Background The empirical literature on the effects of disaster on pregnancy and the postpartum period is limited. The objective of this review was to examine the existing evidence on the effect of disasters on perinatal health. Methods A systematic review was conducted by searching electronic databases (MEDLINE, EMBASE, Cinahl, PsycInfo), including literature on disasters and pregnancy outcomes (e.g., preterm birth, low birthweight, congenital anomalies), mental health, and child development. 110 articles were identified, but many published reports were anecdotes or recommendations rather than systematic studies. The final review included 49 peer-reviewed studies that met inclusion criteria. Results Studies addressing the World Trade Center disaster of September 11th and other terrorist attacks, environmental/chemical disasters, and natural disasters such as hurricanes and earthquakes were identified. Disasters of various types may reduce fetal growth in some women, though there does not appear to be an effect on gestational age at birth. Severity of exposure is the major predictor of mental health issues among pregnant and postpartum women. The mother's mental health after a disaster may more strongly influence on child development than any direct effect of disaster-related prenatal stress. Conclusions There is evidence that disaster impacts maternal mental health and some perinatal health outcomes, particular among highly-exposed women. Future research should focus on under-studied outcomes such as spontaneous abortion. Relief workers and clinicians should concentrate on the most exposed women, particularly with respect to mental health.

Objective To estimate the relative risk of recurrence of oral cleft in first degree relatives in relation to cleft morphology. Design Population based cohort study. Setting Data from the medical birth registry of Norway linked with clinical data on virtually all cleft patients treated in Norway over a 35 year period. Participants 2.1 million children born in Norway between 1967 and 2001, 4138 of whom were treated for an oral cleft. Main outcome measure Relative risk of recurrence of isolated clefts from parent to child and between full siblings, for anatomic subgroups of clefts. Results Among first degree relatives, the relative risk of recurrence of cleft was 32 (95% confidence interval 24.6 to 40.3) for any cleft lip and 56 (37.2 to 84.8) for cleft palate only (P difference=0.02). The risk of clefts among children of affected mothers and affected fathers was similar. Risks of recurrence were also similar for parentoffspring and sibling-sibling pairs. The "crossover" risk between any cleft lip and cleft palate only was 3.0 (1.3 to 6.7). The severity of the primary case was unrelated to the risk of recurrence. Conclusions The stronger family recurrence of cleft palate only suggests a larger genetic component for cleft palate only than for any cleft lip. The weaker risk of crossover between the two types of cleft indicates relatively distinct causes. The similarity of mother-offspring, fatheroffspring, and sibling-sibling risks is consistent with genetic risk that works chiefly through fetal genes. Anatomical severity does not affect the recurrence risk in first degree relatives, which argues against a multifactorial threshold model of causation.

Cleft lip defects are usually regarded as a single entity, with the assumption that an accompanying cleft palate represents the more severe form. The authors linked data from the Medical Birth Registry of Norway with medical records from two centralized centers to provide a population-based data set. They assessed the distribution of cleft lip only and cleft lip with cleft palate by covariate. Among 1.8 million Norwegian livebirths between 1967 and 1998, there were 1,572 cases of cleft lip with cleft palate and 1,122 cases with cleft lip only. Seventeen percent of those with cleft lip and palate had another defect compared with 9% of those with cleft lip only. For boys, the risk was greater for cleft lip and palate than for cleft lip only (odds ratio=2.4 vs. 1.8, p<0.001 for difference). The risk of cleft lip only, but not of cleft lip and palate, was increased for twins (odds ratio=1.6 vs. 1.1, p=0.11) and infants whose parents were first cousins (odds ratio=2.7 vs. 0.7, p=0.07). Although cleft lip with cleft palate may simply represent a more severe form of the defect, epidemiologic assessments of cleft lip should, when possible, include separate analyses of these two groups.

Background-Little is known about the effects of natural disasters on pregnancy outcomes. We studied mental health and birth outcomes among women exposed to Hurricane Katrina.

