 3 years after the Great Eas t Japan Earthquake

Background

To examine changes in psychological distress prevalence among pregnant women in Miyagi Prefecture, which was directly affected by the Great East Japan Earthquake and tsunami, and compare it with the other, less damaged areas of Japan.

Methods

This study was conducted in conjunction with the Japan Environment and Children`s Study. We examined 76,152 pregnant women including 8270 in Miyagi Regional Center and 67,882 in 13 other regional centers from the all-birth fixed data of the Japan Environment and Children’s Study. We then compared the prevalence and risk of distress in women in Miyagi Regional Center and women in the 13 regional centers for 3 years after the disaster.

Results

Women in the Miyagi Regional Center suffered more psychological distress than those in the 13 regional centers: OR 1.38 (95% CI, 1.03–1.87) to 1.92 (95% CI, 1.42–2.60). Additionally, women in the inland area had a consistently higher prevalence of psychological distress compared to those from the 13 regional centers: OR 1.67 (95% CI, 1.18–2.38) to 2.19 (95% CI, 1.60–2.99).

Conclusions

The lack of pre-disaster data in the Japan Environment and Children’s Study made it impossible to compare the incidence of psychological distress before and after the March 2011 Great East Japan Earthquake. However, 3 years after the Great East Japan Earthquake, the prevalence of pregnant women with psychological distress did not improve in Miyagi Regional Center. Further, the prevalence of mental illness in inland areas was consistently higher than that in the 13 regional centers after the disaster.

Evaluating the Effect of Inert Recruiting on Blood Donations Immediately After the Consecutive Earthquakes

OBJECTIVE

Disasters can have impact on the demand and supply of blood, with such a difficult perspective, planning of an appropriate response to counterbalance the need for blood is of paramount importance. The primary objective of this study was to evaluate how the impact of blood imbalances may be absorbed by inert recruitment of donors during 2 life-threatening earthquakes that shook Taiwan on the same date in 2016 and 2018.

METHOD

A retrospective database search from blood bank registries was developed.

RESULTS

Despite the public efforts to restrain the flow, a 3- to 4-fold increase in volunteers responded to the earthquakes. This surge alleviated after a day and did not contribute to sub-par collections. Those who donated more than usual immediately after the event were identified as first-time, younger, and female populations. The hospitals providing inpatient care to the injured transfused a slightly decreased amount of packed red cells, whereas the use of whole blood, platelets, and plasma remained stable. The inert recruiting was effective in reducing the duration of donor overabundance.

CONCLUSION

Compared with other examples, the inert recruiting approach was effective in reducing the duration of donor overabundance to 1 day and may be useful for disaster preparedness of transfusion supplies.

Positive cognitive appraisal "buffers" the long-term effect of peritraumatic distress on maternal anxiety: The Queensland Flood Study

BACKGROUND

Limited research has evaluated distinct aspects of disaster experience as predictors of affective symptoms. In this study, we examined the extent to which maternal depression and anxiety over time were predicted by (1) objective hardship from a flood during pregnancy, (2) peritraumatic distress and (3) cognitive appraisal of the flood's consequences.

METHODS

Data were drawn from the 2011 Queensland Flood Study, a prospective, longitudinal study of pregnancy (n = 183). Mothers' disaster experience was measured within 1 year after the flood. Their levels of depression, anxiety and stress were measured at 16 months, 30 months, 4 years and 6 years after childbirth. Linear mixed models were employed to evaluate symptom trajectories.

RESULTS

There were no time-dependent effects of disaster-related variables. Objective hardship did not predict outcomes. Peritraumatic distress significantly predicted depression and anxiety symptoms when cognitive appraisal was negative. Conversely, when cognitive appraisal was neutral or positive, the effect of peritraumatic distress was "buffered". For anxiety, but not depression, this interaction survived Bonferroni correction. Neutral/positive cognitive appraisal similarly moderated the effect of peritraumatic dissociation.

LIMITATIONS

The generalizability of our findings is limited by overall low levels of depression and anxiety, along with a predominantly Caucasian, higher socioeconomic status sample. Potential confounders such as pre-disaster anxiety were not controlled for.

CONCLUSION

In line with previous evidence, this study supports the predictive validity of peritraumatic distress for post-disaster depression and anxiety. Our findings suggest that cognitive appraisal could be a relevant target for interventions aimed at fostering maternal resilience.

Maternal exposure to Wenchuan earthquake and prolonged risk of offspring birth outcomes: a natural experiment study

Background

The prolonged effects of disasters on reproductive outcomes among the survivors are less studied, and the findings are inconsistent. We examined the associations of maternal exposure to the 2008 Wenchuan earthquake years before conception with adverse birth outcomes.

Methods

We included 73,493 women who delivered in 96 hospitals in 24 provinces and autonomous regions from the 2015/16 China Labor and Delivery Survey. We weighted the multivariable logistic models based on the combination of coarsened exact matching (CEM) weight and survey weight, and performed sex-stratified analysis to test whether associations of maternal earthquake exposure with adverse birth outcomes (Stillbirth, preterm birth [PTB], low birthweight [LBW], and small for gestational age [SGA]) varied by sex.

Results

The bivariate models showed that the weighted incidence of each adverse birth outcome was higher in exposed group than unexposed group: stillbirth (2.00% vs. 1.33%), PTB (14.14% vs. 7.32%), LBW (10.82% vs. 5.76%), and SGA (11.32% vs. 9.52%). The multivariable models showed maternal earthquake exposure was only associated significantly with a higher risk of PTB in offspring among all births (adjusted risk ratio [aRR](95%CI):1.25(1.06–1.48), P = 0.010). The sex-stratified analysis showed the association was significant among male births (aRR (95%CI): 1.40(1.12–1.75),P = 0.002),but unsignificant among female births. The sensitivity analysis reported similar findings.

Conclusions

The 2008 Wenchuan earthquake exposure has a long-term effect on PTB. Maternal acute exposure to disasters could be a major monitor for long-term reproductive outcomes. More attention should be paid to the underlining reasons for disaster-related adverse birth outcomes.

Coping During Pregnancy Following Exposure to a Natural Disaster: The QF2011 Queensland Flood Study

INTRODUCTION

This study investigated how coping strategies moderated the impact of disaster-related objective hardship on subjective distress in pregnant women.

METHODS

The objective hardship (exposure severity), subjective distress (Peritraumatic Distress Inventory, Peritraumatic Dissociative Experiences Questionnaire and Impact of Event Scale-Revised) and coping styles (Brief COPE) of pregnant women (N = 226) exposed to the 2011 Queensland, Australia flood were assessed. Moderation analyses were used to assess how coping strategies moderated the relationship between objective hardship and subjective distress levels.

RESULTS

We found that the more severe the objective flood exposure, the greater the women's subjective distress. The moderation analyses were significant for the Brief COPE's three coping styles (i.e., problem-focused coping, emotion-focused coping, and dysfunctional coping). For women experiencing high levels of objective hardship, problem-focused (∆R² = 1.7%) and dysfunctional coping (∆R² = 1.5%) elevated subjective distress levels. For women experiencing low or moderate levels of objective hardship, emotion-focused coping reduced levels of subjective distress (∆R² = 1.3%). A three-way interaction between objective hardship, emotion-focused coping, and dysfunctional coping approached significance (∆R² = 1.0%), indicating a protective role of emotion-focused coping under high levels of objective hardship, for women who frequently use maladaptive coping strategies.

