Adverse Pregnancy Outcomes Effected by Climate Change ... Black Women See Higher Effects

Clear Pregnancy and Generational Health Warning Resulting From Our Climate Crisis.

All pregnant women need to know about this analysis. We’re all aware of Climate Change and have been feeling and living its environmental and weather related effects for years. Science shows the last 8 out of 10 years have been the hottest on record and rapid Arctic Ice melt is changing our ocean currents which have broad sweeping fallout on how we live.

A new recently published analysis shows some of the silent effects of Climate Change. JAMA’s scientific analysis and findings on adverse pregnancy outcomes related to climate change are out!

“When you talk about climate, people think about severe weather, big storms or huge fires … but we wanted to talk about the impacts that are common and widespread and ongoing and also are rarely attributed to the climate crisis,” said Bruce Bekkar, a co-author of the study and a retired obstetrician.

An analysis was published on June 18, 2020 by JAMA; Journal of the American Medical Association, one of the most well respected, worldwide renown medical journals.

The health of our future generations is at risk.

JAMA Analysis Details

The key finding shows a significant association between Heat (rising global temperatures) and Air Pollution (ozone) from Climate Change and the staggering effects on pregnancy outcomes. Specifically, adverse effects on preterm birth (births before 37 weeks pregnancy), low birth weight, and stillbirth.

The JAMA analysis reviewed research studies conducted over more than a decade between Jan, 2007 - Apr., 2019 among 32.8 million births in the U.S. It found adverse pregnancy outcomes in 57 of 68 studies. Meaning, 84% of the 68 total studies found this correlation.

Let’s dig into how these two key climate change factors; air pollution and heat, each show significant effects on adverse birth outcomes. In the 58 Air Pollution studies reviewed with full-term Prenatal exposure to Air Pollutants; 48 studies [84%] showed a significant association with effects on birth outcomes.  In the 10 Heat studies reviewed with full-term Prenatal exposure to Heat; 9 studies [90%] showed a significant association with effects on birth outcomes.1

See the chart for detailed findings.1

Air Pollution Effect

The risk level associated from Air Pollution was found at 11.5% for Preterm births, 10.8% for Low Birth Weights, and 14.5% for Stillbirths.1

Note: that the percent risk here is not an average of all women falling into this group but a median or the percent falling in the middle of all women.

And, various single studies specific to Air Pollution found significant increases in adverse outcomes based on health, exposure, and proximity. For Asthmatic Mothers, a single study related to Preterm Birth showed an increase in risk of 52%.1 Women with asthma may be particularly susceptible to adverse outcomes, such as preterm birth and stillbirth, in association with Air Pollution defined as PM2.5 exposure during gestation.10,11

Also, if a pregnant woman lives within 3.1 miles of a sold waste plant the risk of Low Birth Weight increased 3%. And, with high 3rd trimester exposure to to Air Pollution Stillbirth risk increased 42%.1

Heat Effect

The risk level from Heat was found at 15.8% for Preterm and 31% for Low Birth Weight.1 

Note: that the percent risk here is not an average of all women falling into this group but a median or the percent falling in the middle of all women.

And, various single studies specific to Heat found significant increases in adverse outcomes based on temperature increases. A single study related to Preterm Birth showed a risk increase of 11.6% per 10.08 degree increase in Fahrenheit.1 And, another study showed that stillbirth risk increased 6% per 1.8 degree F increase the week before delivery during the warm season.1

“Stillbirth is rare, so data on it is limited and it is difficult to draw broad conclusions about why it happens,” Bekkar; the study’s co-author said.

Minority Findings

There is a disproportionate effect on populations defined as pregnant women with specific race/ethnicities. Coupling the below findings with already higher birth risks among minorities, specifically Black Mothers, and the increasing environmental factors unrelated to this analysis is concerning. Black women and other affected minorities need improved health and prenatal care. 

Further research is also needed for greater learning and understanding into birth outcomes. The inclusion of climate change and other healthcare factors such as: prenatal healthcare, compromised women, racial/ethnic disparities and climate change.  What are the synergistic factors and relative associations?

Black Mothers

Among racial/ethnic groups, the analysis findings found that Black Mothers are at greater risk for preterm birth (born prior to 37weeks gestation) and low birth weight. 

