Available online 11 October 2023, 151836

Author links open overlay panel, , , , , ABSTRACT

Climate change is one of the greatest challenges confronting humanity. Pregnant persons, their unborn children, and offspring are particularly vulnerable, as evidenced by adverse perinatal outcomes and increased rates of childhood illnesses. Environmental inequities compound the problem of maternal health inequities, and have given rise to the environmental justice movement.  The International Federation of Gynecology and Obstetrics and other major medical societies have worked to heighten awareness and address the deleterious health effects of climate change and toxic environmental exposures. As part of routine prenatal, neonatal, and pediatric care, neonatal-perinatal care providers should incorporate discussions with their patients and families on potential harms and also identify actions to mitigate climate change effects on their health. This article provides clinicians with an overview of how climate change affects their patients, practical guidance in caring for them, and a frame setting of the articles to follow. Clinicians have a critical role to play, and the time to act is now.

Section snippetsHeat

As Chapter 2 summarizes, the ten hottest years on record have occurred in the last decade. Nearly 4 billion people will soon live outside of appropriate environmental niches, exposed to life-threatening wet bulb temperatures of 35°C or greater.5, 6, 7 Patients can acutely present with high core body temperatures of 40°C or higher, thready pulse/tachycardia, muscle cramps, altered neurologic states, flushed skin, and altered sweating.8 Heat exposure is important in the pregnant population

Air Pollution

Air pollution can be particulate or gaseous in nature and sources can be outdoor, such as from fossil fuel combustion and wildfires, or indoors, such as from cookstoves. As we will see in Chapter 3, fossil fuel combustion produces criteria air pollutants, including ground level ozone, nitrogen dioxide, sulfur dioxide, and carbon monoxide, as well as particulates of 2.5 micron diameter (PM2.5) or smaller, which all pose significant health risks.25 Fine particulates are especially dangerous

Natural Disasters

Women and children are fourteen times more likely than men to die or be injured in natural disasters, and women of lower socioeconomic status experience greater harm.50 Pregnant persons are at particular risk for suffering from stress, post-traumatic stress disorder, depression, and anxiety after experiencing a major natural disaster, with Black women and women of lower socioeconomic status even more adversely affected by the event.12,14,51 Chapter 4 introduces the impact of climate change on

Infectious Disease

As climate changes, vectors that transmit human pathogens are anticipated to become more widespread, resulting in exposures of previously unaffected human populations (Chapter 6) .51 Concerning pathogens with known risks to pregnant patients and developing fetuses include West Nile, chikungunya, dengue, and Zika viruses, as well as malaria and tick-borne illnesses.4,14,51 Water shortages from drought and deterioration of water quality from both droughts and flooding further increase the risk

Environmental Justice and Its Implications

The term environmental racism emerged in the 1980s to describe the unequal exposures of pollution on racial minorities, and since then we have broadened our understanding of how unequal power structures and relationships shape the differential impacts of climate change.59, 60, 61 Social categories such as gender, age, and class, in addition to race and ethnicity, are associated with disproportionate environmental impacts stemming from climate change.61 Environmental justice has emerged as a

Social Policy

The Intergovernmental Panel on Climate Change (IPCC) is a United Nations agency that convenes annually to offer scientific assessments on climate change and potential future risks, and to provide suggestions for adaptation and mitigation. Its most recent Synthesis Report from March 2023 noted that it is almost impossible to limit global warming to less than the critical threshold of 1.5°C compared to pre-industrial times.73 Although many countries have pledged to limit greenhouse gas emissions,

What can clinicians do?

In the immediate sense, obstetrician-gynecologists can help their patients in terms of heat, air pollution, natural disaster, and infectious disease exposures. Obstetricians should have a heightened awareness for patients presenting with signs or symptoms of heat-related complications that may be common during pregnancy, including tachycardia, vomiting, muscle cramps, lightheadedness and dizziness. This is especially important in times of predicted heat waves, when there is high humidity, or

DISCLOSURES

We certify that, to the best of our knowledge, no aspect of our current personal or professional circumstance places us in the position of having a conflict of interest with this chapter.

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