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Abnormal labor outcomes as a function of maternal exposure to a catastrophic hurricane event during pregnancy

Abstract

Hurricane Andrew, which made landfall on August 24, 1992, was one of the most destructive hurricanes in American history, causing atypically high levels of psychological and physical health impairment among the resident population and especially among vulnerable groups. This article investigates whether maternal exposure to Hurricane Andrew during pregnancy increased the risk of dystocia (or dysfunctional labor) and infant delivery by cesarean section, the standard medical response to abnormal labor progression. We analyze 297,996 birth events in Miami-Dade and Broward counties in Florida from 1992 to 1993 using propensity score methodology with stratification and nearest-neighbor matching algorithms. Results show that hurricane-exposed pregnant women were significantly more likely to experience stress-induced abnormal labor and cesarean delivery outcomes as compared to statistically matched comparison groups. The conclusion details the policy implications of our results, with particular attention to the importance of maternal prenatal care in the aftermath of disasters.

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Notes

  1. 1.

    Although an emerging body of research shows links between psychosocial stress and negative pregnancy outcomes like preterm births, studies on stress-related problems related to labor at term are rare (Lowe 2007). Existing studies reveal associations between psychological measures of stress experienced by women, elevated plasma EPI, and dystocia (Lowe 2007; Crammond 1954; Zuspan et al. 1962; Kapp et al. 1963; Lederman et al. 1977; Lederman et al. 1978, 1979; Austin and Leader 2000; Alehagen et al. 2001).

  2. 2.

    Unlike Hurricane Katrina, which led to the temporary evacuation of over 1.5 million people and the permanent displacement of hundreds of thousands, Hurricane Andrew did not cause such large-scale displacement. The majority of persons rendered homeless by Hurricane Andrew relocated to the homes of family or friends, “tent cities,” hotels/motels, or other temporary shelters within Miami-Dade and Broward counties (Yelvington 1997).

  3. 3.

    Denote by U(i) the set of unexposed mothers matched to an exposed mother i with an estimated propensity score of p i . Nearest-neighbor matching sets \( U(i) = { \min }\left\| {p_{i} - p_{j} } \right\| \), allowing for multiple nearest neighbors.

  4. 4.

    Dysfunctional labor rates per 1,000 women for hurricane exposed and unexposed females are derived by: \( ((n_{1} \times {{\upmu}}_{1} + n_{2} \times {{\upmu}}_{2} + \ldots n_{n} \times {{\upmu}}_{n} )/(n_{1} + n_{2} + \ldots n_{n} ) ) \times 1,000 \), where n n is the number of observations per block and μ n is the proportion of females within each block experiencing dystocia. To derive the added number of dysfunctional labor cases attributable to maternal exposure to Hurricane Andrew we: \( ((n_{1} \times {{\upmu}}_{{{\text{c}}1}} + n_{2} \times {{\upmu}}_{{{\text{c}}2}} + \ldots n_{n} \times {{\upmu}}_{cn} )/(n_{1} + n_{2} + \ldots n_{n} )) - ((n_{1} \times {{\upmu}}_{{{\text{t}}1}} + n_{2} \times {{\upmu}}_{{{\text{t}}2}} + \ldots n_{n} \times {{\upmu}}_{tn} )/(n_{1} + n_{2} + \ldots n_{n} )) \), where n n is the number of hurricane exposed pregnant mothers per block and μ cn is the proportion of unexposed (or control) females and μ tn is the proportion of exposed (or treatment) females experiencing dystocia.

