1
|
Bekkar B, DeNicola N, Girma B, Potarazu S, Sheffield P. Pregnancy and newborn health - heat impacts and emerging solutions. Semin Perinatol 2023; 47:151837. [PMID: 37838485 DOI: 10.1016/j.semperi.2023.151837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Evidence is accumulating, both in the US and abroad, of the apparent serious health impacts of various environmental exposures tied to climate change. High ambient temperature, or heat, is a worsening global health risk. Heat risk is affected by many factors such as the magnitude, duration, and timing of exposure - such as specific, critical windows during pregnancy. This article focuses on the association of heat with both adverse pregnancy and newborn health outcomes. Regarding pregnancy, studies link heat and preterm birth, low birth weight and stillbirth. Multiple potential mechanisms support the biological plausibility of these associations. Emerging evidence suggests that heat, via epigenetics, may affect maternal health far beyond pregnancy. For newborn health impacts, heat is associated with increased hospitalization, neurologic and gastrointestinal dysfunction, and infant death. Research gaps include the need to study neonates separately from children and determining the mechanisms linking heat to adverse outcomes. We also highlight disparate adverse reproductive health outcomes for communities of color and low income tied to disproportionate exposures to environmental stressors like heat. Finally, we summarize educational and clinical tool resources for clinicians, information for patients, and opportunities for near-term action using the precautionary principle framework.
Collapse
Affiliation(s)
| | - Nathaniel DeNicola
- Department of Obstetrics and Gynecology, Johns Hopkins Health System, Washington, DC, USA
| | - Blean Girma
- University of Maryland-College Park, Maryland Institute for Applied Environmental Health, Center for Community Engagement, Environmental Justice, and Health, USA
| | - Savita Potarazu
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Perry Sheffield
- Departments of Environmental Medicine and Public Health and of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
2
|
Woodruff TJ, Charlesworth A, Zlatnik MG, Pandipati S, DeNicola N, Latif I. Code OB: We need urgent action on climate change and toxic chemicals. Int J Gynaecol Obstet 2023; 160:363-365. [PMID: 36649076 DOI: 10.1002/ijgo.14566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Tracey J Woodruff
- Program on Reproductive Health and the Environment, Environmental Research and Translation for Health (EaRTH) Center, University of California San Francisco, San Francisco, California, USA
| | - Annemarie Charlesworth
- Program on Reproductive Health and the Environment, Environmental Research and Translation for Health (EaRTH) Center, University of California San Francisco, San Francisco, California, USA
| | - Marya G Zlatnik
- Division of Maternal Fetal Medicine and Program in Reproductive Health & the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Santosh Pandipati
- Obstetrix Medical Group of California, APC, San Jose, California, USA
| | - Nathaniel DeNicola
- Department of Obstetrics and Gynecology, Johns Hopkins Health System, Washington, District of Columbia, USA
| | | |
Collapse
|
3
|
Giudice LC, Llamas-Clark EF, DeNicola N, Pandipati S, Zlatnik MG, Decena DCD, Woodruff TJ, Conry JA. Climate change, women's health, and the role of obstetricians and gynecologists in leadership. Int J Gynaecol Obstet 2021; 155:345-356. [PMID: 34694628 PMCID: PMC9298078 DOI: 10.1002/ijgo.13958] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/16/2021] [Accepted: 09/28/2021] [Indexed: 11/07/2022]
Abstract
Climate change is one of the major global health threats to the world's population. It is brought on by global warming due in large part to increasing levels of greenhouse gases resulting from human activity, including burning fossil fuels (carbon dioxide), animal husbandry (methane from manure), industry emissions (ozone, nitrogen oxides, sulfur dioxide), vehicle/factory exhaust, and chlorofluorocarbon aerosols that trap extra heat in the earth's atmosphere. Resulting extremes of weather give rise to wildfires, air pollution, changes in ecology, and floods. These in turn result in displacement of populations, family disruption, violence, and major impacts on water quality and availability, food security, public health and economic infrastructures, and limited abilities for civil society to maintain citizen safety. Climate change also has direct impacts on human health and well-being. Particularly vulnerable populations are affected, including women, pregnant women, children, the disabled, and the elderly, who comprise the majority of the poor globally. Additionally, the effects of climate change disproportionally affect disadvantaged communities, including low income and communities of color, and lower-income countries that are at highest risk of adverse impacts when disasters occur due to inequitable distribution of resources and their socioeconomic status. The climate crisis is tilting the risk balance unfavorably for women's sexual and reproductive health and rights as well as newborn and child health. Obstetrician/gynecologists have the unique opportunity to raise awareness, educate, and advocate for mitigation strategies to reverse climate change affecting our patients and their families. This article puts climate change in the context of women's reproductive health as a public health issue, a social justice issue, a human rights issue, an economic issue, a political issue, and a gender issue that needs our attention now for the health and well-being of this and future generations. FIGO joins a broad coalition of international researchers and the medical community in stating that the current climate crisis presents an imminent health risk to pregnant people, developing fetuses, and reproductive health, and recognizing that we need society-wide solutions, government policies, and global cooperation to address and reduce contributors, including fossil fuel production, to climate change.
