Protecting Pregnant females and their babies from ill Effects of Climate Change
As is the case for other consequences of climate change-including more intense hurricanes, extreme heat, and deteriorating waterquality-pregnant people and newborns are particularly vulnerable to thehealth harms associated with wildfires. Wildfire smoke results in exposure totoxic gases, volatile organic compounds, and particulate matter; in pregnantpeople, these exposures have been associated with an increased risk ofgestational hypertension and gestational diabetes, conditions that can carrylong-term health risks for the mother. Exposure to wildfire smoke or itscomponents has been associated with an increased risk of preterm birth and lowbirth weight, outcomes that can similarly have lifelong health effects. Theseconsequences are disproportionately borne by marginalized populations, and theycan have long-term, intergenerational effects, if newborns who are harmed bywildfires go on to have poor health as parents.
Failure to combat climate change poses a major health threatto the entire population. Authors believed addressing the underlying problem byreducing greenhouse-gas emissions and strengthening carbon sinks should be aglobal priority. Special consideration must be given to protecting pregnantpeople and newborns, in light of their increased vulnerability toclimate-change–related harm. More research is needed on interventions thatcould alleviate the effects of climate change on these groups, but authorsbelieve actions to reduce these effects should be initiated now. For the past25 years, their work has focused on emerging infectious diseases, and they havehighlighted the need for special considerations for preparedness and responsefocused on pregnant people and newborns.
First, preparedness and response planning to combat theeffects of climate change, including planning specifically focused on pregnantpeople and newborns, should be a priority for public health agencies and healthsystems. As part of investments in pandemic influenza preparedness in the2000s, public health leaders emphasized efforts specific to vulnerablepopulations, including pregnant people. In April 2008, the Centers for DiseaseControl and Prevention (CDC) held a meeting of infectious disease, publichealth, obstetrics, and newborn-care experts and key partners to discussspecial pandemic-related considerations for pregnant people, identify gaps inknowledge, and develop a public health approach that could be pursued in theevent of a pandemic. Issues including prophylaxis and treatment, vaccine use,nonpharmaceutical interventions and health care–system planning for prenataland obstetric care, and communications were discussed. The plans that resultedfrom this meeting facilitated the response to the 2009 H1N1 influenza pandemic.In addition, this planning process brought together a broad range of expertsand partners, many of whom continued to collaborate during later responses toemerging infectious diseases, such as the Ebola, Zika, and SARS-CoV-2 viruses.
Because the effects of climate change are increasing infrequency and intensity, it is believed plans specific to the needs of pregnantpeople should be developed now; such plans could include recommendations forpatient-level, health-system–level, and community-level interventions tomitigate these effects. As an example of an intervention that could have animmediate influence, ensuring that all pregnant patients-particularly thoseliving in areas at high risk for extreme weather events — have access to theirelectronic medical records could support the transfer of prenatal care to a newlocation in the event of disruption.
It will also be necessary to develop better ways ofmonitoring the effects of climate-change– associated events on pregnant peopleand newborns. Flexible surveillance systems could be put in place in advanceand then rapidly adapted to collect relevant data. A system that usesmobile-phone technology, similar to v-safe (the CDC's surveillance system formonitoring Covid-19 vaccine safety), could be used to collect information onpregnancy complications and problems during the newborn period among evacueesfrom areas affected by a severe weather event. Surveillance systems are alsoneeded to identify pregnant people who are at especially high risk of harm,such as those living in low-income communities and members of racial or ethnicgroups that tend to be disproportionately affected by climate-change–relatedevents; interventions can then be tailored to the people at highest risk.Strategies for reducing harm to pregnant people from these events should bemonitored for effectiveness.
Finally, it's essential that experts in maternal and childhealth begin working with climate scientists to address the effects of climatechange. In recent years, in response to the 2009 H1N1 influenza pandemic andthe Zika virus outbreak, the American College of Obstetricians andGynecologists (ACOG) created a work group (the Immunization, InfectiousDisease, and Public Health Preparedness Expert Work Group) focused on reducingmorbidity and mortality from vaccine preventable diseases. ACOG also maintainsa related website with up-to-date information for Ob/Gyns and works closelywith the CDC's Advisory Committee on Immunization Practices to provide input onvaccine recommendations for pregnant people.
These collaborative effortsfacilitated the development and dissemination of recommendations related toCovid-19 diagnosis, treatment, and vaccination during pregnancy. Obstetric careproviders will also need to be educated about climate change's effects on thehealth of their patients. Adding this content to medical school curricula,Ob/Gyn residency training, and maintenance-of-certification activities willhelp clinicians become more proficient in counseling patients about how toreduce their climate-change–associated risks and in advocating for addressingclimate change and its health harms.
Climate change is a major public health threat. National andglobal leaders need to urgently work together to limit the fossil fuelemissions that drive it. The effects of climate change are already threateninghuman health, however, and pregnant people and newborns are at especially highrisk for related harm. Building on experience in preparing for and respondingto emerging infectious diseases will be important to help minimize adverseeffects in these and other vulnerable populations. The health of futuregenerations depends on our actions today.
Source: Sonja A. Rasmussen, M.D., and Denise J. Jamieson; nengl j med 387;11 DOI: 10.1056/NEJMp2210221