References

  1. Alehagen S, Wijma K, Lundberg U, Melin B, Wijma B (2001) Catecholamine and cortisol reaction to childbirth. Int J Behav Med 8:50–65

    Article  Google Scholar 

  2. Anderson DK, Rhees RW, Fleming DE (1985) Effects of prenatal stress on differentiation of the sexually dimorphic nucleus of the preoptic area (SDN-POA) of the rat brain. Brain Res 332:113–118

    Article  Google Scholar 

  3. Austin MP, Leader L (2000) Maternal stress and obstetric and infant outcomes: epidemiological findings and neuroendocrine mechanisms. Aust N Z J Obstet Gynaecol 40:331–337

    Article  Google Scholar 

  4. Barker DJ, Osmond C (1986) Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales. Lancet 1:1077–1081

    Article  Google Scholar 

  5. Bennett T (2005) Women’s health: after the fall. Women’s Health Issues 15:237–239

    Article  Google Scholar 

  6. Callaghan W, Rasmussen S, Jamieson D, Ventura S, Farr SL, Sutton PD, Mathews TJ, Hamilton BE, Shealy KR, Brantley D, Posner S (2007) Health concerns of women and infants in times of natural disasters: lessons learned from Hurricane Katrina. Matern Child Health 11:307–311

    Article  Google Scholar 

  7. Chrousos GP (1997) Stressors, stress and the neuroendocrine integration of the adaptive response: the 1997 Hans Selye Memorial Lecture. Ann N Y Acad Sci 1998(851):311–335

    Google Scholar 

  8. Crammond WA (1954) Psychological aspects of uterine dysfunction. Lancet 2:1241–1245

    Article  Google Scholar 

  9. Cutter SL, Boruff BJ, Shirley WL (2003) Social vulnerability to environmental hazards. Soc Sci Q 84:242–261

    Article  Google Scholar 

  10. Dehejia RH, Wahba S (2002) Propensity score-matching methods for nonexperimental causal studies. Rev Econ Stat 84:151–161

    Article  Google Scholar 

  11. Diego MA, Jones NA, Field T, Hernandez-Reif M, Schanberg S, Kuhn C, Gonzalez-Garcia A (2006) Maternal psychological distress, prenatal cortisol, and fetal weight. Psychosom Med 68:747–753

    Article  Google Scholar 

  12. Dole N, Savitz DA, Hertz-Picciotto I, Siega-Riz AM, McMahon MJ, Buekens P (2003) Maternal stress and preterm birth. Am J Epidemiol 157:14–24

    Article  Google Scholar 

  13. Enarson E, Morrow BH (1997) A gendered perspective: the voices of women. In: Peacock WG, Morrow BH, Gladwin H (eds) Hurricane Andrew: ethnicity, gender, and the sociology of disaster. Routledge, New York, pp 116–140

  14. Enarson E, Fothergill A, Peek L (2006) Gender and disaster: foundations and directions. In: Rodriguez H, Quarantelli EL, Dynes RR (eds) Handbook of disaster research. Springer, New York, pp 130–146

    Google Scholar 

  15. Fothergill A (1996) Gender, risk, and disaster. Int J Mass Emerg Disasters 14:33–56

    Google Scholar 

  16. Fothergill A (2004) Heads above water: gender, class, and family in the grand forks flood. State University of New York Press, Albany

    Google Scholar 

  17. Friedman EA (1955) Primipregnant labor; a graphicostatistical analysis. Obstet Gynecol 6:567–589

    Article  Google Scholar 

  18. Gifford DS, Morton SC, Fiske M, Keesey J, Keeler E, Kahn KL (2000) Lack of progress in labor as a reason for cesarean. Obstet Gynecol 95:589–595

    Article  Google Scholar 

  19. Girard C, Peacock WG (1997) Ethnicity and segregation: post-hurricane relocation. In: Peacock WG, Morrow BH, Gladwin H (eds) Hurricane Andrew: ethnicity, Gender, and the Sociology of Disaster. Routledge, New York, pp 191–205

    Google Scholar 

  20. Gluckman, PD, Hanson MA (2004) Maternal constraint of fetal growth and its consequences. Sem Fetal Neonatal Med 9:419–425

    Google Scholar 

  21. Gluckman PD, Hanson MA, Cooper C, Thornburg KL (2008) Effect of in utero and early-life conditions on adult health and disease. New Engl J Med 359:61–73

