Environmental Factors Involved in Maternal Morbidity and Mortality

Abstract

Nongenetic, environmental factors contribute to maternal morbidity and mortality through chemical exposures via air, water, soil, food, and consumer products. Pregnancy represents a particularly sensitive window of susceptibility during which physiological changes to every major organ system increase sensitivity to chemicals that can impact a woman's long-term health. Nonchemical stressors, such as low socioeconomic status, may exacerbate the effects of chemical exposures on maternal health. Racial/ethnic minorities are exposed disproportionately to both chemicals and nonchemical stressors, which likely contribute to the observed health disparities for maternal morbidities and mortality. Epidemiological studies linking exposures to adverse maternal health outcomes underscore the importance of environmental health impacts, and mechanistic studies in model systems reveal how chemicals perturb biological pathways and processes. Environmental stressors are associated with a variety of immediate maternal health impacts, including hypertensive disorders of pregnancy, fibroids, and infertility, as well as long-term maternal health impacts, such as higher risk of breast cancer and metabolic disorders. Identifying and reducing a pregnant woman's environmental exposures is not only beneficial to her offspring but also important to preserve her short-and long-term health.

Summary and Conclusion: Framing a New Research Agenda on Maternal Morbidities and Mortality in the United States

“…Campbell et al 29 explore the interface between intimate partner violence and pregnancy-associated and pregnancy-related deaths due to homicide, suicide, and drug overdose. Boyles et al 30 review the literature on the role chemical and nonchemical environmental stressors have on maternal health. Environmental stressors are associated with a variety of immediate maternal health impacts, including hypertensive disorders of pregnancy, fibroids, and infertility, as well as long-term maternal health impacts, such as higher risk of breast cancer and metabolic disorders.…”

“…Environmental stressors are associated with a variety of immediate maternal health impacts, including hypertensive disorders of pregnancy, fibroids, and infertility, as well as long-term maternal health impacts, such as higher risk of breast cancer and metabolic disorders. 30 Saluja and Bryant 31 call attention to the potential role of implicit bias on patient–provider communication and its potential impact on maternal health care and outcomes. Crear-Perry et al 32 call out racism as a structural determinant and root cause of inequities in maternal health outcomes, noting that “many of the social and political structures and policies in the United States were born out of racism, classism, and gender oppression.”…”

“…A major unanswered question and the Holy Grail for a new research agenda on maternal morbidities and mortality in the United States is, “What can we do about social, structural, and environmental determinants of maternal health?” The collection of articles in this volume makes a number of recommendations, including assuring trauma-informed health care for pregnant women, 29 strengthening implicit bias and cultural humility training for health care providers and trainees, 31 integrating data on social determinants of health into electronic health records and clinical decision support, 33 and capturing environmental exposures across diverse racial and ethnic populations in big data initiatives, such as the National Institutes of Health's All of Us Research Program. 30 …”

Endocrine Disruptor Compounds—A Cause of Impaired Immune Tolerance Driving Inflammatory Disorders of Pregnancy?

“…Reproductive-aged women are at high risk of EDC exposure, especially through everyday exposure to personal care products and household chemicals, and the events of pregnancy would reasonably heighten the health risks of EDC exposure in women (56). There is compelling evidence implicating EDC exposures as a risk factor in a range of pregnancy disorders (59)(60)(61)(62)(63). Several clinical and epidemiological studies link EDCs, notably pesticides and plasticizers, in common pregnancy complications that together affect around 20% of women, including recurrent miscarriage, fetal growth restriction, preeclampsia and related hypertensive disorders, and preterm birth (13,56,61,64,65).…”

“…EDCs may operate through pre-pregnancy exposures that affect organs systems critical for pregnancy health, through gestational exposures that interfere with hormone control of fetal and placental development and function, or other via systemic adaptations required to sustain pregnancy (63). There is clear evidence that pregnant women with existing health disparities, associated with low socioeconomic status, or certain racial groups such as non-white women in the US where levels of chemical toxicants are often higher, exhibit a disproportionate health burden associate with EDC exposures (3,44).…”