Environmental exposures and prenatal stress related to Hurricane Maria among pregnant women in Puerto Rico: Characterization and impact on birth outcomes

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PROJECT SUMMARY / ABSTRACT Hurricane Maria was the most powerful hurricane to hit Puerto Rico in over 80 years, and recovery and clean-up has been painfully slow. Two months after Maria, 60% of the island is still without electricity and many Puerto Ricans are still struggling to find adequate housing, clean water, and food. Prior to Maria, environmental contamination in Puerto Rico was already extensive, and flooding and damage caused by Maria likely exacerbated these conditions. This has potentially resulted in considerable exposure to a range of hazardous substances for many Puerto Ricans. The extended recovery period has also likely increased exposures to environmental contaminants due to extensive use of gas powered generators, use of water from uncertain sources for drinking, cooking, and washing, and increased consumption of canned and packaged foods, all with potential impacts on health. Experiencing a traumatic natural disaster can itself also have long-term physical and psychological health effects. Exposure to such events during pregnancy has been associated with increased risk of preterm birth, low birth weight, and other adverse birth outcomes. However, no previous studies have evaluated measures of both chemical exposure and stress both before and after the hurricane in the same population, so identification of specific, modifiable, hurricane-related risk factors for adverse birth outcomes has not been possible. The proposed research will leverage an ongoing longitudinal birth cohort, the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT), in which 93 participants were pregnant when Hurricane Maria made landfall. The goals of this research are to 1) assess hurricane-related exposure to a range of contaminants (metals, polycyclic aromatic hydrocarbons (PAHs), phthalates, phenols, parabens), and psychological stress, among PROTECT participants who were pregnant when Hurricane Maria struck the island, 2) identify sources of hurricane-related exposures and stress, and 3) evaluate the effects of these exposures on birth outcomes, such as preterm birth, gestational age, and birth weight. Existing biological samples and prenatal data, including urinary biomarkers of exposure and questionnaires on maternal stress and depression, will be utilized in the proposed work. In addition, post-hurricane urine samples, stress questionnaires, and an additional questionnaire on hurricane-related experiences will be collected. Prior to Hurricane Maria, Puerto Rico’s preterm birth rate was already among the highest within the U.S. and the world, so identifying individuals in need of help, as well as modifiable risk factors within this highly vulnerable population in a timely manner is critical.