Collapse
Affiliation(s)
- Linda C Giudice
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Erlidia F Llamas-Clark
- Department of Obstetrics and Gynecology, Division of Ultrasound, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Nathaniel DeNicola
- Department of Obstetrics and Gynecology, Johns Hopkins Health System, Washington, District of Columbia, USA
| | - Santosh Pandipati
- Obstetrix Medical Group/Mednax (Maternal-Fetal Medicine), Campbell, California, USA
| | - Marya G Zlatnik
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal Fetal Medicine, Program on Reproductive Health and the Environment, Environmental Research and Translation for Health (EaRTH) Center, University of California, San Francisco, San Francisco, California, USA
| | - Ditas Cristina D Decena
- Departments of Anatomy, Clinical Epidemiology and Public Health International, University of Santo Tomas, Manila, Philippines
| | - Tracey J Woodruff
- Program on Reproductive Health and the Environment, Environmental Research and Translation for Health (EaRTH) Center, University of California, San Francisco, San Francisco, California, USA
| | | | | |
Collapse
|
4
|
Abstract
The use of telehealth is gaining momentum in providing obstetric care. Telehealth through various platforms provides obstetricians and gynecologists and other providers of obstetric and postpartum care with the tools to better facilitate prenatal, intrapartum, and postpartum encounters. Telehealth helps facilitate consultation with specialists and subspecialists in maternal-fetal medicine in a team-based fashion to improve quality and safe obstetric practices in a fragmented obstetric care delivery system, especially in rural access communities. Telehealth can be beneficial especially in the postpartum period for breastfeeding and lactation assistance and for postpartum depression follow-up.
Collapse
Affiliation(s)
- Haywood L Brown
- Diversity, Department of Obstetrics and Gynecology, University of South Florida, 13101 Bruce B. Downs Drive, MDC- 3rd Floor, Tampa, FL 33612, USA.
| | - Nathaniel DeNicola
- Department of Obstetrics and Gynecology, The George Washington University, 2511 I Street Northwest, Washington, DC 20037, USA
| |
Collapse
|
5
|
Adebayo AL, Davidson Mhonde R, DeNicola N, Maibach E. The Effectiveness of Narrative Versus Didactic Information Formats on Pregnant Women's Knowledge, Risk Perception, Self-Efficacy, and Information Seeking Related to Climate Change Health Risks. Int J Environ Res Public Health 2020; 17:ijerph17196969. [PMID: 32977683 PMCID: PMC7579394 DOI: 10.3390/ijerph17196969] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/07/2020] [Accepted: 09/17/2020] [Indexed: 12/29/2022]
Abstract
Climate change is a global threat that poses significant risks to pregnant women and to their developing fetus and newborn. Educating pregnant women about the risks to their pregnancy may improve maternal and child health outcomes. Prior research suggests that presenting health information in narrative format can be more effective than a didactic format. Hence, the purpose of this study was to test the effectiveness of two brief educational interventions in a diverse group of pregnant women (n = 151). Specifically, using a post-test only randomized experiment, we compared the effectiveness of brief information presented in a narrative format versus a didactic format; both information formats were also compared to a no information control group. Outcome measures included pregnant women's actual and perceived knowledge, risk perception, affective assessment, self-efficacy, intention to take protective behaviors, and subsequent information seeking behavior. As hypothesized, for all outcome measures, the narrative format was more effective than the didactic format. These results suggest the benefits of a narrative approach (versus a didactic approach) to educating pregnant women about the maternal and child health threats posed by climate change. This study adds to a growing literature on the effectiveness of narrative-based approaches to health communication.
