Climate Change-Related Environmental Exposures and Perinatal and Maternal Health Outcomes in the U.S

Ambient air temperature exposure and foetal size and growth in three European birth cohorts

INTRODUCTION

Ambient air temperature may affect birth outcomes adversely, but little is known about their impact on foetal growth throughout pregnancy. We evaluated the association between temperature exposure during pregnancy and foetal size and growth in three European birth cohorts.

METHODS

We studied 23,408 pregnant women from the English Born in Bradford cohort, Dutch Generation R Study, and Spanish INMA Project. Using the UrbClimTM model, weekly ambient air temperature exposure at 100x100m resolution at the mothers' residences during pregnancy was calculated. Estimated foetal weight, head circumference, and femur length at mid and late pregnancy and weight, head circumference, and length at birth were converted into standard deviation scores (SDS). Foetal growth from mid to late pregnancy was calculated (grams or centimetres/week). Cohort/region-specific distributed lag non-linear models were combined using a random-effects meta-analysis and results presented in reference to the median percentile of temperature (14 °C).

RESULTS

Weekly temperatures ranged from -5.6 (Bradford) to 30.3 °C (INMA-Sabadell). Cold and heat exposure during weeks 1-28 were associated with a smaller and larger head circumference in late pregnancy, respectively (e.g., for 9.5 °C: -1.6 SDS [95 %CI -2.0; -0.4] and for 20.0 °C: 1.8 SDS [0.7; 2.9]). A susceptibility period from weeks 1-7 was identified for cold exposure and a smaller head circumference at late pregnancy. Cold exposure was associated with a slower head circumference growth from mid to late pregnancy (for 5.5 °C: -0.1 cm/week [-0.2; -0.04]), with a susceptibility period from weeks 4-12. No associations that survived multiple testing correction were found for other foetal or any birth outcomes.

CONCLUSIONS

Cumulative exposure to cold and heat during pregnancy was associated with changes in foetal head circumference throughout gestation, with susceptibility periods for cold during the first pregnancy trimester. No associations were found at birth, suggesting potential recovery. Future research should replicate this study across different climatic regions including varying temperature profiles.

Advancing disability-inclusive climate research and action, climate justice, and climate-resilient development

Globally, more than 1 billion people with disabilities are disproportionately and differentially at risk from the climate crisis. Yet there is a notable absence of climate policy, programming, and research at the intersection of disability and climate change. Advancing climate justice urgently requires accelerated disability-inclusive climate action. We present pivotal research recommendations and guidance to advance disability-inclusive climate research and responses identified by a global interdisciplinary group of experts in disability, climate change, sustainable development, public health, environmental justice, humanitarianism, gender, Indigeneity, mental health, law, and planetary health. Climate-resilient development is a framework for enabling universal sustainable development. Advancing inclusive climate-resilient development requires a disability human rights approach that deepens understanding of how societal choices and actions-characterised by meaningful participation, inclusion, knowledge diversity in decision making, and co-design by and with people with disabilities and their representative organisations-build collective climate resilience benefiting disability communities and society at large while advancing planetary health.

Energy consumption in MRI: Determinants and management options

BACKGROUND

Energy consumption awareness is a known concern, and radiology departments have energy-intensive consuming machines. The means of energy consumption management in MRI scanners have yet to be evaluated.

PURPOSE

To measure the MRI energy consumption and to evaluate the means to reduce it.

MATERIALS AND METHODS

Data was retrieved for two MRI scanners through the hospital's automated energy consumption measurement software. After correlation with picture archiving and communication system (PACS) files, they were segmented by machine and mode (as follows: stand-by, idle and active) and analyzed. Active mode data for a specific brain MRI protocol have been isolated, and equivalent low energy consuming protocol was made. Both were performed on phantom and compared. Same protocol was performed on a phantom using 3.0T 16 and 32 head channels coils. Multiples sequences were acquired on phantom to evaluate power consumption.

RESULTS

Stand-by mode accounted for 60 % of machine time and 40 % of energy consumption, active mode accounted for 20 % machine time and 40 % energy consumption, idle mode for 20 % imachine time and 20 % consumption. DWI and TOF sequences were the most consuming in our brain-MRI protocol. The low energy consuming protocol allowed a saving of approximately 10 % of energy consumption, which amounted for 0.20€ for each examination. This difference was mainly due to an energy consumption reduction of the DWI sequence. There were no difference in consumption between a 3.0T 16 and 32 channels head coils. Sequence's active power and duration (especially considering slice thickness) have to be taken into account when trying to optimize energy consumption.