LIMITATIONS

Sample was generally high SES and no measure of social support was available.

CONCLUSION

Results suggest that both problem-focused and dysfunctional coping strategies were maladaptive for women with relatively high exposure levels. Overall, emotion-focused coping strategies were more likely than problem-focused or dysfunctional strategies to reduce pregnant women's subjective distress following the flood.

Experiences of an earthquake during pregnancy, antenatal mental health and infants' birthweight in Bhaktapur District, Nepal, 2015: a population-based cohort study

Background

Infant birthweight is an important public health indicator that is a proxy of maternal and baby’s health. Earthquakes can cause acute distress, but can also contribute to chronic stress through long-term disruptions to social, economic and domestic circumstances. The aims of this study were to examine the direct effect of earthquake experiences on the birthweight of infants of women who experienced the 2015 Nepal Earthquakes during pregnancy and whether mental health mediated this relationship.

Methods

This is a prospective, population-based cohort study. Pregnant women in Bhaktapur District, Nepal who had experienced the 2015 earthquakes after conception were recruited. Baseline data were collected in structured individual interviews. Follow up was a short telephone interview two weeks after the baby’s birth. Infant birthweight recorded on the hospital-issued birth certificate. The direct effect of earthquake experiences on birthweight and the indirect effect via antenatal common mental disorders (CMDs) were tested using Sobel tests simultaneously.

Results

In total 497/498 women contributed baseline data and 469 (94.4%) women also provided the birth weight of their infants. In total 6% of infants had low birth weight (< 2.5 kg). The earthquake experiences did not have a significant direct effect on birthweight (p = 0.116). However, the effect of earthquake experiences had a significant indirect effect on infant birthweight via CMDs. When 15 covariates were controlled, women who had moderate to severe earthquake experiences had an increase of 1.58 scores of antenatal CMD symptoms that resulted in their babies being 20.50 g lighter than those who had low earthquake experiences (p = 0.026).

Conclusions

The findings from this study indicate that the relationship is mediated by the mental health of women during pregnancy. Data demonstrate that the mental health of women who are pregnant should be prioritised in post-disaster management not only because of the burden experienced by women but also because of the risk for the growth and development of their babies.

Impact of Hurricanes Irma and Maria on Puerto Rico Maternal and Child Health Research Programs

Puerto Rico was hit by two major hurricanes in September 2017 causing great devastation, losing over 90% of the power grid, wireless communication and access to potable water, and destroying many homes. Our research programs: Puerto Rico Testsite for Exploring Contamination Threats (PROTECT), Center for Research on Early Childhood Exposure and Development in Puerto Rico (CRECE), Zika in Infants and Pregnancy (ZIP), and Environmental Influences on Child Health Outcomes (ECHO) are ongoing observational cohort studies that have been investigating environmental risk factors for perinatal health outcomes among Puerto Rican mothers and infants. Our projects paused operations for about two weeks, to begin recovery process and become a source of assistance, retaining 95% of study participants across all research programs. We joined with various groups to ensure the safety and welfare of team members, study participants, community health center partners, and members of the surrounding communities. We learned important lessons about the impact of these hurricanes and the difficulties of the recovery. Major challenges post-hurricanes were access to care and nutrition, maternal stress, and environmental damage. We understood the need to integrate disaster preparedness into our programs' operating procedures and future applications, recognizing that these events will recur. We will grow resilience among our staff, maternal and child health partners, and participants by building on the experience of these two storms.

The prevalence and risk of DSM-IV axis I disorder in adults with early-life earthquake stress: A cross-sectional study

OBJECTIVES

Tangshan earthquake which had a magnitude of 7.8 killed approximately 250,000 people in China in 1976. In the present study, we sought to determine the prevalence and risks of mental disorders in adults who experienced earthquake as an infant or in the prenatal period.

METHODS

This cross-sectional cohort study recruited participants based on the urban resident registry of Tangshan, Hebei province, 2013 using a multistage stratified cluster sampling method with selection probabilities proportional to size. We recruited subjects who were born between July 29, 1975 and April 28, 1978 that was one year before and 1.9 years after the occurrence of Tangshan Earthquake, respectively. Current psychiatric diagnoses and lifetime psychiatric diagnoses were obtained through the Structured Clinical Interview for DSM-IV Axis I Disorders Patient Research Version. Unconditional logistic regression analysis was performed to analyze risk factors of mental disorders.

RESULTS

Totally1380 subjects were included with 392 subjects exposed to the earthquake in the fetal period, 399 subjects who experienced the earthquake during their infancy, and 589 subjects who had no exposure to the earthquake. Twenty-one (2.7%; current 1.9%) subjects exposed to earthquake were diagnosed with major depressive disorderversus 2.3% (current 1.5%) in the non-exposure group. Five (0.6%; current 0.6%) subjects with exposure to earthquake had bipolar disorder versus 0.9% in the non-exposure group.Thirteen (1.6%; current 1.6%) subjects with exposure to earthquake had schizophreniaversus 0.2% in the non-exposure group (P=0.006). Furthermore, 5.2% (current 3.7%) subjects with exposure to earthquake had anxiety disorders versus 5.7% (current 3.9%) in the non-exposure group. Moreover, 8.1% (current 7.0%)subjects with exposure to earthquake had alcohol use disorders versus 7.1% (current 5.3%) in the non-exposure group. Furthermore, the prevalence of schizophrenia of the prenatal exposure group (2.3%) was significantly higher than the other two groups (χ² = 10.273, P = 0.006); however, no statistically significant difference was found in the current and lifetime prevalence of other DSM-IV axis I disorders among the three groups (P > 0.05). Our multivariate regression analysis showed that prenatal earthquake stress exposure was not a significant risk of any of the lifetime or current DSD-IV axis I disorders.

CONCLUSION

Adults who were exposed to earthquake in the prenatal period had a significantly higher rate of schizophrenia than those who were not exposed or who experienced earthquake in their infancy. No statistically significant difference was found in the current and lifetime prevalence of other DSM-IV axis I disorders between those exposed and those not exposed to earthquake. Furthermore, prenatal earthquake stress exposure was not a significant risk of any of the lifetime or current DSD-IV axis I disorders.

Prevalence and determinants of symptoms of antenatal common mental disorders among women who had recently experienced an earthquake: a systematic review

BACKGROUND

Antenatal common mental disorders (CMDs) including anxiety, depressive, adjustment, and somatoform disorders are prevalent worldwide. There is emerging evidence that experiencing a natural disaster might increase the risk of antenatal CMDs. This study aimed to synthesise the evidence about the prevalence and determinants of clinically-significant symptoms of antenatal CMDs among women who had recently experienced an earthquake.

METHODS

This systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search included both electronic and manual components. Five major databases were searched. A data extraction table was used to summarise study characteristics and findings. Two authors examined the quality of studies independently using a quality assessment tool. A narrative synthesis of the findings reported.

RESULTS

In total seven articles met inclusion criteria. Quality scores ranged from six to seven out of ten. All the studies were cross-sectional surveys and were conducted in high and middle-income countries. Sample sizes varied among studies. The prevalence of clinically-significant symptoms of antenatal CMD ranged from 4.6% (95% CI, 3.2; 6.5) experiencing 'psychological stress' in Japan to 40.8% (95% CI, 35.5; 46.4) 'depression' in China. While all studies were conducted in an earthquake context, only four examined some aspect of earthquake experiences as a risk factor for antenatal CMDs. In multivariable analyses, higher marital conflict, poor social support, multiparity, stresses of pregnancy and the personality characteristic of a negative coping style were identified as risks and a positive coping style as protective against antenatal CMDs.

