Hurricane Harvey linked to adverse neonatal, maternal outcomes
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The landfall of Hurricane Harvey in Texas was followed by an increase in adverse neonatal and maternal outcomes at two Houston hospitals, according to research published in Obstetrics & Gynecology.
The category 3 hurricane, which made landfall on Aug. 25, 2017, brought 111 to 130 mph winds along the Texas coast and hovered over southeast Texas as a tropical storm for 1 week, according to Hector R. Mendez-Figueroa, MD, associate professor of obstetrics, gynecology and reproductive services in the McGovern School of Medicine at the University of Texas Health Sciences Center, and colleagues. It dumped more than 51 inches of rainfall in Houston and was considered a major natural weather disaster.
“The most important message that we feel comes out of our study is the fact that certain adverse effects from natural disasters may not be evident immediately after the storm,” Mendez-Figueroa told Infectious Diseases in Children. “This may be more apparent among vulnerable populations, such as pregnant women. Therefore, increased surveillance and follow-up may be required even months after the storm has passed.”
The researchers assessed data collected for a perinatal database maintained by two hospitals in Houston. They included all women delivering singleton infants after 24 weeks’ gestation without anomalies between August 2011 and June 2018.
To compare the effects of hurricane landfall on pregnancy outcomes, Mendez-Figueroa and colleagues split the group into those delivering within 280 days, or 40 weeks’ gestation, on or after Aug. 25, 2017, and those who delivered before Aug. 25, 2017.
The researchers defined composite maternal morbidity as hypertensive disorders of pregnancy, chorioamnionitis, endometritis, blood transfusion, peripartum hysterectomy, maternal critical care admission, pulmonary edema or maternal death. Infant morbidity was assessed as an Apgar score of three or less at 5 minutes, respiratory distress syndrome, ventilator use or continuous positive airway pressure, suspected newborn sepsis, seizure, stillbirth or neonatal death.
Approximately 29,000 births met the researchers’ inclusion criteria, and 13.2% of these births occurred within 280 days of the hurricane’s landfall. Women who gave birth after Hurricane Harvey were less likely to have obesity on average and tended to be older, white, married, report a household income of more than $75,000, have a high school education and have private insurance.
After the hurricane’s landfall, composite maternal morbidity rose by 27% compared with rates observed before the storm (11.5% vs. 14.7%; adjusted OR = 1.27; 95% CI, 1.14-1.42). The researchers identified a more significant increase in composite neonatal morbidity after the hurricane’s landfall, with a 50% increase observed for infants born after the storm’s landfall compared with those born before the hurricane (7.8% vs. 11.9%; aOR = 1.52; 95% CI, 1.34-1.71).
According to Mendez-Figueroa and colleagues, a significant shift in maternal morbidity occurred among women of low socioeconomic status in a time series analysis (estimate = 2.87; P = .028).
The researchers suggested that certain biological changes could have affected maternal and infant outcomes:
“Prenatal stress after natural disasters increases insulin excretion, which may lead to metabolic disorders in gravid patients. The transcriptional regulation of the placental glucocorticoid system appears to be downregulated among women affected by prenatal stress after a major flood with associated decreased fetal protection. Cortisol, a hormone known to be involved in parturition, may also be affected. Evening levels of salivary cortisol levels decrease among survivors with high depression after natural disasters.”
However, they suspect that stress is not the only contributing factor. They said exposure to environmental and chemical pollutants may contribute to these effects.
Mendez-Figueroa said resources should focus on the care of pregnant women, who may be at increased risk for adverse effects of natural disasters.
“It is our sincere hope that this study may provide other colleagues and health care professionals with the initial data that are necessary for efforts aimed at prioritizing resources to susceptible individuals (including of lower economic strata) during an emergency,” the researchers wrote. – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
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