CONCLUSION

There are two key factors to consider when trying to reduce MRI scan energy consumption. Stand-by mode energy consumption has to be taken into account when choosing an MRI scan, as it can't be changed further on. Active mode energy consumption is dependent of the MRI protocols used, and can be reduced with sequences adaptation, which must take into account sequence's active power and duration, on top of image quality.

A global analysis of the determinants of maternal health and transitions in maternal mortality

The reduction of maternal mortality and the promotion of maternal health and wellbeing are complex tasks. This Series paper analyses the distal and proximal determinants of maternal health, as well as the exposures, risk factors, and micro-correlates related to maternal mortality. This paper also examines the relationship between these determinants and the gradual shift over time from a pattern of high maternal mortality to a pattern of low maternal mortality (a phenomenon described as the maternal mortality transition). We conducted two systematic reviews of the literature and we analysed publicly available data on indicators related to the Sustainable Development Goals, specifically, estimates prepared by international organisations, including the UN and the World Bank. We considered 23 frameworks depicting maternal health and wellbeing as a multifactorial process, with superdeterminants that broadly affect women's health and wellbeing before, during, and after pregnancy. We explore the role of social determinants of maternal health, individual characteristics, and health-system features in the production of maternal health and wellbeing. This paper argues that the preventable deaths of millions of women each decade are not solely due to biomedical complications of pregnancy, childbirth, and the postnatal period, but are also tangible manifestations of the prevailing determinants of maternal health and persistent inequities in global health and socioeconomic development. This paper underscores the need for broader, multipronged actions to improve maternal health and wellbeing and accelerate sustainable reductions in maternal mortality. For women who have pregnancy, childbirth, or postpartum complications, the health system provides a crucial opportunity to interrupt the chain of events that can potentially end in maternal death. Ultimately, expanding the health sector ecosystem to mitigate maternal health determinants and tailoring the configuration of health systems to counter the detrimental effects of eco-social forces, including though increased access to quality-assured commodities and services, are essential to improve maternal health and wellbeing and reduce maternal mortality.

Mental health impacts of climate change and extreme weather events on mothers

Background: The perinatal period is a time of increased vulnerability for perinatal mood and anxiety disorders (PMADs). Emotional trauma is a risk factor for PMAD development and is common among survivors of extreme weather events (EWEs), which are becoming more frequent and intense as the climate crisis progresses. EWE-related stress and anxiety have not been extensively studied in the perinatal population. However, the limited available data suggest a negative impact of EWE exposure on perinatal mental health, warranting further investigation and investment.Objective: To address this knowledge gap, we interviewed new Australian mothers to understand how EWEs affect the mental health of the perinatal population.Method: Australian mothers (18 years of age or older) with a baby under 12 months of age were recruited to participate in a single virtual focus group session (seven group sessions were run in total) and complete an anonymous survey. Participants were asked questions regarding their concerns about extreme weather and its impact, as well as their general maternal functioning. Maternal functioning, depression, and climate distress were measured via the survey.Results: The study sample comprised 31 Australian mothers (Mage = 31.74, SD = 4.86), predominantly located in Queensland. Findings from the focus groups suggested six key themes; however, of focus to this study are three themes related to maternal mental health: health and well-being, helplessness and avoidant coping, and resilience and adaptation. Predominant subthemes focused on trauma resulting from EWE exposure, economic and heat concerns, social isolation, hopelessness about the future, and feelings of resilience.Conclusions: The evidence linking adverse perinatal mental health outcomes with climate change and EWEs highlights the urgent need for interventions in this context to protect perinatal mental health and well-being. By acknowledging the traumatic impact of these experiences on mothers, this study supports advocacy for policies that specifically address this issue.

Perinatal Mental Health Outcomes Following Natural Disasters

This Viewpoint discusses mental health outcomes associated with natural disaster–related stressors during the perinatal period.

Physical exposures in the work environment during pregnancy - a challenge for risk assessment

Pregnant women have been preforming work-related activities during pregnancy since time immemorial, from the traditional hunter-gatherer or forager society to today’s modern world. But ever since our society has been industrialized, exposure patterns for pregnant women have changed dramatically, and they keep changing. This change is due partly to exposure changes overall in the labor market and partly the changes in the gender balance in different occupations.

To some extent, women have been protected from the most hazardous occupations, since these mainly have been held by men (1). But active strategies within Europe to move towards a gender-balanced work force have increased the number of women seeking employment in hazardous work environments. One example is heavy truck and lorry drivers, who are predicted to be 40% female by 2030 (2). Today, the labor participation rate for women is high, with a total of 67% in Europe and 74–80% in Scandinavian countries (3), leading to a workforce that eventually has as many exposed women as men.