CONCLUSIONS

This systematic review found that women who have recently experienced an earthquake are at heightened risk of antenatal mental health problems. It indicates that in addition to the establishment of services for safe birth which is recognised in post-disaster management strategies, pregnancy mental health should be a priority. The review also revealed that there is no evidence available from the world's low-income nations where natural disasters might have more profound impacts because local infrastructure is more fragile and where it is already established that women experience a higher burden of antenatal CMDs.

TRIAL REGISTRATION

PROSPERO- CRD42017056501 .

Allostatic load: A theoretical model for understanding the relationship between maternal posttraumatic stress disorder and adverse birth outcomes

BACKGROUND

Adverse birth outcomes such as preterm birth and low birth weight are significant public health concerns and contribute to neonatal morbidity and mortality. Studies have increasingly been exploring the predictive effects of maternal posttraumatic stress disorder (PTSD) on adverse birth outcomes. However, the biological mechanisms by which maternal PTSD affects birth outcomes are not well understood. Allostatic load refers to the cumulative dysregulations of the multiple physiological systems as a response to multiple social-ecological levels of chronic stress. Allostatic load has been well documented in relation to both chronic stress and adverse health outcomes in non-pregnant populations. However, the mediating role of allostatic load is less understood when it comes to maternal PTSD and adverse birth outcomes.

OBJECTIVE

To propose a theoretical model that depicts how allostatic load could mediate the impact of maternal PTSD on birth outcomes.

METHOD

We followed the procedures for theory synthesis approach described by Walker and Avant (2011), including specifying focal concepts, identifying related factors and relationships, and constructing an integrated representation. We first present a theoretical overview of the allostatic load theory and the other 4 relevant theoretical models. Then we provide a brief narrative review of literature that empirically supports the propositions of the integrated model. Finally, we describe our theoretical model.

FINDINGS/CONCLUSIONS

The theoretical model synthesized has the potential to advance perinatal research by delineating multiple biomarkers to be used in future. After it is well validated, it could be utilized as the theoretical basis for health care professionals to identify high-risk women by evaluating their experiences of psychosocial and traumatic stress and to develop and evaluate service delivery and clinical interventions that might modify maternal perceptions or experiences of stress and eliminate their impacts on adverse birth outcomes.

Effect of the 2015 Nepal Earthquakes on symptoms of common mental disorders among women who are pregnant

BACKGROUND

Antenatal mental health problems are of concern globally not only because of the burden and limits to participation experienced by women but also because of risks for foetal neurocognitive development and adverse birth outcomes. The aim was to describe the indicative prevalence of and risk and protective factors for clinically-significant symptoms of antenatal common mental disorders (CMDs) among women who experienced the 2015 Nepal earthquakes during pregnancy.

METHODS

A population-based cross-sectional study in Bhaktapur, one of 14 districts highly affected by the 2015 Nepal earthquakes. The primary outcome, clinically significant symptoms of CMDs, was ascertained using the Nepali validation of the Edinburgh Postnatal Depression Scale (EPDS-N). In order to investigate potential trauma reactions, a subset of EPDS items as indicators of trauma symptoms was constructed. Standardised instruments and study-specific questions were used to measure potential risk and protective factors. Data were collected in individual structured interviews by trained health researchers. Hierarchical multiple linear regression models were used to establish risk and protective factors for clinically significant symptoms of CMDs and indicators of post-earthquake trauma reaction.

RESULTS

Overall, 497/498 eligible pregnant women provided complete data. We found that 21.9% (95% CI, 18.4; 25.8) of participants had EPDS-N scores > 12 and another 17.1% (95% CI 13.9; 20.7) scored 10-12 indicating a high prevalence of clinically significant CMD symptoms. In total, 20 factors were included in the final hierarchical multiple linear regression model and together explained 33.3% of the variance in EPDS total scores; seven factors, including earthquake experiences and lifetime experience of intimate partner violence, increased risk and five including having income-generating work and a kind, and encouraging partner were protective. The association between earthquake experiences and the indicators of trauma symptoms was not significant in the hierarchical multiple linear regression analysis.

LIMITATIONS

The EPDS has not yet been formally validated in Nepal for use during pregnancy. Data were collected 6 months post-earthquake, so we were not able to capture the experiences of women who had spontaneous or induced abortions or premature births in the immediate aftermath of the earthquake.

CONCLUSIONS

In addition to the restoration of antenatal and obstetric services, the mental health of women who are pregnant requires specific consideration and interventions after natural disasters. This should take into account the additional adverse impact of violence perpetrated by an intimate partner.

Effects of earthquake on perinatal outcomes: A Chilean register-based study

Background

Natural disasters increase the level population stress, including pregnant women, who can experience prenatal maternal stress, affecting the fetus and triggering perinatal complications, such as low birth weight, smaller head circumference, etc. However, little is known about effects of earthquake on perinatal outcomes.

Objective

To evaluate the effect of earthquake occurred on February 27, 2010 and perinatal outcomes of Chilean pregnant women, and to examine these effects by timing of exposure during pregnancy and newborn gender.

Methods

A register-based study was performed using data collected from women who had a vaginal delivery in a large private health center in Santiago, Chile, during 2009 and 2010. The study population was categorized according to exposure to earthquake and timing during gestation. Primary perinatal outcomes were gestational age at birth, birth weight, length and head circumference. Analyses adjusted for gender, gestational age at exposure, parity, maternal age and income.

Results

A total of 1,966 eligible vaginal deliveries occurred during 2009 and 2,110 in 2010. Birth weight was not affected by the trimester of exposure; however, length, head circumference and gestational age at birth were significantly different according to trimester of exposure and gender of newborn. In multivariable analysis, newborns were shorter by 2 mm, 5 mm and 4.5 mm, if they were exposed during their first, second and third trimester, respectively. Furthermore, newborns had a smaller head circumference by 1.2 mm and 1.5 mm if they were exposed during first and second trimester of gestation.

Conclusion

In this cohort, exposure to the February 2010 earthquake resulted in earlier delivery and reduced length and head circumference in the offspring. This association varied according to trimester of exposure and fetal gender. Health workers should include exposed to high levels of stress associated with natural disasters when assessing pregnancy risk factors.

Trauma and traumatic stress in a sample of pregnant women

OBJECTIVE

To examine the construct validity of the 9 item Traumatic Events Questionnaire (TEQ) and to evaluate the extent to which experiences of trauma assessed using the TEQ are associated with symptoms of psychiatric disorders among 3342 pregnant women in Lima, Peru.

METHODS

Symptoms of depression were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS) while the PTSD Checklist-civilian (PCL-C) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess symptoms of PTSD and generalized anxiety. Hierarchical logistic regression procedures were used to evaluate relations between TEQ and symptoms of psychiatric disorders.

RESULTS

The majority of participants (87.8%) experienced at least one traumatic event (mean = 2.5 events). The trauma occurrence score was moderately correlated with symptoms of PTSD (PCL-C: rho = 0.38, P-value < 0.0001), depression (EPDS: rho = 0.31, P-value < 0.0001; PHQ-9: rho = 0.20, P-value < 0.0001), and GAD (GAD-7: rho = 0.29, P-value < 0.0001). Stronger correlations were observed between the trauma intensity score with symptoms of psychiatric disorders (PCL-C: rho = 0.49, P-value < 0.0001; EPDS: rho = 0.36, P-value < 0.0001; PHQ-9: rho = 0.31, P-value < 0.0001; GAD-7: rho = 0.39, P-value < 0.0001).