Collapse
Affiliation(s)
- Adebanke L. Adebayo
- Department at George Mason University, George Mason University, Fairfax, VA 22030, USA;
- Correspondence:
| | | | - Nathaniel DeNicola
- School of Medicine and Health Sciences, The George Washington University, Washington, DC 20052, USA;
| | - Edward Maibach
- Center for Climate Change Communication, George Mason University, Fairfax, VA 22030, USA;
| |
Collapse
|
6
|
|
7
|
Abstract
IMPORTANCE Knowledge of whether serious adverse pregnancy outcomes are associated with increasingly widespread effects of climate change in the US would be crucial for the obstetrical medical community and for women and families across the country. OBJECTIVE To investigate prenatal exposure to fine particulate matter (PM2.5), ozone, and heat, and the association of these factors with preterm birth, low birth weight, and stillbirth. EVIDENCE REVIEW This systematic review involved a comprehensive search for primary literature in Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, PubMed, ClinicalTrials.gov website, and MEDLINE. Qualifying primary research studies included human participants in US populations that were published in English between January 1, 2007, and April 30, 2019. Included articles analyzed the associations between air pollutants or heat and obstetrical outcomes. Comparative observational cohort studies and cross-sectional studies with comparators were included, without minimum sample size. Additional articles found through reference review were also considered. Articles analyzing other obstetrical outcomes, non-US populations, and reviews were excluded. Two reviewers independently determined study eligibility. The Arskey and O'Malley scoping review framework was used. Data extraction was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. FINDINGS Of the 1851 articles identified, 68 met the inclusion criteria. Overall, 32 798 152 births were analyzed, with a mean (SD) of 565 485 (783 278) births per study. A total of 57 studies (48 of 58 [84%] on air pollutants; 9 of 10 [90%] on heat) showed a significant association of air pollutant and heat exposure with birth outcomes. Positive associations were found across all US geographic regions. Exposure to PM2.5 or ozone was associated with increased risk of preterm birth in 19 of 24 studies (79%) and low birth weight in 25 of 29 studies (86%). The subpopulations at highest risk were persons with asthma and minority groups, especially black mothers. Accurate comparisons of risk were limited by differences in study design, exposure measurement, population demographics, and seasonality. CONCLUSIONS AND RELEVANCE This review suggests that increasingly common environmental exposures exacerbated by climate change are significantly associated with serious adverse pregnancy outcomes across the US.
Collapse
Affiliation(s)
- Bruce Bekkar
- Retired from Southern California Permanente Medical Group, San Diego
| | - Susan Pacheco
- The University of Texas McGovern Medical School, Houston
| | - Rupa Basu
- California Office of Environmental Health Hazard Assessment, Air and Climate Epidemiology Section, Oakland
- Department of Environmental Health Sciences, University of California Berkeley School of Public Health, Berkeley
| | - Nathaniel DeNicola
- George Washington University School of Medicine and Health Sciences, Washington, DC
| |
Collapse
|
8
|
Abstract
Our genetic makeup and environment interact. Evidence has emerged demonstrating preconception and prenatal exposure to toxic agents have a profound effect on reproductive health. We cannot change our genetics, but we can change our environment. Health providers can protect pregnancies from harmful exposures. Pregnancy is the most critical time-window for human development, when any toxic exposure can cause lasting damage to brain development. Reproductive care professionals can provide useful information to patients and refer patients to appropriate specialists when hazardous exposure is identified. Clinical experience and expertise in communicating risks of treatment are transferable to environmental health.
Collapse
Affiliation(s)
- Kelly McCue
- Obstetrics and Gynecology, The Permanente Medical Group, North Valley, 3rd Floor, 501 J Street, Sacramento, CA 95814, USA
| | - Nathaniel DeNicola
- The George Washington University, 2511 I Street Northwest, Washington, DC 20037, USA.
