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Lee SA, Corbett GA, McAuliffe FM. Obstetric care for environmental migrants. Ir J Med Sci 2024; 193:797-812. [PMID: 37715828 PMCID: PMC10961262 DOI: 10.1007/s11845-023-03481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/26/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Migration due to environmental factors is an international crisis affecting many nations globally. Pregnant people are a vulnerable subgroup of migrants. AIM This article explores the potential effects of environmental migration on pregnancy and aims to draw attention to this rising concern. METHODS Based on the study aim, a semi-structured literature review was performed. The following databases were searched: MEDLine (PubMed) and Google Scholar. The search was originally conducted on 31st January 2021 and repeated on 22nd September 2022. RESULTS Pregnant migrants are at increased risk of mental health disorders, congenital anomalies, preterm birth, and maternal mortality. Pregnancies exposed to natural disasters are at risk of low birth weight, preterm birth, hypertensive disorders, gestational diabetes, and mental health morbidity. Along with the health risks, there are additional complex social factors affecting healthcare engagement in this population. CONCLUSION Maternity healthcare providers are likely to provide care for environmental migrants over the coming years. Environmental disasters and migration as individual factors have complex effects on perinatal health, and environmental migrants may be at risk of specific perinatal complications. Obstetricians and maternity healthcare workers should be aware of these challenges and appreciate the individualised and specialised care that these patients require.
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Affiliation(s)
- Sadhbh A Lee
- National Maternity Hospital, Holles St., Dublin 2, Ireland
| | | | - Fionnuala M McAuliffe
- National Maternity Hospital, Holles St., Dublin 2, Ireland.
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.
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Aktoz F, Gunes AC, Yakin K. The effect of earthquake experience on pregnancy outcomes: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2023; 291:70-75. [PMID: 37837936 DOI: 10.1016/j.ejogrb.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/01/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES Pregnant women are vulnerable to the health consequences of earthquakes, experiencing stress and limited access to healthcare. Despite the widespread impact of these events, knowledge about their effects on pregnancy outcomes is scarce and inconsistent. This systematic review and meta-analysis aimed to evaluate the available evidence, estimate the overall effect, and identify key research gaps about earthquake on pregnant women. STUDY DESIGN A comprehensive search of English-language peer-reviewed articles was conducted using PubMed and Web of Science Core Collection. Various combinations of keywords related to earthquakes and pregnancy outcomes were used. Studies comparing quantitative data on pregnancy outcomes between earthquake-affected and unaffected pregnant women were included. Random and fixed-effects models were used to estimate the pooled effect size. RESULTS The meta-analysis revealed no significant difference in preterm delivery rates (OR: 1.18; 95 % CI: 0.94-1.47; I2 = 75 %; five studies, 26,365 women) and low birth weight (LBW) infant delivery rates (OR: 1.19; 95 % CI: 0.83-1.71; I2 = 72 %; three studies, 16,127 women) between the earthquake-affected and control groups. However, a statistically significant increase in small-for-gestational-age (SGA) infants was observed in the earthquake-affected group (OR: 1.25; 95 % CI: 1.08-1.43; I2 = 0 %; two studies, 10,238 women). Data on miscarriage and stillbirth rates were not suitable for meta-analysis. CONCLUSIONS Limited evidence suggests that exposure to earthquakes may be associated with adverse pregnancy outcomes. Further studies are needed to confirm the increased risk of SGA in the affected population and to inform disaster management plans by enhancing our understanding of the adversities associated with earthquake exposure through more comprehensive epidemiologic research.
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Affiliation(s)
- Fatih Aktoz
- Women's Health Center, American Hospital, Istanbul, Turkey.
| | - Ali Can Gunes
- Department of Obstetrics and Gynecology, Mamak State Hospital, Ankara, Turkey
| | - Kayhan Yakin
- Women's Health Center, American Hospital, Istanbul, Turkey; Department of Obstetrics and Gynecology, Koc University, Istanbul, Turkey.