CONCLUSION

Given the high burden of trauma experiences and the enduring adverse consequences on maternal and child health, there is an urgent need for integrating evidence-based trauma informed care programs in obstetrical practices serving Peruvian patients.

Impact of the Great East Japan Earthquake on feeding methods and newborn growth at 1 month postpartum: results from the Fukushima Health Management Survey

This study examined the effects of three disasters (the Great East Japan Earthquake of March 11, 2011, followed by a tsunami and the Fukushima Daiichi Nuclear Power Plant accident) on feeding methods and growth in infants born after the disasters. Using results from the Fukushima Health Management Survey, Soso District (the affected area where the damaged nuclear power plant is located) and Aizu District (a less-affected area located farthest from the plant) were compared. In this study, newborn and maternal background characteristics were examined, as well as feeding methods, and other factors for newborn growth at the first postpartum examination for 1706 newborns born after the disaster in the affected (n = 836) and less-affected (n = 870) areas. Postpartum examinations took place 1 month after birth. Feeding method trends were examined, and multivariate regression analyses were used to investigate effects on newborn mass gain. There were no significant differences in background characteristics among newborns in these areas. When birth dates were divided into four periods to assess trends, no significant change in the exclusive breastfeeding rate was found, while the exclusive formula-feeding rate was significantly different across time periods in the affected area (p = 0.02). Multivariate analyses revealed no significant independent associations of maternal depression and change in medical facilities (possible disaster effects) with other newborn growth factors in either area. No area differences in newborn growth at the first postpartum examination or in exclusive breastfeeding rates were found during any period. Exclusive formula-feeding rates varied across time periods in the affected, but not in the less-affected area. It is concluded that effective guidance to promote breast-feeding and prevent exclusive use of formula is important for women in post-disaster circumstances.

Impact of the Great East Japan Earthquake on Regional Obstetrical Care in Miyagi Prefecture

OBJECTIVES

The authors report the results of surveys on the emergency transport or evacuation status of obstetric patients conducted in Miyagi prefecture, one of the major disaster areas of the Great East Japan Earthquake and tsunami.

METHODS

The surveys examined the damages to maternity institutions, evacuation status and transport of pregnant women, and prehospital childbirths and were conducted in 50 maternity institutions and 12 fire departments in Miyagi.

RESULTS

Two coastal institutions were destroyed completely, and four institutions were destroyed partially by the tsunami, forcing them to stop medical services. In the two-month period after the disaster, 217 pregnant women received hospital transport or gave birth after evacuation. Satisfactory perinatal outcomes were maintained. Emergency obstetric transport increased to approximately 1.4 fold the number before the disaster. Twenty-three women had prehospital childbirths, indicating a marked increase to approximately three times the number of the previous year.

CONCLUSION

In the acute phase of the tsunami disaster, maternity institutions were damaged severely and perinatal transport was not possible; as a result, pregnant women inevitably gave birth in unplanned institutions, and the number of prehospital births was increased extremely. To obtain satisfactory obstetric outcomes, it is necessary to construct a future disaster management system and to re-recognize pregnant women as people with special needs in disaster situations. Sugawara J , Hoshiai T , Sato K , Tokunaga H , Nishigori H , Arai T , Okamura K , Yaegashi N . Impact of the Great East Japan Earthquake on regional obstetrical care in Miyagi Prefecture. Prehosp Disaster Med. 2016;31(3):255- 258.

Psychological distress during pregnancy in Miyagi after the Great East Japan Earthquake: The Japan Environment and Children's Study

OBJECTIVE

To examine psychological distress among pregnant women in Miyagi prefecture which was directly affected by the Great East Japan Earthquake and tsunami and compare other areas of Japan that were less damaged.

METHODS

This study was conducted in conjunction with the Japan Environment and Children's Study (JECS). We examined 10,129 Japanese women using the primary fixed data of the JECS. The Kessler 6-item psychological distress scale (K6) was administered to 7473 eligible women including 998 in Miyagi unit center ('Miyagi UC') and 6475 in the other unit centers ('13UCs'). We compared the prevalence and the risk of distress (K6 ≥ 13) during pregnancy in 'Miyagi UC' and '13UCs'.

RESULTS

More women in 'Miyagi UC' (4.9%) suffered psychological distress, compared with '13UCs' (3.1%) (p<0.001). A significantly higher prevalence of women in 'Miyagi UC' (55.5%) had experienced negative life events, whereas '13UCs' showed 42.7% (p<0.0001). In multivariable logistic analyses adjusted for baseline characteristics, there was a significant regional difference of psychological distress (adjusted odds ratio; aOR in Miyagi UC=1.488; 95%CI, 1.059-2.090). After further adjusting for negative life events, the association was diminished (aOR=1.338; 95%CI, 0.949-1.884).

LIMITATIONS

The JECS had no data before the earthquake and the extent of damage was not investigated. Possible regional representativeness is also a limitation.

CONCLUSION

After the Great East Japan Earthquake, the prevalence of pregnant women with psychological distress (K6 ≥ 13) were high in Miyagi prefecture. Especially in the coastal area directly affected by tsunami, it is high with or without negative life events experienced.

Reproductive and Birth Outcomes in Haiti Before and After the 2010 Earthquake

OBJECTIVE

We aimed to examine the relationship between exposure to the 2010 Haiti earthquake and pregnancy wantedness, interpregnancy interval, and birth weight.

METHODS

From the nationally representative Haiti 2012 Demographic and Health Survey, information on "size of child at birth" (too small or not) was available for 7280 singleton births in the previous 5 years, whereas information on birth weight was available for 1607 births. Pregnancy wantedness, short (<1 year) interpregnancy interval, and maternal-reported birth weight were compared before and after the earthquake and by level of damage. Multiple logistic regression and linear regression analyses were conducted.

RESULTS

Post-earthquake births were less likely to be wanted and more likely to be born after a short interpregnancy interval. Earthquake exposure was associated with increased likelihood of a child being born too small: timing of birth (after earthquake vs. before earthquake, adjusted odds ratio [aOR]: 1.27, 95% confidence interval [CI]: 1.12-1.45), region (hardest-hit vs. rest of country; aOR: 1.43, 95% CI: 1.14- 1.80), and house damage (aOR: 1.27 95% CI: 1.02-1.58). Mean birth weight was 150 to 300 g lower in those exposed to the earthquake.

CONCLUSIONS

Experience with the earthquake was associated with worse reproductive and birth outcomes, which underscores the need to provide reproductive health services as part of relief efforts.

Correlation Between the Great East Japan Earthquake and Postpartum Depression: A Study in Miyako, Iwate, Japan

Objective

This study aimed to explore the correlation between the 2011 Great East Japan Earthquake and postpartum depression among perinatal subjects in the Miyako region of Iwate, an area damaged by earthquakes and tsunamis.

Methods

We retrospectively compared the percentages of women with scores ≥9 on the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS) among 3 groups of women who gave birth prior to the disaster (before-disaster group: n=141), within 3 months after the disaster (within-3-months group: n=70), and 4-6 months after the disaster (4-6-months group: n=89) at the Iwate Prefectural Miyako Hospital. The risk factors for EPDS scores ≥9 were estimated with multivariate logistic regression analyses.