Social determinants of health, including residence in urban areas with higher exposure to air pollutants and long-term high levels of stress, are known to contribute to adverse obstetrical outcomes.7

Preterm Births and Air Pollutants (defined as PM2.5 exposure)

Black Mothers were noted as having the highest risk for Preterm Birth (< 37 weeks) among all minorities in 8 of the 10 studies that reported on minority groups and Preterm Birth and Air Pollutants.1

Low Birth Weight (13 Studies of Racial/Ethnic disparities & low birth weight)

Black Mothers were the most high-risk subpopulation in 10 of the 13 studies (77% of the studies).1

Other Minority Mothers 

Low Birth Weight (13 Studies of Racial/Ethnic disparities & low birth weight)

Asian Mothers - 4 out of 10 studies (31%) noted higher risks among Asians.1

Hispanic Mothers - 3 out of 10 studies (23%) studies noted higher risks among Hispanics.1

What To Be Aware Of / Possibly Discuss With Your OB, Midwife or Physician.

1. Pregnant women’s bodies undergo tremendous change in nurturing and developing a baby. These physiological changes that occur during pregnancy may be worth further conversation with your health care professional because pregnant women may be more health compromised due to Air Pollution given an altered cardiopulmonary physiology state and by significantly high temperatures relative to what is more typical since their ability to thermoregulate is compromised at all gestational ages.2

2. Preterm birth defined as being born before 37 weeks along in pregnancy and is a major risk factor for biobehavioral or neurodevelopmental disorders and other chronic morbidities.3,7

What You Can Do to Improve Birth Outcomes / Precautions to Take:

• Home (Portable) Air Filters - Used for a single room or area. Use HEPA filters. They remove outside air pollutants. Note: not all air pollutants can be removed from the air.

• HVAC system - Replace your filter with a HEPA certified air filter for better filtration. Note: not all air pollutants can be removed from the air.

• Early prenatal care

• Meditation practice (nervous system health, stress reduction). Given Air Pollutants may also impact the autonomic nervous system, Kundalini Yoga Meditations work on strengthening the nervous system and help reduce stress for better health and well being. And, reducing stress allows for living more in the Parasympathetic nervous system vs. the Sympathetic Nervous System. Meaning … more happy hormones are released vs. stress hormones such as, cortisol or causing activation of the fight or flight response.

• Pay attention to your surroundings. Do you live close to a coal power plant or fracking location.1 Studies outside this particular research suggest:

1. Biologic plausibility is further supported by other recent studies not included in this review. The study by Casey et al5 of preterm birth rates in California before and after coal power plant closures showed a 27% reduction during the 10-year period after closure. 

2. Currie et al6 found that among 1.1 million live births in Pennsylvania, the risk of low birth weight was higher within 1.9 miles of a fracking site compared with the background risk and increased by 25% within 0.62 miles of a site.

• Work with your physician, OB or midwife to make a plan to mitigate any environmental factors. 

• Speak with your physician, OB, or midwife about working together to adopt a more active role as patient advocates to educate elected officials entrusted with public policy and insist on effective action to stop the climate crisis.

A Few of the Organizations Supporting Changing the Effects of Climate Change

ACOG’s Position (American College of Obstetricians and Gynecologists) recognizes that “climate change is an urgent women’s health concern as well as a major public health challenge.”3

Paris Agreement - A United Nations agreement on Climate Change and lowering emissions (fossil fuel emissions) and limiting climate change. It was signed in 2016. Worldwide efforts exist with 196 states plus the EU having signed on. The United States under President Trump began the one year process to withdraw from the Paris Agreement. The notice to withdraw to the United Nations was submitted Nov 4, 2019.

Unfortunately, President Trump has rolled back national progress on Climate Change. He replaced Obama’s Clean Power Plan, intended to reduce emission from U.S. power plants. He also took the first step to weaken fuel economy standards for cars, the single most important effort to pull back on the largest driver of U.S. emissions.10

Final Thoughts

We’ve all been seeing, witnessing, participating, cheering on, supporting, leading many of the needed movements for the betterment of humanity. Important issues are coming to light and bubbling up to the surface where they need be addressed. It’s time to be heard!

The largest Air Pollution climate change offenders are Fossil Fuel consumed as Crude Oil, Coal and Natural Gas. Offenders of which we can examine and monitor consumption at least in our personal lives for better family health and wellness.

