A Scoping Review of Climate-Change Related Exposures on Obstetrics Outcomes [18G]

Abstract

INTRODUCTION: Toxic environmental exposures, specifically climate-change related exposures, pose a unique risk to pregnant women and the developing fetus. Robust evidence analysis is needed to guide clinicians on risk assessment and clinical counseling. METHODS: A literature search was conducted by our research team and medical librarian; scope included United States studies from 2007 to 2017. Climate-change related exposures included air pollution components: fine particulate matter (PM 2.5) and ozone, extreme weather, heat and temperature. Exposures ranged throughout all trimesters. Obstetrics outcomes included preterm birth, low birth-weight, and stillbirth. Exposures related to natural disasters were excluded; clinical outcomes related to neurodevelopment, mental illness, gynecology, and fertility were excluded. The Arksey and O'Malley scoping review framework was followed and quality assessment was performed using the Jadad scale. RESULTS: A total of 1,842 references were screened. 24 studies related to air pollution and preterm birth met inclusion; 21 found an effect. 27 studies related to air pollution and low birth-weight and met inclusion; 25 found an effect. 4 studies related to air pollution and stillbirth met inclusion; 3 found an effect. 5 studies related to heat and preterm birth met inclusion; 5 found an effect. 3 studies related to heat and low birth-weight met inclusion; 3 found an effect. 2 studies related to heat and stillbirth met inclusion; 2 found an effect. CONCLUSION: Climate-change related exposures, specifically air pollution and heat, are associated with an effect on important obstetrics outcomes: preterm birth, low birthweight, and stillbirth. Women's health providers should become familiar with this emerging risk.

Taking the Heat: Potential Fetal Health Effects of Hot Temperatures

“…The role of coexposures, especially to air pollution, is one of the many unresolved questions in this area. Some evidence suggests that exposure to high levels of various outdoor air pollutants may increase the risk of congenital heart defects35 as well as adverse birth outcomes and other pregnancy complications 4. Meanwhile, hotter days are associated with higher concentrations of ground-level ozone 36…”

“…Several epidemiological studies over the past five years have reported associations between high temperatures and adverse pregnancy outcomes, including preterm birth, stillbirth, and low birth weight (LBW),3 , 4 as well as congenital heart defects 5. (At least two studies have also examined ambient temperature in relation to neural tube defects 6 , 7…”

The Climate Crisis and Breastfeeding: Opportunities for Resilience

“…Elevated temperatures and prolonged heat waves during pregnancy can have significant repercussions on breastfeeding. In an extremely hot climate, pregnant women face an increased risk of premature birth, stillbirth, low birth weight, and pre-eclampsia (Bekkar et al, 2020; DeNicola et al, 2019; Lusambili & Nakstad, 2023). Premature birth could have direct effects on a parent’s ability to breastfeed as infants may require advanced or critical care, parents may be unable to express sufficient milk for their vulnerable newborns, and low birth weight may lead to concerns about weight gain and the need for supplementation, and result in over-reliance on commercial milk formula.…”

General practice in the era of planetary health: Responding to the climate health emergency

“…Warmer temperatures are also associated with preterm birth, low birth weight and stillbirth. [32][33][34]…”