Intimate partner violence (IPV) has been associated with stress, but few studies have examined the effect of natural disaster on IPV. In this study, we examine the relationship between experience of Hurricane Katrina and reported relationship aggression and violence in a cohort of 123 postpartum women. Hurricane experience was measured using a series of questions about damage, injury, and danger during the storm; IPV was measured using the Conflict Tactics Scale (CTS-2). Multiple log-poisson regression was used to calculate relative risks, adjusted for potential confounders. Most reported that they and their partners had explained themselves to each other, showed each other respect, and also insulted, swore, or shouted during conflicts with each other. Much smaller proportions reported physical violence, sexual force, or destroying property, though in each case at least 5% endorsed that it had happened at least once in the last six months. Similar proportions reported that they and their partners had carried out these actions. Experiencing damage due to the storm was associated with increased likelihood of most conflict tactics. Strong relative risks were seen for the relationship between damage due to the storm and aggression or violence, especially being insulted, sworn, shouted, or yelled at (adjusted relative risk [aRR]1.23, 1.02–1.48), pushed, shoved, or slapped (aRR 5.28, 95% CI 1.93–14.45), or being punched, kicked, or beat up (aRR 8.25, 1.68–40.47). Our results suggest that certain experiences of the hurricane are associated with an increased likelihood of violent methods of conflict resolution. Relief and medical workers may need to be aware of the possibility of increased IPV after disaster.

Objective: Both self-reported indicators of stress and hormones such as cortisol and corticotrophin-releasing hormone (CRH) have been examined in relation to preterm birth. Although these hormones have been interpreted as biomarkers of stress, it is unclear whether psychosocial measures are empirically associated with biomarkers of stress in pregnant women. Methods: We analyzed data from 1,587 North Carolina pregnant women enrolled in the Pregnancy, Infection, and Nutrition study during 2000-2004 who provided at least one saliva sample for cortisol measurement or blood samples for CRH at 14-19 and 24-29 weeks' gestation. Cortisol measures were limited to those taken between 8 and 10 a.m. Perceived stress, state-trait anxiety, coping style, life events, social support, and pregnancy-specific anxiety were measured by questionnaires and interviews. Spearman correlations and multiple regressions were used to describe the relationship among the measures of stress. Results: No correlations larger than r ¼ 0.15 were seen between reported psychosocial measures and cortisol or CRH. Women with demographic characteristics associated with poor pregnancy outcomes (unmarried, AfricanAmerican, young, low pre-pregnancy body mass index) reported higher levels of stress but did not consistently have higher levels of stress hormones. Pre-eclampsia was associated with higher CRH, but not with higher cortisol. Conclusions:The relationship between measurements of reported stress and biomarkers is not straightforward in large epidemiological studies of pregnancy. For online Supplementary Material, see www.liebertonline.com.

Background Pregnancy-related cardiovascular conditions are associated with both poorer pregnancy outcomes and cardiovascular disease later in life. Little is known about the relationship between preconception cardiovascular risk factor levels and pregnancy complications. Methods Data from the Cardiovascular Risk in Young Finns Study were linked with birth registry data for 1142 primiparous women. Age-standardized levels of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, blood pressure, insulin, and glucose from the study visit prior to last menstrual period were calculated. These factors were examined as predictors of gestational age, preterm birth (<37 weeks), birthweight, low birthweight (<2500 g), small-for-gestational-age (weight <10th percentile for gestational age), hypertensive disorders of pregnancy, and gestational diabetes, using linear and Poisson regression with adjustment for age, body mass index, smoking, and socioeconomic status. Results Higher triglycerides were associated with a higher risk of hypertensive disorders (adjusted risk ratio [aRR]= 1.42 [95% confidence interval (CI) = 0.90–2.23]), pre-eclampsia (1.70 [1.08–2.65]), and gestational diabetes (1.68 [1.25–2.25]). After removing women with pregnancy complications (n=30), the estimated aRR for the association between systolic blood pressure and preterm birth was 1.23 (95% CI= 0.99–1.54); for HDL-c and low birthweight, 0.97 (0.73–1.28); for diastolic blood pressure and small-for-gestational-age, 0.98 (0.81–1.20); and for systolic blood pressure and small-for-gestational-age, 1.18 (0.97–1.45). Conclusions High lipid levels before pregnancy predict an increased risk of pre-eclampsia and gestational diabetes. Reported associations between these pregnancy complications and later cardiovascular disease of the mother are probably explained, at least in part, by maternal conditions that precede pregnancy. Interventions to improve cardiovascular health before pregnancy may reduce risk of pregnancy complications.

visits; and an increase in post-partum depression and the exacerbation of other mental health concerns. 9 The organisation of labour and delivery rooms dedicated to women with COVID-19 and restriction of visitors is another example of unavoidable changes that could have a psychological effect on isolated women.Cooperation between countries is needed to address the gaps in knowledge about COVID-19 and its effect on pregnant women and their babies. Additionally, researchers must ensure transparency of reporting to guarantee the accuracy of data. 10 The crucial information obtained from key surveillance and research studies will help to inform clinical recommendations and public health guidance and messages tailored to local contexts. Pregnant women and their neonates should not be ignored.We declare no competing interests.