Post-Disaster Reproductive Health Outcomes

We examined methodological issues in studies of disaster-related effects on reproductive health outcomes and fertility among
women of reproductive age and infants in the United States (US). We conducted a systematic literature review of 1,635 articles
and reports published in peer-reviewed journals or by the government from January 1981 through December 2010. We classified
the studies using three exposure types: (1) physical exposure to toxicants; (2) psychological trauma; and (3) general exposure
to disaster. Fifteen articles met our inclusion criteria concerning research focus and design. Overall studies pertained to
eight different disasters, with most (n = 6) focused on the World Trade Center attack. Only one study examined pregnancy loss,
i.e., occurrence of spontaneous abortions post-disaster. Most studies focused on associations between disaster and adverse
birth outcomes, but two studies pertained only to post-disaster fertility while another two examined it in addition to adverse
birth outcomes. In most studies disaster-affected populations were assumed to have experienced psychological trauma, but exposure
to trauma was measured in only four studies. Furthermore, effects of both physical exposure to toxicants and psychological
trauma on disaster-affected populations were examined in only one study. Effects on birth outcomes were not consistently demonstrated,
and study methodologies varied widely. Even so, these studies suggest an association between disasters and reproductive health
and highlight the need for further studies to clarify associations. We postulate that post-disaster surveillance among pregnant
women could improve our understanding of effects of disaster on the reproductive health of US pregnant women.