Protecting pregnant people and babies from the health consequences of climate change

Reports from meteorologists suggest the 2022 fire season could be one of the worst on record. Forest fires 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-burning wildfires in parts of the United States. Forest fires can also further accelerate climate change through the resulting greenhouse gas emissions and forest loss.1

As is the case with other impacts of climate change—including more intense hurricanes, extreme heat, and degraded water quality—pregnant people and newborns are particularly vulnerable to the health harms associated with wildfires.2 Wildfire smoke leads to exposure to toxic gases, volatile organic compounds and particulate matter; in pregnant humans, these exposures are associated with an increased risk of gestational hypertension and gestational diabetes,3 conditions that may carry long-term risks to the mother’s health. Exposure to wildfire smoke or its components is associated with an increased risk of preterm birth and low birth weight,1 outcomes that may similarly have lifelong health implications. Displacement of communities by wildfires can disrupt access to health care, including prenatal and newborn care, as well as access to social support and other services, which can adversely affect the health of pregnant women and newborns.2 These consequences are disproportionately borne by marginalized groups and can have long-term intergenerational effects if newborns who are damaged by bushfires have poor health as parents.4

Failure to combat climate change poses a major threat to the health of the entire population. We believe that tackling the underlying problem by reducing greenhouse gas emissions and strengthening carbon sinks should be a global priority. Special attention should be paid to the protection of pregnant people and newborns in light of their increased vulnerability to the harms associated with climate change. More research is needed on interventions that could alleviate the effects of climate change on these groups, but we believe that action to reduce these effects must begin now. Over the past 25 years, our work has focused on emerging infectious diseases, and we have highlighted the need for special preparedness and response considerations focused on pregnant people and newborns. We believe that lessons learned from this work can be applied to efforts to mitigate the effects of climate change on these populations.

first, preparedness and response planning to combat the effects of climate change, including planning specifically targeting pregnant people and newborns, should be a priority for public health agencies and health systems. As part of investments in pandemic influenza preparedness in the 2000s, public health leaders emphasized efforts specific to vulnerable populations, including pregnant people. In April 2008, the Centers for Disease Control and Prevention (CDC) convened a meeting of experts in infectious disease, public health, obstetrics, and newborn care and key partners to discuss special considerations related to the pandemic for pregnant people to identify knowledge gaps, and develop a public health approach that can be implemented in the event of a pandemic. Issues including prevention and treatment, vaccine use, non-pharmaceutical interventions, and health system planning for prenatal and obstetric care and communications were discussed.5 The plans resulting 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 drugs in pregnant people with influenza led the CDC to recommend that all pregnant people with known or suspected H1N1 influenza be treated with oseltamivir, a treatment approach that later has been shown to significantly reduce ICU admissions and deaths. In addition, this planning process brought together a wide range of experts and partners, many of whom continued to collaborate during later responses to emerging infectious diseases such as the Ebola, Zika, and SARS-CoV-2 viruses.

As the effects of climate change increase in frequency and intensity, we believe that plans specific to the needs of pregnant people must be developed now; such plans could include recommendations for patient-level, health system-level, and community-level interventions to mitigate these effects. As an example of an intervention that can 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 can support the transition of prenatal care to new location in case of interruption.

It will also be necessary to develop better ways to monitor the effects of climate change events on pregnant people and newborns. Flexible monitoring systems can be implemented in advance and then quickly adapted to collect relevant data. For example, after delays were identified in the implementation of research results related to the 2009 H1N1 flu, researchers in the United Kingdom developed and “hibernated” several emerging infectious disease surveillance systems, including one system focused on pregnancy, with plans to use them in a future pandemic. This program was activated at the beginning 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 the Covid-19 vaccine) can be used to collect information about pregnancy complications and problems during the period of the newborn among evacuees from areas affected by a severe weather event. Surveillance systems are also needed to identify pregnant people who are at particularly high risk of harm, such as those living in low-income communities and members of racial or ethnic groups that tend to be disproportionately affected by climate change events; interventions can then be tailored to those at highest risk. Strategies to reduce harm to pregnant people from these events need to be monitored for effectiveness.

Finally, it is essential that maternal and child health experts begin working with climate scientists 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) created a task force (Workgroup on Immunization, Infectious Diseases, and Public Health Preparedness) focused on reducing of morbidity and mortality from vaccine-preventable diseases. ACOG also maintains a related website (http://www.immunizationforwomen.org) with up-to-date information for obstetricians and works closely with 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. Midwifery care providers will also need to be educated about the effects of climate change on the health of their patients. Adding this content to medical school curricula, obstetrics and gynecology training, and certification support activities will help clinicians become more competent in counseling patients about how to reduce climate change risks and in advocacy to address climate change and its harms to health.

Climate change is a major threat to public health. National and world leaders urgently need to work together to curb the fossil fuel emissions that drive it. However, the effects of climate change are already threatening human health, and pregnant people and newborns are at particularly high risk of related harm. Building on expertise in preparing for and responding to emerging infectious diseases will be important 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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