Adverse Health Outcomes From Extreme Heat, Air Pollution, and Medications in Low-Income Pregnant Women and Their Offspring

Climate change constitutes “the single biggest health threat facing humanity”. Climate change exacerbates heat-related morbidity and mortality due to more frequent, longer and extreme heat events. It also increases wildfire occurrence and worsens air pollution, which is linked to thromboembolic and bleeding events. The health impacts of extreme heat and air pollution will only intensify as a result of the changing climate. Certain subgroups are disproportionately affected, including low-income populations. Pregnant women and their children, especially those from low-income communities, are particularly vulnerable to harms from extreme heat and air pollution, not only due to physiologic changes during pregnancy and social vulnerability, but also because of the medications that are taken in pregnancy to treat chronic diseases, mental health conditions, and pregnancy complications. Nearly two-thirds of pregnant women in the US take at least one prescription drug other than vitamins, and medication use is likely to play an important role in modifying the health effects of heat and air pollution and/or further increasing morbidity in vulnerable pregnant patients and their offspring. However, the current evidence assessing adverse perinatal outcomes in relation to heat and air pollution lacks adequate consideration of individual-level factors including medication use and interactions between medications and other risk factors. While the CDC recently published guidance for heat and medications recognizing the significance of environment-medication interactions, evidence is still limited, especially for pregnant women. In the present proposal, an interdisciplinary team of experts in climatology, environmental and pharmacoepidemiology, obstetrics, congenital abnormalities, data science, and biostatistics will work closely to design a series of observational epidemiologic studies. We will link temperature/humidity and air pollution data with national Medicaid data as well as birth registry data from New Jersey, Massachusetts and California and analyze the linked data using the state-of-the art study designs and analytic methods. Our study aims to: (1) assess the independent and synergistic effects of extreme heat and prescription opioids and other heat-sensitizing medications on heat-related adverse events in low-income pregnant women; (2) assess the independent and synergistic effects of air pollution, i.e., particulate matter (PM2.5), and medications associated with thromboembolic and bleeding events on these outcomes; and (3) assess the independent and synergistic effects of extreme heat/air pollution and potentially teratogenic medications on the incidence of congenital abnormalities. The results of our study will quantify the effects of extreme heat and air pollution exposure and their potential interactions with medication use in low-income pregnant women while also shedding light on potential mechanisms that confer increased risk to certain individuals. The evidence generated from our study will have a direct impact in shaping adaptation strategies and policies for climate change to protect vulnerable populations from the effects of extreme heat and air pollution. Project Number: 1R01HD114056-01A1 | Fiscal Year: 2025 | NIH Institute/Center: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) | Principal Investigator: Soko Setoguchi Iwata | Institution: RUTGERS BIOMEDICAL AND HEALTH SCIENCES, Newark, NJ | Award Amount: $3,140,397 | Activity Code: R01 | Study Section: Special Emphasis Panel[ZRG1 HSS-C (02)] View on NIH RePORTER: https://reporter.nih.gov/project-details/1R01HD11405601A1