title: Maternal exposure to hurricane destruction and fetal mortality.
abstract: BACKGROUND
  The majority of research documenting the public health impacts of natural disasters focuses on the well-being of adults and their living children. Negative effects may also occur in the unborn, exposed to disaster stressors when critical organ systems are developing and when the consequences of exposure are large.
  
  
  METHODS
  We exploit spatial and temporal variation in hurricane behaviour as a quasi-experimental design to assess whether fetal death is dose-responsive in the extent of hurricane damage. Data on births and fetal deaths are merged with Parish-level housing wreckage data. Fetal outcomes are regressed on housing wreckage adjusting for the maternal, fetal, placental and other risk factors. The average causal effect of maternal exposure to hurricane destruction is captured by difference-in-differences analyses.
  
  
  RESULTS
  The adjusted odds of fetal death are 1.40 (1.07-1.83) and 2.37 (1.684-3.327) times higher in parishes suffering 10-50% and >50% wreckage to housing stock, respectively. For every 1% increase in the destruction of housing stock, we observe a 1.7% (1.1-2.4%) increase in fetal death. Of the 410 officially recorded fetal deaths in these parishes, between 117 and 205 may be attributable to hurricane destruction and postdisaster disorder. The estimated fetal death toll is 17.4-30.6% of the human death toll.
  
  
  CONCLUSIONS
  The destruction caused by Hurricanes Katrina and Rita imposed significant measurable losses in terms of fetal death. Postdisaster migratory dynamics suggest that the reported effects of maternal exposure to hurricane destruction on fetal death may be conservative.
authors.affiliation: Department of Economics, Colorado State University, Fort Collins, Colorado, USA Department of Epidemiology, Robert Wood Johnson Health and Society Scholar, Columbia University, Mailman School of Public Health, New York, New York, USA.
authors.forename: Sammy
authors.initials: S
authors.lastname: Zahran
authors.affiliation: Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Breunig
authors.affiliation: Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, USA.
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Link
authors.affiliation: Department of Anthropology, Colorado State University, Fort Collins, Colorado, USA.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Snodgrass
authors.affiliation: Department of Economics, Colorado State University, Fort Collins, Colorado, USA.
authors.forename: Stephan
authors.initials: S
authors.lastname: Weiler
authors.affiliation: Department of Pharmacology, Tulane University, School of Medicine, New Orleans, Louisiana, USA.
authors.forename: Howard W
authors.initials: HW
authors.lastname: Mielke
mesh_terms: D001723:Birth Rate; D055867:Cyclonic Storms; D004190:Disasters; D005260:Female; D046689:Fetal Mortality; D006798:Housing; D006801:Humans; D008145:Louisiana / Q000453:epidemiology; D018811:Maternal Exposure / Q000009:adverse effects*; D016017:Odds Ratio; D012307:Risk Factors
keywords: DISASTER RELIEF; Environmental epidemiology; FERTILITY; FETAL; MATERNAL HEALTH