Results

Compared with the before-disaster group, a significantly greater number of women in the within-3-months group had EPDS scores ≥9 at hospital discharge (31.4% versus 9.9%, P<.0001), whereas women in the 4-6-months group did not (10.1% versus 9.9%, P=.96). In both the after-disaster groups, the destruction of their home (adjusted odds ratio [AOR], 3.68; 95% confidence interval [CI], 1.46-9.26) and dissatisfaction with their living conditions (AOR, 3.02; 95% CI, 1.20-7.59) were significantly associated with EPDS scores ≥9.

Conclusions

An increase in postpartum depression was observed after the Great East Japan Earthquake among perinatal women. (Disaster Med Public Health Preparedness. 2015;9:307-312)

Mental disorders of pregnant and postpartum women after earthquakes: a systematic review

OBJECTIVE

The aim of this review was to systematically search and critique relevant literature on the potential psychological impact of earthquakes on peripartum women to synthesize existing knowledge for further action.

METHODS

A search through 5 databases was conducted for relevant publications in English, and the results were screened through a set of inclusion and exclusion processes.

RESULTS

Eight articles were included. Depression and posttraumatic stress disorder were the most often reported mental disorders. Some factors (eg, family relationships and social support) were associated with mental disorders suffered by peripartum women after earthquakes. An assessment of the quality of the studies showed that most did not have high levels of evidence because of their cross-sectional design and limitations.

CONCLUSIONS

Among the factors that influenced the mental health of pregnant and postpartum women after earthquakes, family function appears to be one of the most important and deserves further exploration. Other mental health conditions such as minor psychiatric disorders should also be studied for their relationship with disasters and pregnancy. Well-designed studies are needed to enable a better understanding of the relationship between earthquakes and the mental disorders of peripartum women so that the most appropriate interventions can be proposed.

Pregnancy and birth survey after the Great East Japan Earthquake and Fukushima Daiichi Nuclear Power Plant accident in Fukushima prefecture

BACKGROUND

On 11 March 2011, the Great East Japan Earthquake followed by a powerful tsunami hit the Pacific Coast of Northeast Japan and damaged Tokyo Electric Power Company's Fukushima Daiichi Nuclear Power Plant, causing a radiation hazard in Fukushima Prefecture. The objective of this report is to describe some results of a questionnaire-based pregnancy and birth survey conducted by the Radiation Medical Science Center for the Fukushima Health Management Survey.

MATERIALS AND METHODS

Questionnaires were sent to women who received maternal and child health handbooks from municipal officers in Fukushima Prefecture between 1 August 2010 and 31 July 2011, with the aim of reaching those who were pregnant at the time of the disaster. Mailing began 18 January 2012. Data were analyzed separately for six geographic areas in Fukushima Prefecture.

RESULTS

The total number of women meeting survey criteria was 15,972. The number of responses received to date is 9,298 (58.2%). Data from 8602 respondents were analyzed after excluding 634 invalid responses and 5 induced and 57 spontaneous abortions (less than 22 gestational weeks). The incidences of stillbirth (over 22 completed gestational weeks), preterm birth, low birth weight and congenital anomalies were 0.25%, 4.4%, 8.7% and 2.72%, respectively. These incidences are similar to recent averages elsewhere in Japan.

CONCLUSION

Considering the pregnancy and birth survey data in aggregate, our disaster seemed to provoke no significant adverse outcomes over the whole of Fukushima prefecture. But post-disaster prenatal care and support intended for patients' safety and security should be coupled with ongoing surveillance and rigorous data analysis.

Effects of the 2011 flood in Thailand on birth outcomes and perceived social support

OBJECTIVE

To determine the effects of displacement due to flooding during pregnancy on birth outcomes (infant birth weight and gestational age) and the moderating effect of perceived social support on the relationship between displacement and birth outcomes.

DESIGN

A descriptive, longitudinal study.

SETTING

A university-affiliated hospital in Pathum Thani, Thailand.

PARTICIPANTS

Pregnant women (N = 175) in the third trimester that had uncomplicated pregnancies and no history of mental illness.

METHODS

During pregnancy, the participants completed standardized measurements of depression symptoms, perceived social support, and questionnaires concerning the effect of the flood. After giving birth, infant birth weight and gestational age at birth were retrieved from delivery records.

RESULTS

Seventy percent (n = 123) of the participants experienced displacement during the flood. The displaced women had a mean infant birth weight of 175 grams less than that of the nondisplaced women, t(173) = -2.38, p = .02, whereas infant gestational age was not different. Displacement and other variables explained approximately 8% of the variance in infant birth weight. The interaction term between displacement and perceived social support was statistically significant and additionally explained the variance in infant birth weight, F(6, 168) = 3.24, p = .005.

CONCLUSION

Being displaced during pregnancy due to a natural disaster affected fetal growth rather than length of gestation. Health care providers should closely monitor maternal weight gain and fetal growth of pregnant women who experience displacement. Among the displaced women, social support was associated with higher infant birth weight; therefore, high levels of perceived social support may be protective for pregnant women who experience stressful events such as displacement from flooding.

Rate and predictors of postpartum depression in a 22-year follow-up of a cohort of earthquake survivors in Armenia

Disasters have serious long-term impact on mental health for those exposed. The aim of this study was to identify predictors of postpartum depression among survivors of the 1988 devastating earthquake in Armenia. A nested case-control design was applied to investigate postpartum depression in a large-scale cohort of survivors followed between 1990 and 2012. From an original group of 725 adults who were assessed for psychopathology in 1990, 146 women reported having a delivery after the earthquake and were included in this study. Women with postpartum depression were identified using Edinburgh Postnatal Depression Scale. A logistic regression model was fitted to identify the predictors of postpartum depression. Of the 146 women, 19 (13.0%) had postpartum depression. Five independent predictors of postpartum depression were identified: number of woman's stressful life events (odds ratio (OR)=2.06), her prior history of postpartum depression (OR=16.98), delivering sick/dead neonate (OR=13.65), poor living standards during the post-earthquake decade (OR=5.77), and perceiving oneself reliable in 1990 (OR=0.24). Anxiety in 1990 was marginally significantly related to the outcome (OR=3.75). The rate of postpartum depression in this 22-year cohort was similar to that among the Armenian general population. Earthquake exposure was not related to postpartum depression, indicating that the impact of disaster-related trauma diminishes over time. The identified predictors provided evidence to develop interventions targeting groups of women most prone to postpartum depression under such circumstances.

Low birth weight, small for gestational age and preterm births before and after the economic collapse in Iceland: a population based cohort study

OBJECTIVE

Infants born small for gestational age (SGA) or preterm have increased rates of perinatal morbidity and mortality. Stressful events have been suggested as potential contributors to preterm birth (PB) and low birth weight (LBW). We studied the effect of the 2008 economic collapse in Iceland on the risks of adverse birth outcomes.

STUDY DESIGN

The study population constituted all Icelandic women giving birth to live-born singletons from January 1(st) 2006 to December 31(st) 2009. LBW infants were defined as those weighing <2500 grams at birth, PB infants as those born before 37 weeks of gestation and SGA as those with a birth weight for gestational age more than 2 standard deviations (SD's) below the mean according to the Swedish fetal growth curve. We used logistic regression analysis to estimate odds ratios [OR] and corresponding 95 percent confidence intervals [95% CI] of adverse birth outcomes by exposure to calendar time of the economic collapse, i.e. after October 6(th) 2008.

