Natural disasters and pregnancy: Population-level stressors and interventions

Global climate change is resulting in more frequent, and increasingly severe, natural disasters that affect large populations. Disasters have a measurable effect on the physical and mental health of citizens, including pregnant women. In addition to increasing the pregnant woman's risk of postpartum depression, prenatal (and perhaps even preconception) exposure to population-level disasters appears to program the unborn child in ways that could compromise long-term well-being. Although there are many options for dealing with stress in individual women going through punctual life events, such as the death of a family member, such individual-level interventions could not feasibly be applied to hundreds or thousands of perinatal women in the wake of a natural disaster that disrupts the functioning of an entire community. The objectives of this chapter are to describe the magnitude and consequences of this form of prenatal maternal stress and to present what is known about ways in which the stress related to natural disaster exposure can be mitigated. The five disaster studies that constitute the Stress in Pregnancy International Research Alliance (SPIRAL) are described. These projects quantify the relative effects of the pregnant woman's objective disaster-related hardship, her cognitive appraisal of its consequences, and her subjective distress from the event on the unborn child's development. We then present evidence on existing interventions and their ability to buffer perinatal women and their children from disaster-related stress. Policy-level, population-level, and family-based solutions are also presented.