    Article  Google Scholar 

  22. Grenier GJ, Morrow BH (1997) Before the storm: the socio-political ecology of Miami. In: Peacock WG, Morrow BH, Gladwin H (eds) Hurricane Andrew: ethnicity, gender, and the sociology of disaster. Routledge, New York, pp 36–51

    Google Scholar 

  23. Ironson G, Wynings C, Schneiderman N, Baum A, Rodriguez M, Greenwood D, Benight C, Antoni M, LaPerriere A, Huang H, Kimas N, Fletcher M (1997) Posttraumatic stress symptoms, intrusive thoughts, loss, and immune function after Hurricane Andrew. Psychosom Med 59:128–141

    Google Scholar 

  24. Jones-DeWeever A (2008) Women in the wake of the storm: examining the post-Katrina realities of the women of New Orleans and the Gulf Coast. Institute for Women’s Policy Research (IWPR) report briefing, part three. IWPR, Washington, DC

  25. Kapp TT, Hornstein S, Graham VT (1963) Some psychologic factors in prolonged labor due to inefficient uterine action. Compr Psychiatry 4:9–18

    Article  Google Scholar 

  26. King S, Mancini-Marie A, Brunet A, Walker E, Meaney MJ, Laplante DP (2009) Prenatal maternal stress from a natural disaster predicts dermatoglyphic asymmetry in humans. Dev Psychopathol 21:343–353

    Article  Google Scholar 

  27. Kuzawa C, Sweet E (2009) Epigenetics and the embodiment of race: developmental origins of US racial disparities in cardiovascular health. Am J H Bio 21:2–15

    Article  Google Scholar 

  28. Laplante DP, Barr RG, Brunet A, Galbaud Du Fort G, Meaney ML, Saucier J, Zelazo PR, King S (2004) Stress during pregnancy affects general intellectual and language functioning in human toddlers. Pediatric Res 56:400–410

    Article  Google Scholar 

  29. Lederman RP, McCann DS, Work B, Huber MJ (1977) Endogenous plasma epinephrine and norepinephrine in last-trimester pregnancy and labor. Am J Obstet Gynecol 129:5–8

    Google Scholar 

  30. Lederman RP, Lederman E, Work BA, McCann DS (1978) The relationship of maternal anxiety, plasma catecholamines, and plasma cortisol to progress in labor. Am J Obstet Gynecol 132:495–500

    Google Scholar 

  31. Lederman RP, Lederman E, Work BA, McCann DS (1979) Relationship of psychological factors in pregnancy to progress in labor. Nurs Res 28:94–97

    Article  Google Scholar 

  32. Lewis PD (1993) Governor’s disaster planning and response review committee: final report, Florida. Diane Publishing Company, Darby

  33. Lowe NK (2007) A review of factors associated with dystocia and cesarean section in nulliparous women. J Midwifery Women’s Health 52:216–228

    Google Scholar 

  34. Maccari S, Darnaudery M, Morley-Fletcher S, Zuena AR, Cinque C, Van-Reeth O (2003) Prenatal stress and long-term consequences: implications of glucocorticoid hormones. Neurosci Biobehav 27:119–127

    Article  Google Scholar 

  35. McEwen BS (2001) From molecules to mind. Stress, individual differences, and the social environment. Ann NY Acad Sci 935:42–49

    Article  Google Scholar 

  36. Monga M, Sanborn BM (2004) Biology and physiology of the reproductive tract and control of myometrial contraction. In: Creasy RK, Resnik R (eds) Maternal-fetal medicine, 5th ed. Saunders, Philadelphia, pp 69–78

  37. Morishima HO, Yeh MN, James LS (1979) Reduced uterine blood flow and fetal hypoxemia with acute maternal stress: experimental observation in the pregnant baboon. Am J Obstet Gynecol 134(3):270–275

    Google Scholar 

  38. Morrow BH (1997) Stretching the bonds: the families of Andrew. In: Peacock WG, Morrow BH, Gladwin H (eds) Hurricane Andrew: ethnicity, gender, and the sociology of disaster. Routledge, New York, pp 141–170