A gender-balanced work force across occupations brings diversity and thus benefits to the work site (4). But it also introduces a challenge, especially in exposed blue-collar occupations. So far, much emphasis has been given to chemical and particles exposure. This is a very important and crucial area for the risk assessment for pregnant workers (5, 6) but not the only hazard present in occupational settings. Too little attention has been paid to physical factors in the work environment during pregnancy in association with health effects, even though physical factors are more prevalent than chemical and particles exposure in occupational settings. The exception is physical load, about which several original articles and reviews have been published (7–9). But physical exposure is a broad concept and also includes exposure to temperature, whole-body vibration, and noise.

Among the physical exposures in occupational settings, physically strenuous work has been the most studied. This area includes work postures, heavy lifting, standing/walking, sedentary work as well as a cardiovascular strain from physical labor. Recent reviews show an overall modest effect for physically strenuous work during pregnancy as well as pregnancy complications and adverse birth outcomes (10). In summary, the evidence so far concludes that pregnant workers should avoid occasional heavy lifting and lifting >10 kg in general (9). Heat in residential settings during pregnancy has been extensively studied (11), and some studies have also focused on occupational settings. An association between heat exposure and heat stress in relation to pregnancy complications as well as birth outcomes has been reported (12). But the evidence is not strong enough to recommend specific temperature levels in occupational settings for pregnant workers.

Only a few studies have investigated noise and whole-body vibration and its effect on pregnant workers. In both areas, reviews have shown inconclusive results (13, 14) and, since then, only a handful studies have been published, including only one large scale cohort study divided into five manuscripts (15–19). The evidence so far suggests that working full-time (8 hours) in weighted average of >80dBA occupational noise and >0.5m/s2 whole-body vibration is associated with an increased risk of pregnancy complications and negative birth outcomes. But since these findings come from one cohort, they need to be confirmed in other high quality cohort studies where levels of exposure can be assessed.

An important review on the evidence so far regarding physical exposures during pregnancy and preterm birth is on the way; the method and protocols have already been published (20), but a review is only as good as its included studies, and we need more high-quality original studies in this research area. Overall, more prospective cohort studies with objectively assessed exposures are needed to be able to identify a safe level for occupational physical exposures during pregnancy. So far, the current evidence on physical load is predominantly based on self-reported physical load, and future studies should focus on high quality objective exposure assessment to increase the level of evidence within this part of the research field.

To be able to progress, future studies also need detailed information on absence from work. In many countries, absence from work due to pregnancy benefit, sick leave and parental leave is common during pregnancy. In Sweden, 7 out of 10 women apply for leave of absence benefits at some point during pregnancy [21). In contrast to chemical exposures, that can bioaccumulate, physical exposures predominately affect the working mother during pregnancy. Hence, to correctly assess occupational exposure to physical factors during pregnancy in relation to health effects in the mother and child, absence from work needs to be addressed properly. Associations can otherwise be missed due to misclassification of exposure. This have been shown in a large-scale cohort study from Sweden, where associations only were found in full time workers with low leave of absence during pregnancy [16-18).

Leave of absence data is also needed to assess the potential beneficial effect that leave of absence can have on the pregnant worker. This was shown in Skröder et al 2021, where pregnant women highly exposed to whole-body vibration only had an increased risk of preterm birth if they had few days of leave of absence during pregnancy. With increased levels of leave of absence from work, women highly exposed to whole-body vibration at work had the same risk of delivering preterm as the general working population. In high levels of leave of absence data, women highly exposed to whole-body vibration had a lower risk of preterm birth then the general population with the same level of absence from work, indicating a healthy worker effect [16). Leave of absence during pregnancy can also be seen as an intermediate measure, since early health effects can lead to an increased level of sick leave, parental leave or pregnancy benefit. An association between exposure at the workplace and level of absence from work have been seen in a recent Danish study and in a recent review [22, 23).

