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

项目摘要 美国妇产科学院认识到，气候变化是一个重大的 孕妇健康问题。怀孕是一个研究不足的关键窗口，很少有研究 研究了气候危机对孕妇及其胎儿的影响。重度孕产妇死亡 (SMM)目前是疾病预防和控制中心用来衡量 并监测产妇保健的改善情况;然而，该系统尚未用于气候变化方面。 SMM是分娩和分娩过程中出现的21种危及生命的疾病的综合体。这些 这种情况被称为“未遂”并发症（即，一个女人几乎死去的事件）， 严重的医疗负担，包括新诊断的慢性健康状况，心理压力 疾病，并扩大孕产妇死亡的风险。黑人女性遭受这些生活的可能性是女性的两倍- 威胁妊娠并发症，这种重要差异的环境原因主要是 未知的和探索不足的。 在确定解释气候和孕产妇健康的措施方面仍然存在一个重要的科学差距 不平等，特别是了解气候变化与怀孕风险之间的关系， 南方的黑人妇女。本项目将使用回顾性出生队列研究来探讨因果关系 上游社会和环境压力因素与气候相关的孕产妇发病率变化之间的关系。 我们的长期目标是制定患者和医疗保健干预措施，以减少气候变化的影响 孕期这项探索性研究的首要目标是研究气候敏感性 在SMM风险和促进种族不平等的社会环境驱动因素的理解， 产妇发病率。我们将通过以下两个具体目标来解决这一研究差距：目标1。审查 响应三种气候灾害的SMM率模式-极端高温，飓风和内陆洪水， a南方出生队列;目标2。描述个人和社区级别的社会（例如，贫穷， 居住隔离）和环境（例如，绿色空间）推动孕产妇健康的决定因素 气候变化中的差异。在这个项目完成后，我们的预期成果是：1）了解 SMM的发生率如何在不同的气候灾害中有所不同; 2）阐明联系 气候变化和孕产妇发病率。这项研究是有意义的，因为结果将扩大 除了识别疾病风险之外，还可以捕获保护因素，并帮助产生假设， 有助于因果推理的途径。这一贡献具有创新性，因为拟议成果将 提供新的知识和必要的第一步，以进一步了解气候的影响 产妇保健的变化，为今后研究产妇保健干预措施提供基础， 需要适应气候变化。

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.