Disasters potentially influence a range of reproductive outcomes (93
). Even in the absence of a direct exposure to the disaster, surrounding circumstances may lead to an increased risk of adverse pregnancy outcomes – for instance, more unplanned pregnancies and sexually transmitted infections (62
). Some studies have indicated that pregnant women with PTSD are at increased risk of adverse birth outcomes (96
), as well as being more likely to smoke, use alcohol and other drugs, and receive inadequate prenatal care (97
However, the literature on disasters indicates limited effect on birth outcomes. Disaster, in and of itself, does not seem to shorten gestation or cause preterm birth. Several large studies of terrorist attacks, hurricanes, and chemical disasters support this conclusion (40
). In fact, more studies have found a reduction in risk (after 9/11 (35
) and hurricanes (34
)) than have found an increase in risk (after earthquakes (37
) and floods (86
)). Although gestational age is measured less well than birthweight (99
), the consistency of the results and lack of associations with very preterm birth (which is more consistently measured) implies a true lack of effect. Negative effects on fetal growth and birthweight have been seen more consistently, after terrorist attacks and bombings (35
), environmental disaster (65
), and natural disasters (36
), though counter-examples can be found (34
). It should be noted that many studies have looked at multiple indicators of fetal growth (birth weight, low birth weight, very low birth weight, small for gestational age, birth length, and/or head circumference), and found an association with only one (35
). The growth indicators variously reported to be associated with disaster exposure have not been consistent, nor has a consistent risk period during the pregnancy been identified.
The effects of disaster on congenital anomalies are likely to vary by type of disaster, with disasters that have a strong environmental (e.g., Chernobyl (22
)) or nutritional component (e.g., Hurricane Gilbert in Jamaica (79
)) more likely to yield increased risk. An increase in spontaneous abortion has been reported after floods (85
), but the published studies are small and thus difficult to interpret. Gaps in the literature include the absence of detailed studies of spontaneous abortion, as well as other complications of pregnancy such as pre-eclampsia. Most studies have not found major effects of low-level disaster-related environmental exposure (22
), but the effects of environmental exposures will vary by disaster and it may be difficult to extrapolate from the existing studies to future disasters.
With respect to mental health, women are generally more vulnerable to post-disaster psychopathology than men (11
), and some evidence indicates that mothers are more vulnerable than other women (14
). However, the factors that predict poor mental health are similar for pregnant and other women, particularly the severity of the disaster exposure (e.g., (73
)). The evidence so far indicates that pregnancy does not render a woman at particularly high risk (73
), but studies designed specifically to address this question have not been performed. Current studies also indicate a possible relationship between disaster-related prenatal stress (as measured during the ice storm studies (5
)) and child development, but indicate that maternal mental health after a disaster is more influential on child development than the disaster itself (68
). Future studies should examine this issue in larger-scale studies with sufficient sample size, and determine the relevance of the small effects seen in the existing studies.
Another gap in the literature involves the location and type of disaster assessed. The majority of published studies were conducted in the United States; few were conducted in developing countries. Further research on the effects of disaster in developing countries would be appropriate. A large number of studies have addressed the 9/11 disaster; several have addressed natural disasters; and fewer have addressed other technological disasters. We did not find any studies that addressed wildfires, tornadoes, plane crashes, or most chemical disasters. However, since a variety of natural and technological disasters have been studied, the research performed is likely to be applicable to these other situations. The exception would be research on the effects of specific chemical exposures.
In conclusion, the research so far indicates that the major concerns for pregnant women exposed to disaster relate to decreased fetal growth and maternal mental health problems, especially in the most directly exposed women. Clinicians treating pregnant women under these conditions should be especially sensitive to these issues, and researchers should attempt to address the gaps in our knowledge.