High quality environmental epidemiological studies have been of use when assessing the effect of occupational exposure during pregnancy to chemical and particle exposure on pregnancy complications and birth outcomes. But for physical exposures, the exposures and levels differ substantially between environmental and occupational settings and some of the mechanisms. This is true for the mechanism between noise and health, where occupational and residential exposure to noise both are associated with a stress mechanism, but were only the residential exposure contribute to sleep disturbance and related health effects [13). An exposome approach is needed to identify and assess all the potential risk factors for pregnant women [24). In the exposome concept, multiple exposures in a life course perspective are assessed, with a focus on vulnerable stages, such as pregnancy. It is important to adjust for other co-exposures in the work environment, such as chemical and particle exposure, psychosocial exposures, shift work and other physical exposures when assessing the relationship between occupational exposure to one physical factor and the outcome. These exposures are partly correlated with each other [15-19). Few previous studies have been able to adjust for other occupational exposures at work when investigating individual occupational exposures. Very few studies examined the interaction of occupational exposure and how they jointly contribute to the risk of health effects in the mother and child, even though most of these exposures correlate in the work place [25). Some of the existing birth cohort studies can be regarded as hidden treasures for occupational data, with detailed information on occupational environment of the parents that many times have not been used [26). We need to be able to produce valid exposure-response curves and thereby ensure a safe work environment for the pregnant worker and her child. But also, to avoid excluding women from the labor market during pregnancy unnecessary. An unnecessary exclusion from the labor market can hinder female workers career advancement to the next level of their career and lead to lower salaries, and in the end lower pensions compared to men. So, a well-balance discussion based on high quality evidence can provide a safe and non-discriminatory work environment for pregnant women.

Regarding chemical and particle exposure, an equal low level of exposure for both men and women in reproductive ages can reduce reproductive effects successfully. In physical exposures, there is less need to reduce exposure levels for all, unless these are associated with other health outcomes. It is mainly women of reproductive age who need to be protected, preferably early on since at least whole-body vibration is suspected to be associated with miscarriages. A better system to identify and inform pregnant workers already at the time of their prenatal care registration (usually in gestational week 10) is needed. Overall, there remains a significant knowledge gap regarding the effect of physical occupational exposures during pregnancy and health effects among children. More high-quality cohort studies with objectively assessed exposure that have access to leave-of-absence-during-pregnancy data are needed to increase the level of knowledge in this important area so researchers can generate accurate exposure–response functions and provide correct and well-balanced advice to occupational health services, employers, and pregnant workers.

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Trends in Gestational Weight Gain in Louisiana, March 2019 to March 2022

Importance

Average gestational weight gain (GWG) increased during the COVID-19 pandemic, but it is not known whether this trend has continued.

Objective

To examine patterns of GWG during the COVID-19 pandemic by delivery and conception timing through the second year of the pandemic.

Design, Setting, and Participants

This cohort study is a retrospective review of birth certificate and delivery records from 2019 to 2022. Electronic health records were from the largest delivery hospital in Louisiana. Participants included all individuals giving birth from March 2019 to March 2022. Data analysis was performed from October 2022 to July 2023.

Exposure

Delivery date (cross-sectionally) and conception before the pandemic (March 2019 to March 2020) and during the peak pandemic (March 2020 to March 2021) and late pandemic (March 2021 to March 2022).

Main Outcomes and Measures

The primary outcome was GWG (total GWG and adherence to the 2009 Institute of Medicine recommendations) analyzed using linear and log-linear regression with control for covariates.

Results

Among 23 012 total deliveries (8763 Black individuals [38.1%]; 11 774 White individuals [51.2%]; mean [SD] maternal age, 28.9 [5.6] years), 3182 individuals (42.0%) exceeded the recommended weight gain in the year proceeding the pandemic, 3400 (45.4%) exceeded recommendations during the peak pandemic, and 3273 (44.0%) exceeded recommendations in the late pandemic. Compared with those who delivered before the pandemic (reference), participants had higher total GWG if they delivered peak or late pandemic (adjusted β [SE], 0.38 [0.12] kg vs 0.19 [0.12] kg; P = .007). When cohorts were defined by conception date, participants who conceived before the pandemic but delivered after the pandemic started had higher GWG compared with those whose entire pregnancy occurred before the pandemic (adjusted β [SE], 0.51 [0.16] kg). GWG was lower in the pregnancies conceived after the pandemic started and the late pandemic (adjusted β [SE], 0.29 [0.12] kg vs 0.003 [0.14] kg; P = .003) but these participants began pregnancy at a slightly higher weight. Examining mean GWG month by month suggested a small decrease for March 2020, followed by increased mean GWG for the following year. Individuals with 2 pregnancies (1289 individuals) were less likely to gain weight above the recommended guidelines compared with their prepandemic pregnancy, but this association was attenuated after adjustment.

Conclusions and Relevance

In this cohort, individuals with critical time points of their pregnancy during the COVID-19 pandemic gained more weight compared with the previous year. The increased GWG leveled off as the pandemic progressed but individuals were slightly heavier beginning pregnancy.