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. 2020 Sep;42(1):95-111.
doi: 10.1007/s11111-020-00345-7. Epub 2020 Mar 17.

Investigating the impact of Hurricane Maria on an ongoing birth cohort in Puerto Rico

Deborah J Watkins  1 , Héctor Ramón Torres Zayas  2 , Carmen M Vélez Vega  2 , Zaira Rosario  2 , Michael Welton  3 , Luis D Agosto Arroyo  2 , Nancy Cardona  2 , Zulmarie J Díaz Reguero  2 , Amailie Santos Rivera  2 , Gredia Huerta-Montañez  2 , Phil Brown  4 , Akram Alshawabkeh  5 , José F Cordero  3 , John D Meeker  1
Affiliations

Investigating the impact of Hurricane Maria on an ongoing birth cohort in Puerto Rico

Deborah J Watkins et al. Popul Environ. 2020 Sep.

Abstract

Prior to Hurricane Maria, Puerto Rico already had 200+ hazardous waste sites, significant contamination of water resources, and among the highest rates of preterm birth in the US. To address these issues, the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) Center was formed in 2010 to investigate prenatal environmental exposures, particularly phthalates, and adverse birth outcomes. Recent work from the PROTECT study confirms that in utero exposure to certain phthalates is associated with shorter gestation and increased risk of preterm birth. However, previous research also suggests that pregnant women who experience a natural disaster such as Hurricane Maria are at higher risk of adverse birth outcomes, but it is unknown whether this is due to stress, hazardous exposures, or a combination of factors. Thus, the aim of this analysis was to characterize hurricane-related changes in phthalate exposures and experiences within the PROTECT cohort. Among 176 participants who were pregnant during or within 5 months after Maria, 122 completed a questionnaire on hurricane-related experiences. Questionnaire results and biomarkers of exposure suggest that participants did not have regular access to fresh foods and water during hurricane recovery, and almost half reported structural damage to their home. In addition, biomarker concentrations of phthalates commonly used in food packaging were higher among participants post-hurricane, while phthalates commonly used in personal care products were lower compared to pre-hurricane levels. Hurricane-related increases in phthalate exposure, as well as widespread structural damage, food and water shortages, and long-term absence of electricity and cell phone service, likely increased the risk of adverse birth outcomes among this already vulnerable population.

Keywords: Hurricane Maria; Puerto Rico; birth cohort; environmental exposures; pregnancy.

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Figures

Figure 1.
Figure 1.
PROTECT, CRECE, and Hurricane Study Design
Figure 2.
Figure 2.
Responses to the Hurricane Experiences Questionnaire among PROTECT participants pregnant during or after Hurricane Maria (n=122).
See this image and copyright information in PMC

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