Case challenge: pregnancy & climate change
Module: health threats
Chapter: Heat Waves
Questions to think about before scrolling:
What are the risks of climate change for expectant mothers and their babies?
What are steps that expectant mothers could take to stay safe during their pregnancy?
What are some steps that people can take to reduce climate change?
The Patient:
You are a 3rd-year medical student on your family practice rotation in Abbotsford. You are asked to assess Therma Terr, a 27-year-old female at 20 weeks gestation.
When you are introduced to Therma, she looks flushed and is wiping sweat off her brow. She states that the weather has been incredibly warm over the past month, and the two of you reflect on the fact that in the last few years, summer heat seems to start earlier in the year and lasts for longer periods.
“I’ve lived in Abbotsford my whole life, and have noticed the weather getting warmer over the years, and frankly I’m worried – can climate change affect me or my baby?”
You assure her that most women have healthy pregnancies and deliveries, despite our changing climate. However, climate change can increase health risks for women and their babies. She asks what these risks are:
What are the risks of climate change for expectant mothers and their babies?
Firstly, longer and hotter heat waves can lead to dehydration in pregnant women and can put them at risk of kidney failure. Pregnant women are physiologically less tolerant to extreme heat, as their ability to thermoregulate is less effective. [1] Dehydration early in pregnancy can affect the baby’s growth, and later in pregnancy this can lead to preterm birth. [2,3]
Secondly, climate change impacts air quality. Warmer temperatures result in more ground level ozone formation which can cause respiratory illness in pregnant women, and also lead to low birth weight, or pre-term birth. Air pollution for example near busy roads or from wildfire smoke may increase the risk of the baby having low birth weight, which can be associated with future health issues. [2,3]
A systematic review in 2020 that examined over 32 million births in the USA found a significant association between heat, ozone, and fine particulate matter with adverse pregnancy outcomes, such as preterm birth, low birth weight, and stillbirth. [4]
Thirdly, increased extreme weather events such as floods, hurricanes, or wildfires can lead to poor nutrition, negative mental health impacts, and reduced access to healthcare. Floods can increase exposure to toxins and molds. [2,3]
don’t forget:
Think about what populations are disproportionately impacted by the effects of climate change, such as low air quality and heat waves on health. Expectant mothers living in poverty may not have access to air conditioning and are more likely to live in urban centres and be exposed to the harmful effects of “heat islands” [8].
Additionally, they may not have the ability to reduce pollution exposure due to occupation, or location of residence. Studies have shown that living in an older home, or in close proximity to high pollution areas (such as busy roads) may increase the risk of low birth weight. [2].
Therma is surprised, but glad to be made aware of the possible impacts of climate change on her own health, and the health of her future baby. She wants to know how she can stay safe during this time.
What are steps that Therma could take to stay safe during her pregnancy?
Being aware of heat wave warnings & in times of warm weather prevent heat related illness by doing her best to avoid outdoor activity between 10am and 4pm, taking a cool bath or shower, and ensuring hydration. [5]
Ensuring active living which among its many other benefits, is also shown to improve heat tolerance. [6]
Checking the air pollution levels near her home, choosing less strenuous activities during times of poor air quality, and reducing time spent near high traffic areas. [7]
This is especially relevant during wildfire season in BC. Some resources to monitor outdoor air quality include the Air Quality Health Index from Health Canada, or the Plume app.
It’s important to be aware of indoor air pollution too, such as smoke from cigarettes or vapes, and burning wood indoors without proper ventilation.
Next Steps:
Therma bookmarks the Air Quality Health Index from Health Canada during your conversation so she can access it quickly in the future. “Thank you so much for this information – climate change sometimes feels so overwhelming, so it’s great to know there are steps I can take to stay safe and help reduce its impacts.
How can I do my part to act on climate change?”
What are some steps that people can take to act on climate change?
Choose walking, biking, or public transit whenever possible
Start a conversation – talk to your family and friends and explain the connection between climate change and health, and how it stands to impact us all.
Get involved – ask local leaders about ways you can help create a greener & healthier community. This can range from planting trees and vegetation in your community, to getting involved in city council city planning decisions.
The Outcome:
You see Therma 6 months later, and she has given birth to a happy and healthy baby boy. She now often speaks about waste reduction to her friends and family. She also has taken up regularly attending City Hall meetings (on zoom) to speak for mothers and help shape priorities for the city’s climate action in the next 10 years.
References
1 Whyte, K. P. (2014). Indigenous women, climate change impacts, and collective action. Hypatia, 29(3), 599-616. doi:10.1111/hypa.12089
2 Climate Change and Pregnancy: Low Birth Weight. (2021, February 17). C-CHANGE | Harvard T.H. Chan School of Public Health. https://www.hsph.harvard.edu/c-change/subtopics/climate-change-and-pregnancy-low-birth-weight/
3 USGCRP, 2016: The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. Crimmins, A., J. Balbus, J.L. Gamble, C.B. Beard, J.E. Bell, D. Dodgen, R.J. Eisen, N. Fann, M.D. Hawkins, S.C. Herring, L. Jantarasami, D.M. Mills, S. Saha, M.C. Sarofim, J. Trtanj, and L. Ziska, Eds. U.S. Global Change Research Program, Washington, DC, 312 pp. http://dx.doi.org/10.7930/J0R49NQX
4 Bekkar, B., Pacheco, S., Basu, R., & DeNicola, N. (2020). Association of Air Pollution and Heat Exposure With Preterm Birth, Low Birth Weight, and Stillbirth in the US. JAMA Network Open, 3(6), e208243. https://doi.org/10.1001/jamanetworkopen.2020.8243
5 HealthLinkBC. Heat-related Illness. (2019, March 4). Retrieved from https://www.healthlinkbc.ca/healthlinkbc-files/heat-related-illness
6 Mora-Rodriguez, R. (2012). Influence of Aerobic Fitness on Thermoregulation During Exercise in the Heat. Exercise and Sport Sciences Reviews, 40(2), 79–87. doi: 10.1097/jes.0b013e318246ee56
7 Public Health Agency of Canada. (2018, June 8). Government of Canada. Retrieved from https://www.canada.ca/en/public-health/services/health-promotion/environmental-public-health climate-change/climate-change-public-health-factsheets-air.html
8 Rochette, A. (2016). Climate change is a social justice issue: The need for a gender-based analysis of mitigation and adaptation policies in Canada and Quebec. Journal of Environmental Law and Practice, 29, 383.
Adapted from:
Adebayo, Adebanke L., et al. “The Effectiveness of Narrative Versus Didactic Information Formats on Pregnant Women’s Knowledge, Risk Perception, Self-Efficacy, and Information Seeking Related to Climate Change Health Risks.” International Journal of Environmental Research and Public Health, vol. 17, no. 19, 2020, p. 6969., doi:10.3390/ijerph17196969.