Protecting Pregnant People and Babies from the Health Effects of Climate Change

Reports from meteorologists suggest that the 2022 fire season could be one of the worst ever. Wildfires are increasing in frequency and intensity because of climate change1; severe drought, increasing temperatures, and strong winds have led to more widespread, hotter, and faster-burning wildfires in parts of the United States. Wildfires can also further accelerate climate change, owing to the resulting greenhouse-gas emissions and forest loss.1

As is the case for other consequences of climate change — including more intense hurricanes, extreme heat, and deteriorating water quality — pregnant people and newborns are particularly vulnerable to the health harms associated with wildfires.2 Wildfire smoke results in exposure to toxic gases, volatile organic compounds, and particulate matter; in pregnant people, these exposures have been associated with an increased risk of gestational hypertension and gestational diabetes,3 conditions that can carry long-term health risks for the mother. Exposure to wildfire smoke or its components has been associated with an increased risk of preterm birth and low birth weight,1 outcomes that can similarly have lifelong health effects. Displacement of communities by wildfires can disrupt access to health care, including prenatal and newborn care, as well as access to social support and other services, which can adversely affect the health of pregnant and postpartum people and newborns.2 These consequences are disproportionately borne by marginalized populations, and they can have long-term, intergenerational effects, if newborns who are harmed by wildfires go on to have poor health as parents.4

Failure to combat climate change poses a major health threat to the entire population. We believe addressing the underlying problem by reducing greenhouse-gas emissions and strengthening carbon sinks should be a global priority. Special consideration must be given to protecting pregnant people and newborns, in light of their increased vulnerability to climate-change–related harm. More research is needed on interventions that could alleviate the effects of climate change on these groups, but we believe actions to reduce these effects should be initiated now. For the past 25 years, our work has focused on emerging infectious diseases, and we have highlighted the need for special considerations for preparedness and response focused on pregnant people and newborns. We believe lessons learned from that work could be applied to efforts to mitigate the effects of climate change on these populations.

First, preparedness and response planning to combat the effects of climate change, including planning specifically focused on pregnant people and newborns, should be a priority for public health agencies and health systems. As part of investments in pandemic influenza preparedness in the 2000s, public health leaders emphasized efforts specific to vulnerable populations, including pregnant people. In April 2008, the Centers for Disease Control and Prevention (CDC) held a meeting of infectious disease, public health, obstetrics, and newborn-care experts and key partners to discuss special pandemic-related considerations for pregnant people, identify gaps in knowledge, and develop a public health approach that could be pursued in the event of a pandemic. Issues including prophylaxis and treatment, vaccine use, nonpharmaceutical interventions and health care–system planning for prenatal and obstetric care, and communications were discussed.5 The plans that resulted from this meeting facilitated the response to the 2009 H1N1 influenza pandemic.

For example, prepandemic discussions about the benefits and risks associated with using antiviral medications in pregnant people with influenza led to a CDC recommendation that all pregnant people with known or suspected H1N1 influenza be treated with oseltamivir, a treatment approach that was later shown to have significantly reduced ICU admissions and deaths. In addition, this planning process brought together a broad range of experts and partners, many of whom continued to collaborate during later responses to emerging infectious diseases, such as the Ebola, Zika, and SARS-CoV-2 viruses.

Because the effects of climate change are increasing in frequency and intensity, we believe plans specific to the needs of pregnant people should be developed now; such plans could include recommendations for patient-level, health-system–level, and community-level interventions to mitigate these effects. As an example of an intervention that could have an immediate influence, ensuring that all pregnant patients — particularly those living in areas at high risk for extreme weather events — have access to their electronic medical records could support the transfer of prenatal care to a new location in the event of disruption.

It will also be necessary to develop better ways of monitoring the effects of climate-change–associated events on pregnant people and newborns. Flexible surveillance systems could be put in place in advance and then rapidly adapted to collect relevant data. For example, after delays in the implementation of research findings related to 2009 H1N1 influenza were recognized, researchers in the United Kingdom developed and “hibernated” several surveillance systems for emerging infectious diseases, including one system focused on pregnancy, with plans to use them in a future pandemic. This program was activated early in the Covid-19 pandemic and provided timely data on the effects of Covid-19 during pregnancy.5

The types of data-collection challenges that were seen after Hurricane Katrina, when affected people were scattered throughout the United States, also need to be addressed. A system that uses mobile-phone technology, similar to v-safe (the CDC’s surveillance system for monitoring Covid-19 vaccine safety), could be used to collect information on pregnancy complications and problems during the newborn period among evacuees from areas affected by a severe weather event. Surveillance systems are also needed to identify pregnant people who are at especially high risk of harm, such as those living in low-income communities and members of racial or ethnic groups that tend to be disproportionately affected by climate-change–related events; interventions can then be tailored to the people at highest risk. Strategies for reducing harm to pregnant people from these events should be monitored for effectiveness.

Finally, it’s essential that experts in maternal and child health begin working with climate scientists to address the effects of climate change. In recent years, in response to the 2009 H1N1 influenza pandemic and the Zika virus outbreak, the American College of Obstetricians and Gynecologists (ACOG) created a work group (the Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group) focused on reducing morbidity and mortality from vaccine-preventable diseases. ACOG also maintains a related website (http://www.immunizationforwomen.org) with up-to-date information for Ob/Gyns and works closely with the CDC’s Advisory Committee on Immunization Practices to provide input on vaccine recommendations for pregnant people. These collaborative efforts facilitated the development and dissemination of recommendations related to Covid-19 diagnosis, treatment, and vaccination during pregnancy. Obstetric care providers will also need to be educated about climate change’s effects on the health of their patients. Adding this content to medical school curricula, Ob/Gyn residency training, and maintenance-of-certification activities will help clinicians become more proficient in counseling patients about how to reduce their climate-change–associated risks and in advocating for addressing climate change and its health harms.

Climate change is a major public health threat. National and global leaders need to urgently work together to limit the fossil-fuel emissions that drive it. The effects of climate change are already threatening human health, however, and pregnant people and newborns are at especially high risk for related harm. Building on experience in preparing for and responding to emerging infectious diseases will be important to help minimize adverse effects in these and other vulnerable populations. The health of future generations depends on our actions today.