RESULTS

Compared to the preceding period, we observed an increased adjusted odds in LBW-deliveries following the collapse (aOR = 1.24, 95% CI [1.02, 1.52]), particularly among infants born to mothers younger than 25 years (aOR = 1.85, 95% CI [1.25, 2.72]) and not working mothers (aOR = 1.61, 95% CI [1.10, 2.35]). Similarly, we found a tendency towards higher incidence of SGA-births (aOR = 1.14, 95% CI [0.86, 1.51]) particularly among children born to mothers younger than 25 years (aOR = 1.87, 95% CI [1.09, 3.23]) and not working mothers (aOR = 1.86, 95% CI [1.09, 3.17]). No change in risk of PB was observed. The increase of LBW was most distinct 6-9 months after the collapse.

CONCLUSION

The results suggest an increase in risk of LBW shortly after the collapse of the Icelandic national economy. The increase in LBW seems to be driven by reduced fetal growth rate rather than shorter gestation.

Depression and its risk factors among pregnant women in 2008 Sichuan earthquake area and non-earthquake struck area in China

BACKGROUND

On May 12, 2008, a powerful 8.0 magnitude earthquake struck China's Sichuan province. While some studies have assessed the mental and physical wellbeing of disaster victims, few have examined the long-term impact of natural disasters on pregnant women's mental health. As such, this study aims to assess whether the Sichuan earthquake continues to negatively affect women's mental health, 4 years since its occurrence. In addition, predictive and protective risk factors of depressive symptoms among pregnant women were also identified.

METHODS

From June 2012 to October 2012, 520 pregnant women were interviewed, of whom 253 were from an earthquake struck area and 267 were from a non-earthquake struck area. Symptoms of antenatal depression were measured using the Edinburgh Postnatal Depression Scale (EPDS) with a cutoff of≥10.

RESULTS

The prevalence rate of depression among pregnant women in the earthquake area was 34.5% (95% CI, 28.9-40.6), while the rate in the non-earthquake area was 39.6% (95% CI, 33.9-45.5). The perceived stresses associated with pregnancy and social support from husbands are significantly correlated with antenatal depression.

LIMITATIONS

Lack of diagnosis for antenatal depression and it is a self-report evaluation.

CONCLUSIONS

This study found that the Sichuan earthquake does not necessarily have a long-lasting effect on pregnant women who were once victims of the disaster. It was found that pregnant women who experience high levels of pressures from the pregnancy and receive medium support from husbands are more susceptible to experience antenatal depression than pregnant women who perceive higher levels of support from husbands.

Effect of the September 2009 Sumatra Earthquake on Reproductive Health Services and MDG 5 in the City of Padang, Indonesia

Indonesia has been making good progress in reproductive health (RH) outcome. This study aimed to examine the effect of the September 2009 Sumatra earthquake on availability and accessibility of RH services and its possible impact on local Millennium Development Goals (MDGs). Twenty-six health facilities in Padang City were reviewed and 667 clients directly interviewed. Water supply shortage was most widespread and slowest to recover, taking more than 1 year to normalize. Antenatal and emergency obstetric care was minimally disrupted, and family planning practice of the study couples was not changed by the earthquake. The previous rate of improvement in maternal and child mortality was slowed down, whereas stillbirths increased after the earthquake. Thus, there is a need to speed up the recovery to achieve the local MDGs.

Quercetin alleviates predator stress-induced anxiety-like and brain oxidative signs in pregnant rats and immune count disturbance in their offspring

This study was performed in rats to investigate the effect of a psychogenic stress during late gestation on the immediate behavior and brain oxidative status in dams as well as on the immune cell counts in their offspring up to weaning. Besides, the ability of quercetin (a natural flavonoid) to prevent stress effects was evaluated. Quercetin was orally administered for 6 consecutive days before the pregnant rats were acutely exposed to predator stress on gestational day 19. Post-stress corticosterone level, brain oxidative stress parameters and anxiety-like behavior were assessed in dams, whereas immune cell counts were postnatally determined in both male and female pups. Predator stress caused an oxidative stress in the brain and elicited an elevation in plasma corticosterone with concomitant behavioral impairment in dams. Prenatally-stressed pups mainly showed a decrease in total leukocytes and lymphocytes along with monocytosis and granulocytosis, but these changes were sex-dependent throughout the postnatal period studied. Quercetin pretreatment blocked the stress-induced corticosterone release and alleviated the brain oxidative stress with the maternal anxiety measures being slightly attenuated, whereas its effects on the offspring immune cell counts were mostly revealed at birth. Our findings suggest that late gestational exposure to traumatic events may cause anxiety symptoms in dams, in which corticosterone and brain oxidative stress play a certain role, and trigger negative immune changes in the early postnatal life of progeny. Notably, quercetin intake before such adverse events seems to be beneficial against negative outcomes in both dams and offspring.

Impact of earthquakes on sex ratio at birth: Eastern Marmara earthquakes

OBJECTIVE

Previous reports suggest that maternal exposure to acute stress related to earthquakes affects the sex ratio at birth. Our aim was to examine the change in sex ratio at birth after Eastern Marmara earthquake disasters.

MATERIAL AND METHODS

This study was performed using the official birth statistics from January 1997 to December 2002 - before and after 17 August 1999, the date of the Golcuk Earthquake - supplied from the Turkey Statistics Institute. The secondary sex ratio was expressed as the male proportion at birth, and the ratio of both affected and unaffected areas were calculated and compared on a monthly basis using data from gender with using the Chi-square test.

RESULTS

We observed significant decreases in the secondary sex ratio in the 4th and 8th months following an earthquake in the affected region compared to the unaffected region (p= 0.001 and p= 0.024). In the earthquake region, the decrease observed in the secondary sex ratio during the 8th month after an earthquake was specific to the period after the earthquake.

CONCLUSION

Our study indicated a significant reduction in the secondary sex ratio after an earthquake. With these findings, events that cause sudden intense stress such as earthquakes can have an effect on the sex ratio at birth.

Perception of earthquake risk in Taiwan: effects of gender and past earthquake experience

This study explored how individuals in Taiwan perceive the risk of earthquake and the relationship of past earthquake experience and gender to risk perception. Participants (n= 1,405), including earthquake survivors and those in the general population without prior direct earthquake exposure, were selected and interviewed through a computer-assisted telephone interviewing procedure using a random sampling and stratification method covering all 24 regions of Taiwan. A factor analysis of the interview data yielded a two-factor structure of risk perception in regard to earthquake. The first factor, "personal impact," encompassed perception of threat and fear related to earthquakes. The second factor, "controllability," encompassed a sense of efficacy of self-protection in regard to earthquakes. The findings indicated prior earthquake survivors and females reported higher scores on the personal impact factor than males and those with no prior direct earthquake experience, although there were no group differences on the controllability factor. The findings support that risk perception has multiple components, and suggest that past experience (survivor status) and gender (female) affect the perception of risk. Exploration of potential contributions of other demographic factors such as age, education, and marital status to personal impact, especially for females and survivors, is discussed. Future research on and intervention program with regard to risk perception are suggested accordingly.

Adverse perinatal outcomes after the February 27th 2010 Chilean earthquake

OBJECTIVE

To investigate whether the February 27th earthquake exposition was associated to adverse perinatal outcomes in Chilean pregnant women.

