Health Concerns of Women and Infants in Times of Natural Disasters: Lessons Learned from Hurricane Katrina

William M. Callaghan; Sonja A. Rasmussen; Denise J. Jamieson; Stephanie J. Ventura; Sherry L. Farr; Paul D. Sutton; Thomas J. Mathews; Brady E. Hamilton; Katherine R. Shealy; Dabo Brantley; Sam F. Posner

Disclosures

Matern Child Health J. 2007;11(4):307-311.

The Population at Risk

It is estimated that more than 1.1 million women of reproductive age (15-44 years) resided in the affected areas before the storm.^[23] Among women living in these areas there were 74,859 live births in 2003.^[24] In that approximately three-fourths of women who give birth in a one year period are pregnant at any point in time, there would be an estimated 56,100 pregnant women and 74,900 infants who were directly affected by the hurricane. Although exact estimates are lacking, many pregnant women in affected areas were displaced from their homes. Within 2 weeks of the hurricane more than 600 shelters were accommodating more than 200,000 evacuees in up to 18 states.^[25] By the end of September, evacuees were living in nearly all 48 contiguous states.^[1] In addition, some pregnant women probably remained in their homes, many of them cut off from essential services such as electricity and potable water as well as prenatal and other medical care.

Historic data have shown that women living in Louisiana, Mississippi, and Alabama are at greater risk for adverse pregnancy and infant outcomes than women in the general U.S. population.^[24] Further, rates of adverse outcomes are higher in the Katrina-affected counties and parishes of these three states than overall rates for each of the states. Women living in the affected areas were more likely than women nationally to give birth to low birthweight infants (<2,500 g) and very low birthweight infants (<1500 g) ( Table 1 ). The infant mortality rate for the affected areas was 9.4 per 1,000 live births in 2002 compared with a national rate of 7.0.^[26] Women living in the hurricane-affected areas are also at greater risk for not breastfeeding and for shorter duration of breastfeeding compared with women nationally. In 2004, data from the CDC National Immunization Survey showed that 51.3% of infants in Alabama, Mississippi, and Louisiana were ever breastfed, compared with 70.3% nationwide.^[27] Only 7.0% of infants in hurricane-affected states were breastfed the recommended 12 months, compared with 17.8% nationally. Therefore, Hurricane Katrina affected a large number of pregnant women and infants already at high risk for adverse outcomes.

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Cite this: Health Concerns of Women and Infants in Times of Natural Disasters: Lessons Learned from Hurricane Katrina - Medscape - Jul 01, 2007.

Percentage of Preterm, Low Birthweight, and Very Low Birthweight Infants in Counties and Parishes Affected by Hurricane Katrina -- 2003
	In areas affected by Hurricane Katrina*	In Alabama, Louisiana, and Mississippi	In United States
Number of births	74,859	166,972	4,089,950
Percent low birthweight**	11.1	10.6	7.9
Percent very low birthweight***	2.3	2.1	1.4
Percent preterm****	16.9	16.2	12.3

Source. National Vital Statistics System, National Center for Health Statistics, Centers for Disease Control and Prevention.
*FEMA-designated counties/parishes as of September 23, 2005. In Alabama -- Baldwin, Choctaw, Clarke, Mobile, Pickens, Greene, Hale, Sumter, Tuscaloosa, and Washington Counties. In Louisiana -- the parishes of Ascension, Assumption, East Baton Rouge, Iberia, Iberville, Jefferson, Lafourche, Livingston, Orleans, Plaquemines, St. Bernard, St. Charles, St. Helena, St. James, St. John the Baptist, St. Mary, St. Martin, St. Tammany, Tangipahoa, Terrebonne, Washington, and West Baton Rouge. In Mississippi -- Adams, Amite, Claiborne, Clarke, Copiah, Covington, Forrest, Franklin, George, Greene, Hancock, Harrison, Hinds, Jackson, Jasper, Jefferson, Jefferson Davis, Jones, Kemper, Lamar, Lauderdale, Lawrence, Leake, Lincoln, Lowndes, Madison, Marion, Neshoba, Newton, Noxubee, Oktibbeha, Pearl River, Perry, Pike, Rankin, Scott, Simpson, Smith, Stone, Walthall, Wayne, Wilkinson, and Winston Counties.
**Birth weight of <2,500 g.
***Birth weight of <1,500 g.
****Gestation of <37 completed weeks.

Considerations for Pregnant Women and Infants When Preparing and Responding to Natural Disasters
Ascertain pregnancy status as part of medical intake process. Consider contraceptive needs for evacuated women in order to avoid unintended pregnancies. Promote continuation of exclusive breastfeeding. Understand the impact on infants and pregnant women of disrupting the public health and clinical care infrastructures. For prenatal care, this may involve training non-obstetrical healthcare providers to effectively triage pregnant women. Recognize the effects of exposures related to the disaster (e.g., vaccinations and medications used in the public health response) on pregnant women and their infants. Ensure that information about the effects of these exposures is available to women and their health care providers. Determine the feasibility of establishing a pregnancy registry early in the event to track outcomes for pregnant women. Equip disaster medical assistance teams and other response teams with awareness of and capabilities for managing pregnant and lactating women and their infants.

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