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Lian Q, Zheng T, Huo X, Zhang J, Zhang L. Prophylactic antibiotic use during labor and delivery in China: a nationwide, multicenter, hospital-based, cross-sectional study. BMC Med 2022; 20:391. [PMID: 36320077 PMCID: PMC9628083 DOI: 10.1186/s12916-022-02577-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Prophylactic antibiotic use during delivery is common in routine obstetric practice to prevent infection globally, especially in low- and middle-income countries. In China, however, little is currently known about the national estimates for prophylactic antibiotic use during delivery. Therefore, we aimed to describe the prevalence of prophylactic antibiotic use and guideline adherence using national data in China. METHODS This cross-sectional study analyzed a national dataset from the China Labor and Delivery Survey in 2015-2016. The primary outcomes were prophylactic antibiotic use and clinician adherence to WHO recommendations for the prevention and treatment of maternal peripartum infections. We estimated the weighted prevalence of the outcomes with Taylor series linearization and investigated the associated factors of the outcomes with logistic regression. RESULTS Of the 72,519 deliveries, the prevalence of antibiotic prophylaxis was 52.0%, varying from 92.8% in Shanxi to 17.3% in Hainan. The prevalence of clinician adherence to the WHO guideline was 79.9%, ranging from 93.4% in Shandong to 50.0% in Shanxi. Prophylactic antibiotic use was associated with cesarean delivery (AOR, 55.77; 95%CI, 25.74-120.86), operative vaginal delivery (AOR, 4.00; 95%CI, 1.64-9.78), preterm (AOR, 1.96; 95%CI, 1.60-2.41), premature rupture of membranes (PROM) (AOR, 2.80; 95%CI, 1.87-4.18), and meconium-stained amniotic fluid (AOR, 1.91; 95%CI, 1.30-2.81) in all deliveries and also episiotomy (AOR, 1.48; 95%CI, 1.02-2.16) in vaginal deliveries. Clinician adherence was positively associated with cesarean delivery (AOR, 5.72; 95%CI, 2.74-11.93) while negatively associated with operative vaginal delivery (AOR, 0.26; 95%CI, 0.11-0.61), PROM (AOR, 0.50; 95%CI, 0.35-0.70), and meconium-stained amniotic fluid (AOR, 0.66; 95%CI, 0.48-0.91) in all deliveries. In vaginal deliveries, clinician adherence was negatively associated with episiotomy (AOR, 0.67; 95%CI, 0.46-0.96) and severe perineal trauma (AOR, 0.09; 95%CI, 0.02-0.44). Besides, clinicians in general hospitals prescribed prophylactic antibiotics more likely (AOR, 2.79; 95%CI, 1.50-5.19) and had a lower adherence (AOR, 0.38; 95%CI, 0.20-0.71) than their peers in maternity hospitals. CONCLUSIONS We observed that about half of all deliveries in China received antibiotics for prophylaxis, and most deliveries were prescribed according to the WHO guideline. Furthermore, the two prevalence rates for prophylactic antibiotic use and clinician adherence varied widely across provinces of China.
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Affiliation(s)
- Qiguo Lian
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, 200237, China
| | - Tao Zheng
- Department of Obstetrics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Xiaona Huo
- Department of Obstetrics, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Jun Zhang
- MOE-Shanghai Key Lab of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Lin Zhang
- Department of Obstetrics, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China. .,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, China.
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Deziel NC, Clark CJ, Casey JA, Bell ML, Plata DL, Saiers JE. Assessing Exposure to Unconventional Oil and Gas Development: Strengths, Challenges, and Implications for Epidemiologic Research. Curr Environ Health Rep 2022; 9:436-450. [PMID: 35522388 PMCID: PMC9363472 DOI: 10.1007/s40572-022-00358-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Epidemiologic studies have observed elevated health risks in populations living near unconventional oil and gas development (UOGD). In this narrative review, we discuss strengths and limitations of UOG exposure assessment approaches used in or available for epidemiologic studies, emphasizing studies of children's health outcomes. RECENT FINDINGS Exposure assessment challenges include (1) numerous potential stressors with distinct spatiotemporal patterns, (2) critical exposure windows that cover long periods and occur in the past, and (3) limited existing monitoring data coupled with the resource-intensiveness of collecting new exposure measurements to capture spatiotemporal variation. All epidemiologic studies used proximity-based models for exposure assessment as opposed to surveys, biomonitoring, or environmental measurements. Nearly all studies used aggregate (rather than pathway-specific) models, which are useful surrogates for the complex mix of potential hazards. Simple and less-specific exposure assessment approaches have benefits in terms of scalability, interpretability, and relevance to specific policy initiatives such as set-back distances. More detailed and specific models and metrics, including dispersion methods and stressor-specific models, could reduce exposure misclassification, illuminate underlying exposure pathways, and inform emission control and exposure mitigation strategies. While less practical in a large population, collection of multi-media environmental and biological exposure measurements would be feasible in cohort subsets. Such assessments are well-suited to provide insights into the presence and magnitude of exposures to UOG-related stressors in relation to spatial surrogates and to better elucidate the plausibility of observed effects in both children and adults.
