Climate Change Impacts on Maternal Health in a Southern Birth Cohort: A Causal Analysis

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PROJECT SUMMARY The American College of Obstetricians and Gynecologists recognizes that climate change is a significant health concern for pregnant women. Pregnancy is an understudied critical window, and few studies have examined the impact of the climate crisis on pregnant women and their unborn. Severe Maternal Morbidity (SMM) is currently a surveillance indicator used by the Centers for Disease Prevention and Control to measure and monitor improvements in maternal health; however, it has yet to be used in the context of climate change. SMM is a composite of 21 life-threatening conditions that arise during the process of labor and delivery. These conditions are known as “near miss” complications (i.e., an event in which a woman nearly dies) that result in significant medical care burden, including newly diagnosed chronic health conditions, psychological stress disorders, and amplified risks of maternal deaths. Black women are 2 times more likely to suffer from these life- threatening pregnancy complications, and the environmental causes of this important disparity are largely unknown and underexplored. An important science gap remains in identifying measures that elucidate climate and maternal health inequities, particularly for understanding the relationship between climate change and pregnancy risks among Black women in the South. This project will use a retrospective birth cohort to explore the causal linkages between the upstream social and environmental stressors and climate-related changes in maternal morbidity. Our long-term goal is to develop patient and healthcare interventions to reduce the impact of climate change during pregnancy. The overarching objectives of this exploratory study is to examine climate-sensitivity in SMM risk and advance understanding of the social-environmental drivers of racial inequalities in maternal morbidity. We will address this research gap with the following two specific aims: Aim 1. Examine patterns in SMM rates in response to three climate hazards--extreme heat, hurricanes, and inland flooding for a Southern birth cohort; Aim 2. Characterize the individual and neighborhood-level social (e.g., poverty, residential segregation) and environmental (e.g., greenspace) determinants that drive maternal health disparities in a changing climate. At the completion of this project, our expected outcomes are to 1) understand how the rate of SMM differs across different climate hazards and 2) elucidate the causal pathways linking climate change and maternal morbidity. The proposed research is significant because results will extend beyond identifying disease risks to capturing protective factors, as well as aid in hypothesis generation around pathways that contribute towards causal inference. This contribution is innovative since proposed results will provide new knowledge and a necessary first step in furthering understanding of the impacts of climate change on maternal health, providing the foundation for future studies on maternal health interventions and needed adaptations to climate change.