| |
Collapse
|
9
|
Bennett D, Bellinger DC, Birnbaum LS, Bradman A, Chen A, Cory-Slechta DA, Engel SM, Fallin MD, Halladay A, Hauser R, Hertz-Picciotto I, Kwiatkowski CF, Lanphear BP, Marquez E, Marty M, McPartland J, Newschaffer CJ, Payne-Sturges D, Patisaul HB, Perera FP, Ritz B, Sass J, Schantz SL, Webster TF, Whyatt RM, Woodruff TJ, Zoeller RT, Anderko L, Campbell C, Conry JA, DeNicola N, Gould RM, Hirtz D, Huffling K, Landrigan PJ, Lavin A, Miller M, Mitchell MA, Rubin L, Schettler T, Tran HL, Acosta A, Brody C, Miller E, Miller P, Swanson M, Witherspoon NO. Project TENDR: Targeting Environmental Neuro-Developmental Risks The TENDR Consensus Statement. Environ Health Perspect 2016; 124:A118-22. [PMID: 27479987 PMCID: PMC4937840 DOI: 10.1289/ehp358] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Summary: Children in America today are at an unacceptably high risk of developing neurodevelopmental disorders that affect the brain and nervous system including autism, attention deficit hyperactivity disorder, intellectual disabilities, and other learning and behavioral disabilities. These are complex disorders with multiple causes—genetic, social, and environmental. The contribution of toxic chemicals to these disorders can be prevented. Approach: Leading scientific and medical experts, along with children’s health advocates, came together in 2015 under the auspices of Project TENDR: Targeting Environmental Neuro-Developmental Risks to issue a call to action to reduce widespread exposures to chemicals that interfere with fetal and children’s brain development. Based on the available scientific evidence, the TENDR authors have identified prime examples of toxic chemicals and pollutants that increase children’s risks for neurodevelopmental disorders. These include chemicals that are used extensively in consumer products and that have become widespread in the environment. Some are chemicals to which children and pregnant women are regularly exposed, and they are detected in the bodies of virtually all Americans in national surveys conducted by the U.S. Centers for Disease Control and Prevention. The vast majority of chemicals in industrial and consumer products undergo almost no testing for developmental neurotoxicity or other health effects. Conclusion: Based on these findings, we assert that the current system in the United States for evaluating scientific evidence and making health-based decisions about environmental chemicals is fundamentally broken. To help reduce the unacceptably high prevalence of neurodevelopmental disorders in our children, we must eliminate or significantly reduce exposures to chemicals that contribute to these conditions. We must adopt a new framework for assessing chemicals that have the potential to disrupt brain development and prevent the use of those that may pose a risk. This consensus statement lays the foundation for developing recommendations to monitor, assess, and reduce exposures to neurotoxic chemicals. These measures are urgently needed if we are to protect healthy brain development so that current and future generations can reach their fullest potential.
Collapse
|
10
|
Di Renzo GC, Conry JA, Blake J, DeFrancesco MS, DeNicola N, Martin JN, McCue KA, Richmond D, Shah A, Sutton P, Woodruff TJ, van der Poel SZ, Giudice LC. International Federation of Gynecology and Obstetrics opinion on reproductive health impacts of exposure to toxic environmental chemicals. Int J Gynaecol Obstet 2015; 131:219-25. [PMID: 26433469 DOI: 10.1016/j.ijgo.2015.09.002] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Exposure to toxic environmental chemicals during pregnancy and breastfeeding is ubiquitous and is a threat to healthy human reproduction. There are tens of thousands of chemicals in global commerce, and even small exposures to toxic chemicals during pregnancy can trigger adverse health consequences. Exposure to toxic environmental chemicals and related health outcomes are inequitably distributed within and between countries; universally, the consequences of exposure are disproportionately borne by people with low incomes. Discrimination, other social factors, economic factors, and occupation impact risk of exposure and harm. Documented links between prenatal exposure to environmental chemicals and adverse health outcomes span the life course and include impacts on fertility and pregnancy, neurodevelopment, and cancer. The global health and economic burden related to toxic environmental chemicals is in excess of millions of deaths and billions of dollars every year. On the basis of accumulating robust evidence of exposures and adverse health impacts related to toxic environmental chemicals, the International Federation of Gynecology and Obstetrics (FIGO) joins other leading reproductive health professional societies in calling for timely action to prevent harm. FIGO recommends that reproductive and other health professionals advocate for policies to prevent exposure to toxic environmental chemicals, work to ensure a healthy food system for all, make environmental health part of health care, and champion environmental justice.
