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

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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. 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. 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. 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. 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.

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Authors and Affiliations

  1. Economics, Colorado State University, Fort Collins, CO, USA

    Sammy Zahran & Stephan Weiler

  2. Sociology, Colorado State University, Fort Collins, CO, USA

    Lori Peek & Lynn Hempel

  3. Anthropology, Colorado State University, Fort Collins, CO, USA

    Jeffrey G. Snodgrass

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  1. Sammy Zahran
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  2. Lori Peek
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  3. Jeffrey G. Snodgrass
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  4. Stephan Weiler
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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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