22 July 2021

New guidance clears the air on pollution and pregnancy

Climate Change Clinical Women

RANZCOG has issued official guidance on the health effects of air pollution on pregnancy, with a pamphlet that includes advice for pregnant people on minimising the risk from harmful bushfire smoke.

“After the 2020 bushfires we realised there was a need for a resource for women who were concerned about the effects of air pollution in pregnancy,” said Hobart-based obstetrician Dr Kristine Barnden, who helped RANZCOG develop the guiding document.

In January 2020, the AMA sounded warnings about the “new health threats” of prolonged exposure to bushfire smoke with worsening fire conditions, and acknowledged pregnant women were among the most vulnerable, as did RANZCOG.

Many experts also expressed their concerns at the time and highlighted the need for improved guidance to help pregnant people protect themselves and their babies from air pollution.

But few resources were available for pregnant people on the health impacts of smoke haze,

and those that mentioned pregnant women were vulnerable didn’t say why or to what extent, Dr Barnden told Allergy & Respiratory Republic.

“I certainly felt that needed to be addressed, and that there needed to be more information for doctors and pregnant women,” she said.

In the new patient information pamphlet, which is thought to be a world-first from a professional body, RANZCOG outlines the health impacts of bushfire smoke as well as other sources of air pollution, such as heavily trafficked roads, gas heating and cooking.

To limit exposure and minimise risk, RANZCOG advises pregnant people to stay indoors with windows shut, monitor air quality and use high-quality air filters – but to consult their doctor before using high-grade masks, which can restrict breathing.

Developed by a team of obstetricians, air pollution public health experts and a fertility specialist, the downloadable resource provides an expert reading of the evidence – from studies of urban pollution and wildfires – and its implications, Dr Barnden said.

“There’s a varying degree of understanding amongst doctors about the risks,” she said. “There have been very few Australian studies and for most people in Australia, air pollution hasn’t been an issue until now.”

Albury GP Dr Rebecca McGowan echoed Dr Barnden’s statements in The Guardian saying the release should be “wake-up call” to the impacts of climate change, and the need to protect women and their children.

Air pollution, which stimulates a low-grade inflammatory response and can restrict foetal growth, has been linked to increased rates of preterm birth, low birth weight and other pregnancy complications, such as gestational diabetes.

“Air pollution during pregnancy has less conclusively been linked to an increased risk of high blood pressure in pregnancy, miscarriage, and effects on fertility,” RANZCOG says in the pamphlet.

Dr Arnagretta Hunter, a physician and cardiologist in Canberra, said the pamphlet offers sensible information and sound advice to pregnant women that will also help doctors be better prepared for future events.

“This contribution from the RANZCOG is timely, sensible, and helpful both today for women in cities where air pollution is a challenge, as well as for the future if hazardous bushfire smoke emerges as a challenge again,” Dr Hunter said.

More research will also be needed to address unanswered questions about the effects of lengthy exposures to air pollution to babies in utero and in early childhood, said Dr Barnden.

“What we have at the moment suggests there might be lifelong vulnerabilities to disease that result from significant exposures to air pollution in utero.”

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