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Exposure to 9/11 disaster tied to low birthweight, preterm delivery

Infants whose mothers performed rescue or recovery work were 1.9 times more likely to be born preterm in the first couple of years.

Associations between disaster, poorer birth outcomes lasted among infants conceived up to 3 years after 9/11

An American flag flies over the rubble of the collapsed World Trade Center buildings in New York in this 2001 photo. Women who have been exposed to a disaster should inform the prenatal care provider of the nature and extent of their exposure, doctors say. (Beth A. Keiser/Associated Press)
For years following the events ofSeptember 11, 2001 in lower Manhattan, the disaster and itsaftermath may have affected women and their babies who were noteven conceived yet, according to a new study.

Researchers found that among women who were rescue orrecovery workers responding to the events of 9/11, or women whoresided below Canal Street in the World Trade Center'sneighbourhood, those with the most intense exposures to thedisaster had doubled rates of preterm delivery and lowbirthweight babies over the next few years.

"Associations between disaster exposure and adverse birthoutcomes have been demonstrated repeatedly in the past," saidlead author Carey Maslow, deputy director of research for theWorld Trade Center Health Registry. "What is surprising is thatthese associations persisted among infants conceived up to threeyears after 9/11."

The researchers matched birth certificates for infants bornin New York City between September 11, 2001 and the end of 2010to disaster exposure data on women who were enrolled in theWorld Trade Center Health Registry.

In that time there were 3,360 babies born in the city towomen enrolled in the registry. Less than 10 per cent of babieswere born to women pregnant on 9/11.

Almost 7 per cent of the babies were delivered preterm,meaning before 37 weeks of pregnancy, and 6 per cent had lowbirthweight, meaning they weighed less than 5 pounds, 8 ounces.

We can't prevent the disaster but we can doa better job of responding to it.-Dr. IrisUdasin

The average newborn in the U.S. weighs about 8 pounds, andabout 8 per cent of all babies are low birthweight, according tothe Centers for Disease Control and Prevention.

The researchers also looked at the mothers' level ofexposure to the disaster and its aftermathfor example,whether they were injured, witnessed traumatic scenes, wereevacuated from a residence in the neighbourhood, performed rescueor recovery work "on the pile" (of smoldering wreckage), andother types of exposure.

The study team found that through the end of December 2003,women with at least two out of four exposures were 2.3 timesmore likely than women with less exposure to have alow-birthweight baby and 2.1 times more likely to have a pretermdelivery.

Infants whose mothers performed rescue or recovery work were1.9 times more likely to be born preterm in the first couple ofyears.

Later in the 10-year study period, differences started todiminish, the researchers note in American Journal of PublicHealth.And throughout the study period, babies of mothers with highexposure were not more likely to be small for their gestationalage, which was surprising, the authors write.

Increase attention to mental health care

Physical contaminants and psychological trauma tend to occursimultaneously in a disaster setting, and disentangling theirrelative effects is very difficult, Maslow told Reuters Healthby email.

"Whether the important exposure is posttraumatic stress orcomponents of the toxic dust themselves, the eggs were exposedto it," since reproductive effects appear to persist even forwomen who were not pregnant at the time of the disaster butconceived in the following year or so, said Dr. Iris Udasin,medical director of the Environmental and Occupational HealthSciences Institute Clinical Center at Rutgers University in NewBrunswick, New Jersey.

"The good news is, even though these numbers are higher thanwe would like them to be, they're not overwhelmingly large,"Udasin, who was not part of the new study, told Reuters Health.

It may never be clear exactly how these interactions work,she said.

"Adverse reproductive outcomes have been associated withother terrorist attacks, with environmental disasters, chemicaldisasters, and even with natural disasters, like hurricanes andearthquakes," Maslow said.

"The real message is, increasing attention to mental healthcare," Udasin said. "We can't prevent the disaster but we can doa better job of responding to it."

She wouldn't tell women to delay pregnancy after a disaster,but to do everything possible to make themselves healthy,
mentally and physically, she said.

"Women who have been exposed to a disaster, including thoseinvolved in disaster response, should inform the prenatal careprovider of the nature and extent of their exposure," Maslowsaid.