I’m hoping to help educate by sharing science supporting women in making small changes in our personal lives and for those we love for better overall health and for the improved health and livelihood of our babies and future generations.

Of grave concern is both mankind’s and industry’s ever increasing consumption of fossil fuel leading to stronger climate change effects and ultimately impacting the human race and all planetary life. There’s been research predicting that our children’s lifespan will not reach our own. The continuation of business and consumption as usual further adds to increases in air pollution, heat and climate change leading to continued adverse health outcomes on our future generations. 

As Mothers in this world we do our part! We are the guardians and protectors of our loved ones and future generations. Wishing you empowerment, courage and strength in doing your best to mitigate any environmental risk factors and have an empowered, safe and healthy pregnancy and Motherhood journey. 

YOU make the difference!

Happy Mama, Happy Womb, Happy Baby

Kundalini Baby

Disclaimer:

Kundalini Baby nor Katherine Mardesich are trained nor licensed health professionals nor give advice on what or how to best address climate change and it’s effect on pregnancy. Please seek out the advice of your OB, Midwife, or birth professional for the best guidance and practices related to any of the above studies and comments.

Resources:

 1.  JAMA STUDY: Association of Air Pollution and Heat Exposure With Preterm Birth, Low Birth Weight, and Stillbirth in the US - A Systematic Review.   https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767260     Published: June 18, 2020. doi:10.1001/jamanetworkopen.2020.8243

2. An associated Editorial Comment: A Clarion Warning About Pregnancy Outcomes and the Climate Crisis.  Published: June 18, 2020. doi:10.1001/jamanetworkopen.2020.8811

3. American College of Obstetrics and Gynecology. Climate change and women’s health. Position paper. Reaffirmed April 2018. Accessed February 20, 2019. https://www.acog.org/clinical-information/policy-and-position-statements/position-statements/2018/climate-change-and-womens-health

4. Guardian Article  https://www.theguardian.com/environment/2020/jun/18/climate-change-air-pollution-investigation-study

5. Casey  JA, Karasek  D, Ogburn  EL,  et al.  Retirements of coal and oil power plants in California: association with reduced preterm birth among populations nearby.   Am J Epidemiol. 2018;187(8):1586-1594. doi:10.1093/aje/kwy110PubMedGoogle Scholar

6. Currie  J, Greenstone  M, Meckel  K.  Hydraulic fracturing and infant health: new evidence from Pennsylvania.   Sci Adv. 2017;3(12):e1603021. doi:10.1126/sciadv.1603021PubMedGoogle Scholar

7. American College of Obstetricians and Gynecology. Racial and ethnic disparities in obstetrics and gynecology, committee opinion. Number 649. December 2015. Accessed March 10, 2019. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/12/racial-and-ethnic-disparities-in-obstetrics-and-gynecology

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767256#zic200083r7. #3

8. World Health Organization. Born too soon: the global action report on preterm birth. Published May 2, 2012. Accessed April 29, 2020. https://www.who.int/pmnch/media/news/2012/preterm_birth_report/en/

9. 10 (article from www.insideclimatenews.org called “Donald Trump’s Record on Climate Change.

10. Mendola  P, Wallace  M, Hwang  BS,  et al.  Preterm birth and air pollution: critical windows of exposure for women with asthma.   J Allergy Clin Immunol. 2016;138(2):432-440.e5. doi:10.1016/j.jaci.2015.12.1309PubMedGoogle ScholarCrossref

11. Mendola  P, Ha  S, Pollack  AZ,  et al.  Chronic and acute ozone exposure in the week prior to delivery is associated with the risk of stillbirth.   Int J Environ Res Public Health. 2017;14(7):731. doi:10.3390/ijerph14070731PubMedGoogle ScholarCrossref

Authors:

Bruce Bekkar, MD1; Susan Pacheco, MD2; Rupa Basu, PhD3,4; Nathaniel DeNicola, MD, MSHP5

• 1Retired from Southern California Permanente Medical Group, San Diego

• 2The University of Texas McGovern Medical School, Houston

• 3California Office of Environmental Health Hazard Assessment, Air and Climate Epidemiology Section, Oakland

• 4Department of Environmental Health Sciences, University of California Berkeley School of Public Health, Berkeley

• 5George Washington University School of Medicine and Health Sciences, Washington, DC