Protecting pregnant women and babies from the health effects of climate change

Reports from meteorologists suggest the 2022 fire season could be one of the worst ever. Wildfires are increasing in frequency and intensity due to climate change1; Severe drought, rising temperatures and high winds have led to more widespread, hotter and faster wildfires in parts of the United States. Wildfires can also further accelerate climate change, due to the resulting greenhouse gas emissions and forest loss.1

As with other consequences of climate change – including more intense hurricanes, extreme heat and deteriorating water quality – pregnant women and newborns are particularly vulnerable to harm to health associated with forest fires.2 Wildfire smoke leads to exposure to toxic gases, volatile organic compounds and particulates; in pregnant women, these exposures have been associated with an increased risk of gestational hypertension and gestational diabetes,3 conditions that may pose long-term health risks to the mother. Exposure to wildfire smoke or its components has been associated with an increased risk of premature birth and low birth weight,1 results that can also have lifelong health effects. Displacement of communities by wildfires can disrupt access to health care, including prenatal and neonatal care, as well as access to social support and other services, which can adversely affect the health of pregnant and postpartum women and newborns.2 These consequences are borne disproportionately by marginalized populations, and they can have long-term intergenerational effects, if newborns who are injured by wildfires continue to experience poor health as parents.4

Failure to address climate change poses a major threat to the health of the entire population. We believe that addressing the underlying problem by reducing greenhouse gas emissions and enhancing carbon sinks should be a global priority. Particular attention should be paid to the protection of pregnant women and newborns, given their increased vulnerability to climate change-related harm. More research is needed on interventions that could mitigate the effects of climate change on these groups, but we believe that actions to reduce these effects should be started now. Over the past 25 years, our work has focused on emerging infectious diseases, and we have highlighted the need for special considerations for preparedness and response focused on pregnant women and newborns. We believe that lessons learned from this work could be applied to efforts to mitigate the effects of climate change on these populations.

First, preparedness and response planning to address the effects of climate change, including planning specifically focused on pregnant women and newborns, should be a priority for public health agencies and health systems. As part of pandemic influenza preparedness investments in the 2000s, public health officials emphasized efforts specific to vulnerable populations, including pregnant women. In April 2008, the Centers for Disease Control and Prevention (CDC) convened a meeting of experts and key partners in infectious disease, public health, obstetrics, and newborn care to discuss special considerations related to the pandemic for pregnant women, identify knowledge gaps, and develop a public health approach that could be pursued in the event of a pandemic. Issues such as prophylaxis and treatment, vaccine use, non-pharmaceutical interventions and health care system planning for prenatal and obstetric care, and communications were discussed.5 The plans that resulted from this meeting facilitated the response to the 2009 H1N1 influenza pandemic.

For example, pre-pandemic discussions about the benefits and risks associated with the use of antiviral medications in pregnant women with influenza led to a CDC recommendation that all pregnant women with known or suspected H1N1 influenza should be treated with oseltamivir, a therapeutic approach that was later shown to have significant effects. reduction in ICU admissions and deaths. Additionally, this planning process brought together a wide range of experts and partners, many of whom have continued to collaborate during subsequent responses to emerging infectious diseases, such as Ebola, Zika, and SARS-CoV-2.

As the effects of climate change increase in frequency and intensity, we believe that plans specific to the needs of pregnant women should be developed now; these plans could include recommendations for interventions at the patient, health system and community levels to mitigate these effects. As an example of an intervention that could have an immediate impact, ensuring that all pregnant patients – especially those living in areas at high risk of extreme weather events – have access to their electronic medical records could help relocating antenatal care to a new location in the event of disruption.

It will also be necessary to develop better means of monitoring the effects of events associated with climate change on pregnant women and newborns. Flexible monitoring systems could be set up in advance and then quickly adapted to collect the relevant data. For example, after delays in implementing research findings related to the 2009 H1N1 flu were recognized, researchers in the UK developed and “hibernate” several emerging infectious disease surveillance systems. , including a pregnancy-focused system, with plans to use them in a future pandemic. This program was activated at the start of the Covid-19 pandemic and provided timely data on the effects of Covid-19 during pregnancy.5

The kinds of data collection challenges that were seen after Hurricane Katrina, when affected people were scattered across the United States, also need to be addressed. A system that uses mobile phone technology, similar to v-safe (the CDC’s surveillance system for monitoring the safety of Covid-19 vaccines), could be used to collect information about pregnancy complications and problems. during the neonatal period among evacuees from areas affected by a severe weather event. Surveillance systems are also needed to identify pregnant women who are at particularly high risk of harm, such as those living in low-income communities and members of racial or ethnic groups who tend to be disproportionately affected by harm. events related to climate change; interventions can then be tailored to those most at risk. The effectiveness of strategies to reduce harm to pregnant women from these events needs to be monitored.

Finally, it is essential that maternal and child health experts start working with climatologists to address the effects of climate change. In recent years, in response to the 2009 H1N1 influenza pandemic and the Zika virus outbreak, the American College of Obstetricians and Gynecologists (ACOG) established a Task Force (Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group) focused on reducing morbidity and mortality from vaccine-preventable diseases. ACOG also maintains a related website ( with up-to-date information for obstetricians and gynecologists and works closely with the CDC’s Advisory Committee on Immunization Practices to provide information on vaccine recommendations for pregnant women. These collaborative efforts have facilitated the development and dissemination of recommendations related to the diagnosis, treatment and vaccination of Covid-19 during pregnancy. Obstetric care providers will also need to be informed about the effects of climate change on the health of their patients. Adding this content to medical school curricula, obstetrics and gynecology residency training, and certification maintenance activities will help clinicians become more proficient in counseling patients on how to reduce their risks associated with climate change and to advocate for the fight against climate change and its consequences. health harms.

Climate change is a major threat to public health. National and world leaders must urgently work together to limit the emissions of the fossil fuels that power them. However, the effects of climate change are already threatening human health, and pregnant women and newborns are at particularly high risk of related harm. It will be important to leverage the experience gained in preparing for and responding to emerging infectious diseases to help minimize adverse effects in these and other vulnerable populations. The health of future generations depends on our actions today.

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