An environmental health investigation published Thursday in the Journal of the American Medical Association (JAMA) finds compelling evidence that links global climate change to negative pregnancy outcomes across the country.
The review analyzed 68 U.S. studies dating back to 2007 – which included over 32 million births.
84 percent of the births showed a statistically significant association between increased air pollution and heat exposure (related to climate change) and serious risks for pregnancy – specifically preterm birth, low birth weight, and stillbirth.
“We spend so much time trying to reduce complications in obstetrics and improve outcomes, that to me this is a landmark study,” said Dr. Jeanne Conry, MD, PhD, past president of the American College of Obstetricians and Gynecologists (ACOG), current CEO/founder of the Environmental Health Leadership Foundation, and president-elect of the International Federation of Gynecology and Obstetrics.
“[The investigation shows] that there is a clear association of prenatal exposure of air pollutants and health outcomes – children’s health outcomes…Here, we’re saying, the air we breathe affects deliveries,” said Conry, who was not an author of this new research.
Preterm birth and low birth weight can also increase a child’s risk for future health and developmental problems.
“The more you dig, you could really say there’s a whole generation of children being born like ‘pre-polluted,’” said Dr. Nathaniel DeNicola, MD, MSHP, the senior author of the study, an obstetrician/gynecologist, and Environmental Health Expert for ACOG.
“[As OB-GYNs] we have an obligation to look at where our field can have an impact.”
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Both Conry and DeNicola stress the importance of recognizing that one of the greatest consequences of climate change is its association with human health.
“Who’s the image of climate change? For a while it’s been the polar bear – the polar bear on a floating iceberg. More recently, it’s kind of become the super-storm – and maybe the TV journalists blowing in the wind in those super-storms,” DeNicola said.
“[But] really the image of climate change and its effects should be human health – kids and pregnant women being affected right now.”
The lead author of the study, Dr. Bruce Bekkar, MD, a retired obstetrician and current full-time climate activist, agrees. He also describes why their research in this particular study focused exclusively on the U.S.:
“We purposely excluded papers that had any sort of population in them that were other than US domestic, because we want people to understand the impact of this story,” he said. “It may well be worse in other places, but you can’t step away from the findings of our story and say, ‘It’s happening somewhere else.’ It’s literally all around us all over the country right now.”
The subpopulations found in the investigation to have highest risk included minority groups, especially Black mothers, and well as individuals with asthma.
Conry explains how under-served women who do outdoor labor, or live in a “desert in the cities,” for example, are strongly impacted.
“Black and Hispanic women who are working in the farms or in the fields…they’ve got heat and air pollution, so they’re particularly vulnerable,” she said.
As environments and living conditions across the world, and even the country, vary, the importance of education is stressed.
”We hope [women and families] realize that this is a risk factor for them that they need to engage with,” said Bekkar. “And that means asking their [health care providers] ways specifically that they can address it, because these effects vary so widely in terms of time of year, and location geographically.”
ACOG finds climate change to be an urgent concern to women’s health, as well as a major public health challenge worldwide – something the organization reaffirmed in April 2018.
“Climate change has a disproportionate effect on global women’s health, as it broadens existing gender-based health disparities,” ACOG wrote in a position statement.
“We ask that government and public health agencies take steps to ensure the protection of women’s health services and human rights.”
And although Conry feels that even more research could be done, she stresses that that doesn’t need to halt change.
“We don’t have to wait for all the research to take place to be able to take a strong stance on climate change, on air pollution, on the quality of life,” she said. “I think that’s what ACOG stands for – we’re saying, prioritize health and the environment, and we call for reproductive and environmental justice.”
In terms of policy, Conry urges the U.S. to re-join, and be a leader, of the Paris Climate Agreement. She also suggests that more regulations may be necessary – whether that be changing air standards, or improving working conditions.
“Global health should be a guiding light,” said Conry, “so when we say that we’ve got a crisis, we need to address it as the global emergency it is.”
Bekkar, DeNicola and Conry explain the need for all parties – the medical community, policymakers, and families themselves across the country – to learn more and act, in order to help combat these serious consequences.
“We spend, as obstetricians, so much time counseling pregnant women about all these precautions,” said DeNicola. “But there’s only so much [pregnant women] can do, they realistically cannot control the temperature outside or the air pollution that they encounter, and so, beyond the individual actions…the real solutions are system solutions, and primarily those are controlled by policymakers.”
Both DeNicola and Bekkar also believe that they can already see some change, but it’s an ongoing process.
“I think it’s a time, right now, in society where we’re being reminded that we’re not just independent, we’re all connected…all of those sort of micro-decisions make a significant impact on the exposures that people face,” said Bekkar. “All of these exposures are at the hands of elected officials, so, come November, no one should vote for anybody that doesn’t stand up against the climate crisis and want to do something about it right now.”
“As we’ve so vividly been shown around the world in the past couple of months, when you stop burning fossil fuels so much, when traffic drops off and airplanes fly less and things like that – nature rebounds…and that has a direct impact on people’s health.”