Impact of prenatal exposure to climate stressors and severe maternal morbidity: a retrospective birth cohort study

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PROJECT SUMMARY The climate crisis, in combination with other social and environmental stressors, negatively influences human health; its impact varies across age groups and life stages. Pregnancy is an understudied critical window of susceptibility. Few studies have focused on the impact of prenatal exposure to climate stressors on pregnant populations and infants in the Southeastern US, despite pronounced trends in climate warming, an escalating maternal death rate, and persistent maternal and infant health disparities in the region. An important science gap remains in identifying national climate change and health surveillance indicators, particularly for understanding the relationship between climate change and pregnancy risks. Our long-term goal is to develop clinic-based and public health interventions to reduce the adverse impact of climate change during pregnancy. The overarching goal of this population-based study is to examine extreme temperature-sensitivities in maternal and infant health risk during critical windows of pregnancy and advance understanding of the social-environmental drivers of health disparities in a changing climate. We will achieve the following two specific aims: Aim 1. Characterize the relationship between exposure to cold and hot ambient temperature extremes and adverse maternal and infant health outcomes during critical periods of pregnancy; Aim 2. Examine the joint effects of prenatal exposure to temperature extremes and socio-environmental stressors on excess maternal and infant health risks. The new NIH Climate Change and Health Strategic Initiative has prioritized protecting the health of pregnant populations in the face of extreme temperatures. This low-cost retrospective birth cohort study will advance understanding on how social and environmental conditions that occur during pregnancy interact with climate change stressors to negatively affect the health of pregnant populations and their infants. Our expected outcomes will include: 1) the quantification of prenatal exposure to climate change as a risk multiplier during pregnancy; and 2) the identification of maternal and infant surveillance indicators for tracking the health effects of climate change. The proposed research is innovative because results will 1) show how climate and social stressors interact to exacerbate climate-health risks during pregnancy, and 2) aid in hypothesis generation on the pathways that contribute to climate resilience and the reduction of maternal and infant health risks. This work has significant potential to be transformative to the field through the identification of maternal or infant health outcomes as potential surveillance health indicators of climate change impacts, which can be leveraged to measure local and state-level health interventions and policy changes in the United States. Results will address a well-cited research need from the NIH Strategic Climate & Health Initiative on the timing of exposure to climate stressors and associated maternal and infant complications and the critical windows of susceptibility during the prenatal period.