By Vishwadha Chander

(Reuters Health) – Pregnant women and their newborns may be among the worst hit after a hurricane.

A Texas study of women who delivered after Hurricane Harvey showed they had more complications than women who delivered in the years and months before the storm.

High blood pressure, cesarean sections, and infection during labor were all more common in women who gave birth after the hurricane, researchers report in Obstetrics and Gynecology.

“Natural disasters can truly have deleterious effects, especially on vulnerable populations, that may not be evident until weeks or months later,” lead author Dr. Hector Mendez-Figueroa told Reuters Health in an email.

Hurricane Harvey made landfall along the Texas coast on August 25, 2017, displacing 30,000 people and damaging thousands of homes.

Mendez-Figueroa and colleagues studied 29,179 women with singleton pregnancies. Most gave birth during the six years before the storm hit, but 3,842 women delivered within 280 days (40 weeks) after Hurricane Harvey made landfall, meaning they’d been “exposed” to the hurricane while pregnant.

“We collected our data during pregnancy and did not rely on interviews sent to patients months or years after the disaster, lowering recall bias,” said Mendez-Figueroa, who was at Baylor College of Medicine during the research project and is now at McGovern Medical School, UTHealth.

Compared to women who delivered before the hurricane, those who gave birth afterward were generally older, Caucasian, married, and had better insurance — all “favorable baseline maternal characteristics”, the authors note.

But storm-exposed women also had higher rates of hypertensive disorders of pregnancy (7.4%, versus 4.4% in unexposed women) and higher rates of infection during labor (31.6% versus 24.6%).

Babies born after the storm were also more likely to have problems. Overall, the rate of any kind of medical issue was 11.9% in newborns of mothers who’d been pregnant during the hurricane, compared to 7.8% in babies born before the storm.

Not all socioeconomic groups were affected equally. Maternal morbidity saw a “significant increase after Harvey only among low socioeconomic women”, said Mendez-Figueroa.

This could be stress-related, said Janet Currie, the Henry Putnam Professor of Economics and Public Affairs at Princeton University and co-director of Princeton’s Center for Health and Wellbeing.

“Many lost their homes, vehicles, and in some cases their jobs,” Currie, who was not involved in the study, told Reuters Health by email. “People with greater resources could be confident of being able to rebuild. Poorer people are likely to have had a more stressful experience struggling to cope with the aftermath.”

The authors say they can’t “truly assess” what increased the risk for pregnant women, but biological changes may play a role. For instance, stress after a natural disaster increases insulin excretion that could cause metabolic disorders. Stress also affects the placenta, reducing protection for the fetus. Chemical and environmental pollutants in the air, water and soil following a hurricane could also contribute.

To reduce their exposure, pregnant women in regions prone to hurricanes could be temporarily evacuated, Shao Lin of the University at Albany, State University of New York, told Reuters Health by email.

“To reduce psychological stress related to property damage, providing social support may help,” said Lin, who was not part of the study but has studied natural disasters.

Currie said the study adds to growing knowledge about effects of natural disasters on pregnant women and newborns and suggests first responders be aware of pregnant women’s increased risk.

One limitation of the study is that it involved women who gave birth at only two medical centers, Currie pointed out.

Lin agrees, adding, “The authors said the respondents being from two hospitals with ethnic and racial diversity was a strength, but how well they represent the general population remains unclear.”

Still, said Mendez-Figueroa, the findings could help in policy-making and planning for natural disasters.

“Surveillance among these groups should continue,” he said. “We cannot assume that after the initial damage, adverse effects may be forgotten.”

SOURCE: http://bit.ly/2ompxd2 Obstetrics & Gynecology, October 10, 2019.