Post-Disaster Reproductive Health Outcomes

Abstract

We examined methodological issues in studies of disaster-related effects on reproductive health outcomes and fertility among women of reproductive age and infants in the United States (US). We conducted a systematic literature review of 1,635 articles and reports published in peer-reviewed journals or by the government from January 1981 through December 2010. We classified the studies using three exposure types: (1) physical exposure to toxicants; (2) psychological trauma; and (3) general exposure to disaster. Fifteen articles met our inclusion criteria concerning research focus and design. Overall studies pertained to eight different disasters, with most (n = 6) focused on the World Trade Center attack. Only one study examined pregnancy loss, i.e., occurrence of spontaneous abortions post-disaster. Most studies focused on associations between disaster and adverse birth outcomes, but two studies pertained only to post-disaster fertility while another two examined it in addition to adverse birth outcomes. In most studies disaster-affected populations were assumed to have experienced psychological trauma, but exposure to trauma was measured in only four studies. Furthermore, effects of both physical exposure to toxicants and psychological trauma on disaster-affected populations were examined in only one study. Effects on birth outcomes were not consistently demonstrated, and study methodologies varied widely. Even so, these studies suggest an association between disasters and reproductive health and highlight the need for further studies to clarify associations. We postulate that post-disaster surveillance among pregnant women could improve our understanding of effects of disaster on the reproductive health of US pregnant women.

Evaluation of reproductive health indicators in women affected by East Azarbaijan earthquake on August 2012

“…[15] Researchers believed that the presence of some indicators such as accessible prenatal care, accessible contraceptive methods, and breastfeeding in affected areas can help health care professionals in identifying and fulfilling reproductive health needs of women. [13] These enable health care professionals to decrease the impacts of natural disasters through some basic measures.…”

Addressing Maternal Health During CDC's Ebola Response in the United States

“…Little to no surveillance is conducted among this vulnerable population. 11,12 This may be due to pregnant women making up just 1% of the general population and 5% of women of reproductive age at a given point in time in the United States, making it difficult to conduct population-based surveillance.…”

Maternal exposure to hurricane destruction and fetal mortality

“…With respect to postdisaster reproductive outcomes, it is unclear which of these proximate sources of hurricane-induced distress exercises the greatest influence over fetal outcomes. Zotti et al 23 maintain that improved public health surveillance can resolve such questions, advancing understanding of exposure effects on maternal risk factors, behaviours and fetal outcomes. Specifically, they suggest appending a disaster-specific module to the Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based surveillance survey collecting vital information on maternal and child health before, during and after pregnancy.…”

“…While postdisaster negative effects on fetal health are partly explained by compromised maternal access to healthcare before and after a hurricane event,21 22 researchers postulate that disaster-induced trauma and distress experienced by pregnant mothers may impair the development of an unborn child 23. Observational studies have found associations between maternal stress and newborn health 24–29.…”

“…In a recent review of research, Zotti et al 23 found uneven empirical evidence that negative fetal outcomes increase in maternal exposure to postdisaster destruction, maintaining that differences in research design, measurement and sample sizes may account for inconsistent findings across studies 17–19. Our study aims to extend understanding of the in utero costs of natural disasters by investigating whether maternal exposure to destruction caused by HKR increased the risk of fetal death.…”