METHODS

We analyzed all deliveries occurred in 2009 (n = 3,609) and 2010 (n = 3,279) in a reference hospital in the area of the earthquake. Furthermore, we investigated pregnant women who gave birth between March 1st and December 31st 2010 (n = 2,553) and we classified them according to timing of exposition.

RESULTS

We found a 9% reduction in birth rate, but an increase in the rate of early preterm deliveries (<34 weeks), premature rupture of membranes (PROM), macrosomia, small for gestational age, and intrauterine growth restriction (IUGR) after the earthquake, in contrast to the previous year. Women exposed to the earthquake during her first trimester delivered smaller newborns (3,340 ± 712 g v/s 3,426 ± 576 g respectively, p = 0.007) and were more likely diagnosed with early preterm delivery, preterm delivery (<37 weeks) and PROM but were less likely diagnosed with IUGR and late delivery (42 weeks, p < 0.05) compared to those exposed at third trimester. Accordingly, IUGR and preterm deliveries presented elevated healthcare costs.

CONCLUSION

Natural disasters such as earthquakes are associated to adverse perinatal outcomes that impact negatively the entire maternal-neonatal healthcare system.

Disaster Psychiatry in Taiwan: A Comprehensive Review

Natural disasters have caused millions of deaths worldwide, and hundreds of millions of people have suffered from various types of physical or mental traumas. Disasters change patterns of thinking and the concept of security among members of a community, which highlights the importance of mental rehabilitation in disaster psychiatry. Mental rehabilitation is not only a short-term intervention, but also involves long-term follow-up and referral of cases to regular psychiatric management. We used PubMed (http://www.ncbi.nlm.nih.gov/pubmed) to search for papers related to the Chi-Chi Earthquake and the Morakot Typhoon published between January 2001 and November 2011. We found that 33 articles are involved in seven topics. The most common disaster-related psychiatric diagnoses were major depressive episodes and posttraumatic stress disorder. The prevalence of posttraumatic stress disorder ranged from 8.0% to 34.3% in Taiwan after the 1999 Earthquake. However, lifetime and current prevalence for psychiatric disorders ranged from 1% to 74%, affecting women twice more than men. Because disasters are becoming increasingly common, it is vital to train a sufficient number of specialists with guidelines for standard clinical treatment, and to create a standard operating procedure for reducing traumatic conditions.

Posttraumatic stress disorder and depression among new mothers at 8 months later of the 2008 Sichuan earthquake in China

On May 12, 2008, a magnitude 8.0 earthquake struck China's southwestern Sichuan province. Recent studies have identified mental health problems among the survivors, but little is known about the impact of the Sichuan earthquake on the mental health of new mothers in the area. The main objective was to assess the impact of the Sichuan earthquake on the posttraumatic stress disorders (PTSD) and depression of new mothers. A total of 317 new mothers were interviewed in the hospital from January 2009 to March 2009. Symptoms of PTSD were measured using the impact of event scale-revised, and symptoms of postpartum depression were measured using the Center for Epidemiologic Studies Depression scale. The prevalence rates of PTSD and postpartum depression were 19.9% and 29.0%, respectively. Women with high earthquake exposure had higher risks of PTSD (odds ratio (OR), 5.91; 95% confidence interval (CI), 1.75-19.97; P < 0.001) and postpartum depression (OR, 7.28; 95% CI, 2.51-21.08; P < 0.001) than women without earthquake experience. In addition, women with low monthly family income and farm workers had a higher risk of having PTSD; women who were unemployed or with lower monthly family income and poor sleep had a higher risk of having depression. Earthquake experience increased the risks of having PTSD and depression among new mothers at 8 months later of the earthquake.

Earthquake distresses reproductive function but not fetal development in rats

BACKGROUND

It is well known that earthquake severely threatens life-safety and physical damage. However, the empirical literature on the effects of nature disasters such as earthquake on the reproductive outcomes is limited.

METHODS

On May 12th, 2008, a massive 8.0 magnitude earthquake occurred in Wenchuan, a city 92 km away from our animal facility [National Chengdu Center for Safety Evaluation of Drugs (NCCSED)]. To investigate whether this tremendous earthquake exerted adverse effects on the reproductive and developmental functions in Sprague-Dawley rats, we collected some relevant data from reproductive toxicity studies around the earthquake, and compared them with the background data, which were gathered before and after the earthquake. Copulation ratio, gestation ratio, and fertility of female rats, as well as uterine and fetal morphology, were examined.

RESULTS

Our data demonstrated that the Wenchuan earthquake significantly decreased the copulation and gestation ratio, although it did not exhibit obvious side effects on some other reproductive and developmental parameters.

The impact of the catastrophic earthquake in China's Sichuan province on the mental health of pregnant women

BACKGROUND

On May 12, 2008, a magnitude 8.0 earthquake struck China's southwestern Sichuan province. Recent studies have identified mental health problems among the survivors, but little is known about the impact of the Sichuan earthquake on the mental health of pregnant women in the area. The main objective was to assess the impact of the Sichuan earthquake on the mental health of pregnant women in earthquake stricken areas.

METHODS

During November 2009 and January 2010, 311 pregnant women were interviewed. Symptoms of PTSD were measured using IES-R, while symptoms of antenatal depression were measured using EPDS.

RESULTS

The prevalence rate of PTSD symptoms was 12.2% (95% CI, 9.0-16.4). The rate of major depression was 40.8% (95% CI, 35.5-46.4). Living through an earthquake has been significantly correlated with PTSD but no significant correlation has been found with depression. The perceived stresses of pregnancy are significantly correlated with both depression and PTSD.

LIMITATIONS

Lack of long term follow up data and comparison group from non earthquake struck area.

CONCLUSIONS

18 months after the Sichuan earthquake, the incidence of depression and PTSD were still quite high among pregnant women in the earthquake stricken areas. Depression was more common than PTSD. Living through an earthquake has been significantly correlated with PTSD but not with depression.

Post-traumatic stress disorder, child abuse history, birthweight and gestational age: a prospective cohort study

OBJECTIVE

To determine the extent to which prenatal post-traumatic stress disorder (PTSD) is associated with lower birthweight and shorter gestation, and to explore the effects of childhood maltreatment as the antecedent trauma exposure.

DESIGN

Prospective three-cohort study.

SETTING

Ann Arbor and Detroit, Michigan, United States.

SAMPLE

In all, 839 diverse nulliparas in PTSD-positive (n = 255), trauma-exposed, resilient (n = 307) and non-exposed to trauma (n = 277) cohorts.

METHODS

Standardised telephone interview before 28 weeks of gestation to ascertain trauma history, PTSD, depression, substance use, mental health treatment history and sociodemographics, with chart abstraction to obtain chronic condition history, antepartum complications and prenatal care data, as well as outcomes.

MAIN OUTCOME MEASURES

Infant birthweight and gestational age per delivery record.

RESULTS

Infants born to women with PTSD during pregnancy had a mean birthweight 283 g less than infants of trauma-exposed, resilient women and 221 g less than infants of non-exposed women (F(3,835) = 5.4, P = 0.001). PTSD was also associated with shorter gestation in multivariate models that took childhood abuse history into account. Stratified models indicated that PTSD subsequent to child abuse trauma exposure was most strongly associated with adverse outcomes. PTSD was a stronger predictor than African American race of shorter gestation and a nearly equal predictor of birthweight. Prenatal care was not associated with better outcomes among women abused in childhood.