    Google Scholar 

  39. Morrow BH, Enarson E (1996) Hurricane Andrew through Women’s eyes: issues and recommendations. Int J Mass Emerg Disasters 14(1):1–22

    Google Scholar 

  40. Mulder EJH, Robles de Medina PG, Huizink AC, Van den Bergh BRH, Buitelaar JK, Visser GHA (2002) Prenatal maternal stress: effects on pregnancy and the (unborn) child. Early Human Dev 70:3–14

    Article  Google Scholar 

  41. Neumann ID, Johnstone HA, Hatzinger M, Liebsch G, Shipston M, Russell JA, Landgraf R, Douglas AJ (1998) Attenuated neuroendocrine responses to emotional and physical stressors in pregnant rats involve adenohypophysial changes. J Physiol 508:289–300

    Article  Google Scholar 

  42. Norris FH, Perilla JL, Riad JK, Kaniasty K, Lavizzo EA (1999) Stability and change in stress, resources, and psychological distress following natural disaster: findings from Hurricane Andrew. Anxiety Stress Coping 12:363–396

    Article  Google Scholar 

  43. Norris FH, Friedman MJ, Watson PJ, Byrne CM, Diaz E, Kaniasty K (2002) 60,000 disaster victims speak: part I. An empirical review of the empirical literature, 1981–2001. Psychiatry 65:207–239

    Google Scholar 

  44. Oakes JM (2006) Commentary: advancing neighbourhood-effects research—selection, inferential support, and structural confounding. Int J Epidemiol 35:643–647

    Google Scholar 

  45. Omer H (1986) Possible psychophysiologic mechanisms in premature labor. Psychosomatics 27:580–584

    Article  Google Scholar 

  46. Paarlberg KM, Vingerhoats AJ, Passchier J, Dekker GA, Van Geijn HP (1995) Psychosocial factors and pregnancy outcome: a review with emphasis on methodological issues. J Psychosom Res 39(5):563–595

    Article  Google Scholar 

  47. Peacock WG, Morrow BH, Gladwin H (eds) (1997) Hurricane Andrew: ethnicity, gender, and the sociology of disaster. Routledge, New York

    Google Scholar 

  48. Pinto ML, Shetty PS (1995) Influence of exercise-induced maternal stress on fetal outcome in Wistar rats: inter-generational effects. Br J Nutr 73:645–653

    Article  Google Scholar 

  49. Quenby S, Pierce SJ, Brigham S, Wray S (2004) Dysfunctional labor and myometrial lactic acidosis. Obstet Gynecol 103:718–723

    Article  Google Scholar 

  50. Rhees RW, Fleming DE (1981) Effects of malnutrition, maternal stress, or ACTH injections during pregnancy on sexual behavior of male offspring. Physiol Behav 27:879–992

    Article  Google Scholar 

  51. Riad JK, Norris FH (1996) The influence of relocation on the environmental, social, and psychological stress experienced by disaster victims. Environ Behav 28(2):163–182

    Article  Google Scholar 

  52. Rondó PHC (2007) Maternal stress/distress and low birth weight, preterm birth and intrauterine growth restriction—A review. Curr Women’s Health Rev 3:13–29

    Article  Google Scholar 

  53. Rosenbaum PR (2002) Observational studies, 2nd edn. Springer, New York

    Google Scholar 

  54. Rosenbaum PR, Rubin DB (1983) The central role of the propensity score in observational studies for causal effects. Biometrika 41–55

  55. Rotton J, Dubitsky SS, Milov A, White SM, Clark MC (1996) Distress, elevated cortisol, cognitive deficits, and illness following a natural disaster. Environ Psychol 17(2):85–98

    Article  Google Scholar 

  56. Sjostrom K, Valentin L, Thelin T, Marsal K (1997) Maternal anxiety in late pregnancy and fetal hemodynamics. Eur J Obstet Gynecol Reprod Biol 74:149–155

    Article  Google Scholar 

  57. Teixeira JM, Fisk NM, Glover V (1999) Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study. Br Med J 318:153–157

