Environmental influences on pregnancy outcomes after Hurricane Michael

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The natural world and human influences work together to create the devastation that follows a major disaster such as a hurricane. Although many studies have examined broad patterns of effects on pregnancy outcomes after disasters, the causes of adverse outcomes are not always clear, as there are interrelated environmental pollutant exposures, psychological stressors, and lack of health care. Without understanding which aspects of disaster exposure are the strongest contributors to adverse outcomes, it will not be possible to establish disaster responses that efficiently target the most important factors. The objective of this application is to examine effects of environmental (harmful algal bloom, carbon monoxide) exposures and generally encountered disaster exposures (power outages, storm damage) on pregnancy-related outcomes. Our central hypothesis is that severe exposure (defined by both magnitude and duration) to any of these stressors will be associated with worse outcomes. Our specific aims are to 1) Examine the relationship between environmental exposures (HAB and CO) and birth outcomes; 2) Assess the relationship between general disaster-related exposures (extent of damage, health care closings) and birth outcomes; 3) Determine which disaster- related exposures most strongly predict birth outcomes, and the combined effect of environmental and general disaster exposure; 4) Engage primary care practitioners to build EOH knowledge and skills by developing CME content on HAB and CO. We will accomplish these specific aims by comparing birth outcomes in areas exposed to these environmental predictors to areas and times that are unexposed. We will map exposure patterns based on ecological sampling and satellite-based estimates (HAB), CO surveillance data and poison control centers data, and hurricane damage reports (state of the art satellite measurements, disaster declarations, power outage data, health facility closing) and physical impacts measurements (storm surge inundation, wind speed, land cover change). Comparisons will be made across and within areas exposed to different levels of environmental contaminants, as well as pre-post hurricane. To promote translation and dissemination, we will develop CME content targeting the potential risks adverse pregnancy and birth outcomes associated with exposures to HAB and CO. At the end of the project, our expected outcome is to have identified the aspects of Hurricane Michael most associated with adverse birth outcomes. The proposed research represents a three-pronged innovative design- conceptually, by determining the potential cumulative risk of two integrated exposure domains - environmental contaminants and traditional disaster; methodologically, by using Synthetic Aperture Radar data to examine exposures to HAB during pregnancy in humans; and 3) translational, by utilizing time sensitive disaster-related environmental health findings for frontline CME.