Collapse
Affiliation(s)
| | - Jeanne A Conry
- American College of Obstetricians and Gynecologists, Washington, DC, USA
| | - Jennifer Blake
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
| | - Mark S DeFrancesco
- American College of Obstetricians and Gynecologists, Washington, DC, USA
| | - Nathaniel DeNicola
- American College of Obstetricians and Gynecologists, Washington, DC, USA
| | - James N Martin
- American College of Obstetricians and Gynecologists, Washington, DC, USA
| | - Kelly A McCue
- American College of Obstetricians and Gynecologists, Washington, DC, USA
| | - David Richmond
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Abid Shah
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Patrice Sutton
- Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, CA, USA
| | - Tracey J Woodruff
- Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, CA, USA.
| | | | - Linda C Giudice
- American Society for Reproductive Medicine, Birmingham, AL, USA
| |
Collapse
|
11
|
Dola CP, Khan R, DeNicola N, Amirgholami M, Benjamin T, Bhuiyan A, Longo S. Combination antiretroviral therapy with protease inhibitors in HIV-infected pregnancy. J Perinat Med 2011; 40:51-5. [PMID: 22044007 DOI: 10.1515/jpm.2011.111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Accepted: 08/26/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the possible association between protease inhibitor (PI) and premature birth and low birth-weight in HIV-infected pregnancies. MATERIALS AND METHODS Data were collected retrospectively for maternal and pregnancy characteristics, antiretroviral medication, lowest CD4 count and highest viral load during pregnancy, and pregnancy outcomes. χ(2) Analysis, Student's t-test, and multiple logistic regression analysis were performed. RESULTS Data from 161 HIV-infected women who delivered singleton gestation were analyzed. Fifty-three received an antepartum regimen with PI, 84 received a regimen without PI, and six did not receive antepartum treatment. The mean estimated gestational age (EGA)± SD at delivery was 37.7 ± 3.2 weeks. The premature birth rate was 18.4%. No difference was detected between women receiving the antiretroviral regimen including PI and those on the regimen without PI or on no antepartum medication with regard to: EGA ± SD at delivery (37.7 ± 3.2 vs. 37.6 ± 3.1 weeks, respectively, P=0.87), rate of premature birth (14% vs. 20.6%, respectively, P=0.32) and low birth-weight (12.5% vs. 20.2%, respectively, P=0.25). In multiple logistic regression analysis, PI was not associated with premature birth or low birth-weight. CONCLUSION Women receiving antiretroviral therapy with PI have a similar rate of premature birth and low birth-weight as women receiving antiretroviral therapy without PI or on no medication.
Collapse
Affiliation(s)
- Chi P Dola
- Department of Obstetrics and Gynecology, Tulane Health Sciences Center, Tulane University School of Medicine, New Orleans, LA 70112, USA.
| | | | | | | | | | | | | |
Collapse
|
12
|
Dola C, Tran T, Duong C, Federico C, DeNicola N, Maupin R. Rapid HIV testing and obstetrical characteristics of women with unknown HIV serostatus at time of labor and delivery. J Natl Med Assoc 2011; 102:1158-64. [PMID: 21287896 DOI: 10.1016/s0027-9684(15)30770-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe the obstetrical characteristics of women without prenatal care and/or undocumented human immunodeficiency virus (HIV) serostatus who presented for delivery and to assess the usefulness of rapid HIV screening in these women. MATERIALS AND METHODS The study design was a retrospective analysis. Demographics, labor, delivery characteristics, and pregnancy outcomes of women without prenatal care and/or unknown HIV serostatus were reviewed. RESULTS Three hundred fifty parturients met the inclusion criteria: 15.2% presented at complete cervical dilation, 48.6% with cervical dilation of at least 5 cm, and 43.1% with ruptured membranes. Twenty-two percent of parturients delivered within 1 hour of admission, 47.6% delivered within 4 hours of admission, and 5.5% delivered prior to arrival to the hospital. With the lengthy admission process and procurement of zidovudine from the pharmacy requiring at least 1 hour at best, 27.5% would not have the benefit of intrapartum zidovudine treatment. Single Use Diagnostic System HIV-1 rapid test was reactive and confirmed in 7 women (2.5%). CONCLUSION Rapid HIV screening is a useful tool for guiding immediate obstetrical management and coordinated care for the neonate. In some circumstances, the full benefit of rapid HIV detection will not be realized due to advanced labor, ruptured members, or delivery prior to arrival.
Collapse
Affiliation(s)
- Chi Dola
- Tulane School of Medicine, Department of Obstetrics and Gynecology, SL-11, Section of Maternal-Fetal Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA.
| | | | | | | | | | | |
Collapse
|