    Article  Google Scholar 

  58. Tobin-Gurley J, Peek L, Loomis J (2010) Displaced single mothers in the aftermath of Hurricane Katrina: resource needs and resource acquisition. Int J Mass Emerg Disasters 28(2):170–206

    Google Scholar 

  59. Wadhwa PD, Dunkel-Schetter C, Chicz-De MA, Porto M, Sandman CA (1996) Prenatal psychosocial factors and the neuroendocrine axis in human pregnancy. Psychosom Med 58:432–446

    Google Scholar 

  60. Wadhwa PD, Sandman CA, Chicz-De MA, Porto M (1997) Placental CRH modulates maternal pituitary adrenal function in human pregnancy. Ann NY Acad Sci 814:276–281

    Article  Google Scholar 

  61. Weinstock M (1997) Does prenatal stress impair coping and regulation of the hypothalamic–pituitary–adrenal axis? Neurosci Biobehav 21:1–10

    Article  Google Scholar 

  62. Weinstock M (2001) Alterations induced by gestational stress in brain morphology and behaviour of the offspring. Prog Neurobiol 65:427–451

    Article  Google Scholar 

  63. Weinstock M (2002) Can the behavioral abnormalities induced by gestational stress in rats be prevented or reversed? Stress 5:167–176

    Article  Google Scholar 

  64. Weinstock M (2005) The potential influence of maternal stress hormones on developmental and mental health of the offspring. Brain Behav Immun 19:296–308

    Article  Google Scholar 

  65. Weinstock M, Fride E, Hertzberg R (1988) Prenatal stress effects on functional development of the offspring. Progr Brain Res 73:319–331

    Article  Google Scholar 

  66. Weinstock M, Matlina E, Maor GI, Rosen H, McEwen BS (1992) Prenatal stress selectively alters the reactivity of the hypothalamic–pituitary adrenal system in the female rat. Brain Res 595:195–200

    Article  Google Scholar 

  67. Williams MT, Hennessy MB, Davis HN (1995) CRF administered to pregnant rats alters offspring behavior and morphology. Pharmacol Biochem Behav 52:161–167

    Article  Google Scholar 

  68. Williams MT, Davis HN, McCrea AE, Long SJ, Hennessy MB (1999) Changes in the hormonal concentrations of pregnant rats and their fetuses following multiple exposures to a stressor during the third trimester. Neurotoxicol Teratol 21:403–414

    Article  Google Scholar 

  69. Yehuda R, Bierer LM (2008) Transgenerational transmission of cortisol and PTSD risk. Prog Brain Res 167:121–135

    Article  Google Scholar 

  70. Yelvington KA (1997) Coping in a temporary way: the tent cities. In: Peacock WG, Morrow BH, Gladwin H (eds) Hurricane Andrew: ethnicity, gender, and the sociology of disaster. Routledge, New York, pp 171–190

    Google Scholar 

  71. Zahran S, Brody SD, Peacock WG, Vedlitz A, Grover H (2008) Social vulnerability and the natural and built environment: a model of flood casualties in Texas. Disasters 32:537–560

    Article  Google Scholar 

  72. Zahran S, Snodgrass JG, Peek L, Weiler S (2010) Maternal hurricane exposure and fetal distress risk. Risk Anal 30:1590–1601

    Article  Google Scholar 

  73. Zuspan FP, Cibils LA, Pose A (1962) Myometrial and cardiovascular responses to alterations in plasma epinephrine and norepinephrine. Am J Obstet Gynecol 84:841–851

    Google Scholar 

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Correspondence to Sammy Zahran.

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Zahran, S., Peek, L., Snodgrass, J.G. et al. Abnormal labor outcomes as a function of maternal exposure to a catastrophic hurricane event during pregnancy. Nat Hazards 66, 61–76 (2013). https://doi.org/10.1007/s11069-011-0065-5

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Keywords

  • Dysfunctional labor
  • Cesarean section
  • Maternal exposure
  • Hurricane Andrew
  • Disaster
  • Gender
  • Vulnerability
  • Propensity scoring