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Affiliation(s)
- Nicole C. Deziel
- grid.47100.320000000419368710Department of Environmental Health Sciences, Yale School of Public Health, 60 College St., New Haven, CT 06510 USA
| | - Cassandra J. Clark
- grid.47100.320000000419368710Department of Environmental Health Sciences, Yale School of Public Health, 60 College St., New Haven, CT 06510 USA
| | - Joan A. Casey
- grid.21729.3f0000000419368729Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 630 West 168th Street, Room 16-416, New York, NY 10032 USA
| | - Michelle L. Bell
- Yale School of the Environment, 195 Prospect St., New Haven, CT 06511 USA
| | - Desiree L. Plata
- grid.116068.80000 0001 2341 2786Department of Civil and Environmental Engineering, Parsons Laboratory, Massachusetts Institute of Technology, 15 Vassar Street, Cambridge, MA 02139 USA
| | - James E. Saiers
- Yale School of the Environment, 195 Prospect St., New Haven, CT 06511 USA
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Evans J, Bansal A, Schoenaker DAJM, Cherbuin N, Peek MJ, Davis DL. Birth Outcomes, Health, and Health Care Needs of Childbearing Women following Wildfire Disasters: An Integrative, State-of-the-Science Review. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:86001. [PMID: 35980335 PMCID: PMC9387511 DOI: 10.1289/ehp10544] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND The frequency and severity of extreme weather events such as wildfires are expected to increase due to climate change. Childbearing women, that is, women who are pregnant, soon to be pregnant, or have recently given birth, may be particularly vulnerable to the effect of wildfire exposure. OBJECTIVES This review sought to systematically assess what is known about birth outcomes, health, and health care needs of childbearing women during and after exposure to wildfires. METHODS An integrative review methodology was utilized to enable article selection, data extraction, and synthesis across qualitative and quantitative studies. Comprehensive searches of SCOPUS (including MEDLINE and Embase), CINAHL, PubMed, and Google Scholar identified studies for inclusion with no date restriction. Included studies were independently appraised by two reviewers using the Crowe Critical Appraisal Tool. The findings are summarized and illustrated in tables. RESULTS Database searches identified 480 records. Following title, abstract, and full text screening, sixteen studies published between 2012 and 2022 were identified for this review. Eleven studies considered an association between in utero exposure to wildfire and impacts on birth weight and length of gestation. One study reported increased rates of maternal gestational diabetes mellitus and gestational hypertension following exposure; whereas one study reported differences in the secondary sex ratio. Two studies reported higher incidence of birth defects following in utero exposure to wildfire smoke. Three studies reported increased mental health morbidity, and one study associated a reduction in breastfeeding among women who evacuated from a wildfire disaster. DISCUSSION Evidence indicates that wildfire exposure may be associated with changes to birth outcomes and increased morbidity for childbearing women and their babies. These effects may be profound and have long-term and wide-ranging public health implications. This research can inform the development of effective clinical and public health strategies to address the needs of childbearing women exposed to wildfire disaster. https://doi.org/10.1289/EHP10544.
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Affiliation(s)
- Jo Evans
- School of Midwifery, University of Canberra, Canberra, Australian Capital Territory, Australia
- Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Amita Bansal
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Danielle A J M Schoenaker
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michael J Peek
- Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Deborah L Davis
- School of Midwifery, University of Canberra, Canberra, Australian Capital Territory, Australia
- ACT Government, Health Directorate, Canberra, Australian Capital Territory, Australia
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Establishing Chinese Fetal Growth Standards: Why and How. MATERNAL-FETAL MEDICINE 2022. [DOI: 10.1097/fm9.0000000000000157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ding X, Liang M, Wu Y, Zhao T, Qu G, Zhang J, Zhang H, Han T, Ma S, Sun Y. The impact of prenatal stressful life events on adverse birth outcomes: A systematic review and meta-analysis. J Affect Disord 2021; 287:406-416. [PMID: 33838476 DOI: 10.1016/j.jad.2021.03.083] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Stressful life events as important stressors have gradually been recognized as the potential etiology that may lead to adverse birth outcomes such as preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA). However, researches on this topic have shown relatively inconsistent results. This systematic review and meta-analysis was performed to synthesize available data on the association between prenatal stressful life events and increased risks of PTB, LBW, and SGA. METHODS Electronic databases were searched from their inception until September 2020. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated to assess the association between prenatal stressful life events and PTB, LBW, and SGA using random effects models. In addition, subgroup analyses, cumulative meta-analyses, sensitivity analyses, and publication bias diagnosis were conducted. STATA 14.0 was applied for statistical analyses. RESULTS Totally 31 cohort studies involving 5,665,998 pregnant women were included. Prenatal stressful life events were associated with a 20% higher risk of PTB (RR = 1.20, 95%CI = 1.10-1.32), a 23% increased risk for LBW (RR = 1.23, 95%CI = 1.10-1.39), and a 14% higher risk of SGA (RR = 1.14, 95%CI = 1.08-1.20). Sensitivity analysis indicated the results were stable. CONCLUSIONS Findings indicated that pregnant women experiencing prenatal stressful life events were at increased risk of PTB, LBW, and SGA. This information provided additional supports that pregnant women experiencing prenatal stressful life events would benefit from receiving assessment and management in prenatal care services.
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Affiliation(s)
- Xiuxiu Ding
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Mingming Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Yile Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Tianming Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Guangbo Qu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Jian Zhang
- Department of Neonatology, Anhui Provincial Children's Hospital/Children's Hospital of Anhui Medical University, Hefei 230051, Anhui, China
| | - Huimei Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Tiantian Han
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Shaodi Ma
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China; Centre for Evidence-Based Practice, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China.
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