CONCLUSIONS

Abuse-related PTSD may be an additional or alternative explanation for adverse perinatal outcomes associated with low socio-economic status and African American race in the USA. Biological and interventions research is warranted along with replication studies in other nations.

Influence of the Wenchuan earthquake on self-reported irregular menstrual cycles in surviving women

OBJECTIVE

To explore the influence of stress induced by the Wenchuan earthquake on the menstrual cycles of surviving women.

METHODS

Self-reports of the menstrual cycles of 473 women that survived the Wenchuan earthquake were analyzed. Menstrual regularity was defined as menses between 21 and 35 days long. The death of a child or the loss of property and social resources was verified for all surviving women. The severity of these losses was assessed and graded as high, little, and none.

RESULTS

About 21% of the study participants reported that their menstrual cycles became irregular after the Wenchuan earthquake, and this percentage was significantly higher than before the earthquake (6%, p < 0.05). About 30% of the surviving women with a high degree of loss in the earthquake reported menstrual irregularity after the earthquake. Association analyses showed that some stressors of the Wenchuan earthquake were strongly associated with self-reports of menstrual irregularity, including the loss of children (RR: 1.58; 95% CI: 1.09, 2.28), large amounts of property (RR: 1.49; 95% CI: 1.03, 2.15), social resources (RR: 1.34; 95% CI: 1.00, 1.80) and the hormonal contraception use (RR: 1.62; 95% CI: 1.21, 1.83).

CONCLUSIONS

Self-reported menstrual irregularity is common in women that survived the Wenchuan earthquake, especially in those who lost children, large amounts of property and social resources.

The establishment of a standard operation procedure for psychiatric service after an earthquake

This study presents information on the design and creation of a standard operation procedure (SOP) for psychiatric service after an earthquake. The strategies employed focused on the detection of survivors who developed persistent psychiatric illness, particularly post-traumatic stress and major depressive disorders. In addition, the study attempted to detect the risk factors for psychiatric illness. A Disaster-Related Psychological Screening Test (DRPST) was designed by five psychiatrists and two public health professionals for rapidly and simply interviewing 4,223 respondents within six months of the September 1999 Chi-Chi earthquake. A SOP was established through a systemic literature review, action research, and two years of data collection. Despite the limited time and resources inherent to a disaster situation, it is necessary to develop an SOP for psychiatric service after an earthquake in order to assist the high number of survivors suffering from subsequent psychiatric impairment.

Reproductive health and access to healthcare facilities: risk factors for depression and anxiety in women with an earthquake experience

Background

The reproductive and mental health of women contributes significantly to their overall well-being. Three of the eight Millennium Development Goals are directly related to reproductive and sexual health while mental disorders make up three of the ten leading causes of disease burden in low and middle-income countries. Among mental disorders, depression and anxiety are two of the most prevalent. In the context of slower progress in achieving Millennium Development Goals in developing countries and the ever-increasing man-made and natural disasters in these areas, it is important to understand the association between reproductive health and mental health among women with post-disaster experiences.

Methods

This was a cross-sectional study with a sample of 387 women of reproductive age (15-49 years) randomly selected from the October 2005 earthquake affected areas of Pakistan. Data on reproductive health was collected using the Centers for Disease Control reproductive health assessment toolkit. Depression and anxiety were measured using the Hopkins Symptom Checklist-25, while earthquake experiences were captured using the Harvard Trauma Questionnaire. The association of either depression or anxiety with socio-demographic variables, earthquake experiences, reproductive health and access to health facilities was estimated using multivariate logistic regression.

Results

Post-earthquake reproductive health events together with economic deprivation, lower family support and poorer access to health care facilities explained a significant proportion of differences in the experiencing of clinical levels of depression and anxiety. For instance, women losing resources for subsistence, separation from family and experiencing reproductive health events such as having a stillbirth, having had an abortion, having had abnormal vaginal discharge or having had genital ulcers, were at significant risk of depression and anxiety.

Conclusion

The relationship between women's post-earthquake mental health and reproductive health, socio-economic status, and health care access is complex and explained largely by the socio-cultural role of women. It is suggested that interventions that consider gender differences and that are culturally appropriate are likely to reduce the incidence.

Reproductive Health Assessment After Disaster: introduction to the RHAD toolkit

This article reviews associations between disaster and the reproductive health of women, describes how Hurricane Katrina influenced our understanding about postdisaster reproductive health needs, and introduces a new toolkit that can help health departments assess postdisaster health needs among women of reproductive age.

Impact of the Red River catastrophic flood on women giving birth in North Dakota, 1994-2000

To document changes in birth rates, birth outcomes, and pregnancy risk factors among women giving birth after the 1997 Red River flood in North Dakota. We analyzed detailed county-level birth files pre-disaster (1994-1996) and post-disaster (1997-2000) in North Dakota. Crude birth rates and adjusted fertility rates were calculated. The demographic and pregnancy risk factors were described among women delivering singleton births. Logistic regression was conducted to examine associations between the disaster and low birth weight (<2,500 g), preterm birth (<37 weeks), and small for gestational age infants adjusting for confounders. The crude birth rate and direct-adjusted fertility rate decreased significantly after the disaster in North Dakota. The proportion of women giving birth who were older, non-white, unmarried, and had a higher education increased. Compared to pre-disaster, there were significant increases in the following maternal measures after the disaster: any medical risks (5.1-7.1%), anemia (0.7-1.1%), acute or chronic lung disease (0.4-0.5%), eclampsia (0.3-2.1%), and uterine bleeding (0.3-0.4%). In addition, there was a significant increase in births that were low birth weight (OR 1.11, 95% CI 1.03-1.21) and preterm (OR 1.09, 95% CI 1.03-1.16) after adjusting for maternal characteristics and smoking. Following the flood, there was an increase in medical risks, low birth weight, and preterm delivery among women giving birth in North Dakota. Further research that examines birth outcomes of women following a catastrophic disaster is warranted.

Effects of the September 11, 2001 disaster on pregnancy outcomes: a systematic review

BACKGROUND

The terrorist explosions of the World Trade Center in New York City and the other events on the Pentagon and in Pennsylvania on 11 September 2001 were stressful events that affected people around the world. Pregnant women and their offspring are especially vulnerable during and after such a terrorist attack. The objective was to systematically review the risks of adverse pregnancy outcomes after the terrorist attacks on Sept 11, 2001.

METHODS

The Meta-analysis of Observational Studies in Epidemiology (MOOSE) criteria were used for reporting of this review. Statistical analyses were performed using RevMan 5.0.

RESULTS

Ten reports of low-to-moderate risk of methodological bias were included. There was increased risks of infants with birthweight of 1,500 g-1,999 g (adjusted odds ratio [AOR] 1.67 [95%CI 1.11-2.52]) and small-for-gestational age births (AOR 1.90; 95%CI 1.05-3.46) in New York. There was increased risks of low birthweight (relative risk 2.25; 95%CI 1.29-3.90) and preterm births (relative risk 1.50; 95%CI 1.06-2.14) among ethnically Arabic women living in California There was a reduction in birthweight by 276 g and in head circumference by 1 cm when DNA adducts, a marker for environmental toxin exposure, were doubled in maternal blood. In Holland, a 48-g reduction in birthweight was reported.

CONCLUSIONS

The World Trade Center disaster influenced pregnancy outcomes in New York, among ethnically Arab women living in California and among Dutch women. The adverse outcomes are likely due to environmental pollution and stress in New York, ethnic harassment in California and communal bereavement and stress in Holland.