A Strategic Program for Risk Assessment and Intervention to Mitigate Environmental Stressor-Related Adverse Pregnancy Outcomes in the Indian Population

Abstract

The Problem: Global environmental stressors of human health include, but are not limited to, conflict, migration, war, natural disasters, climate change, pollution, trauma, and pandemics. In combination with other factors, these stressors influence physical and mental as well as reproductive health. Maternal stress is a known factor for adverse pregnancy outcomes such as preterm birth (PTB); however, environmental stressors are less well-understood in this context and the problem is relatively under-researched. According to the WHO, major Indian cities including New Delhi are among the world's 20 most polluted cities. It is known that maternal exposure to environmental pollution increases the risk of premature births and other adverse pregnancy outcomes which is evident in this population. Response to the Problem: Considering the seriousness of this problem, an international and interdisciplinary group of researchers, physicians, and organizations dedicated to the welfare of women at risk of adverse pregnancy outcomes launched an international program named Optimal Pregnancy Environment Risk Assessment (OPERA). The program aims to discover and disseminate inexpensive, accessible tools to diagnose women at risk for PTB and other adverse pregnancy outcomes due to risky environmental factors as early as possible and to promote effective interventions to mitigate these risks. OPERA has been supported by the Worldwide Universities Network, World Health Organization (WHO) and March of Dimes USA. Addressing the Problem: This review article addresses the influence of environmental stressors on maternal-fetal health focusing on India as a model population and describes the role of OPERA in helping local practitioners by sharing with them the latest risk prediction and mitigation tools. The consequences of these environmental stressors can be partially mitigated by experience-based interventions that build resilience and break the cycle of inter- and-transgenerational transmission. The shared knowledge and experience from this collaboration are intended to guide and facilitate efforts at the local level in India and other LMIC to develop strategies appropriate for the jurisdiction for improving pregnancy outcomes in vulnerable populations.

Keywords: India; adverse pregnancy outcomes; environment; pregnancy; resilience; stress.

Figure 1

The psychological well-being of a woman during pregnancy depends on the combination of her internal emotions and external relationships. (A) Internal emotions. A pregnant woman experiences a wide range of internal emotions which are partly influenced by her own childhood experiences and partly by the physiological changes of pregnancy. (B) External relationships. Resilience and stress both can originate from a woman's social relationships. Social support from family, friends as well as healthcare providers is particularly important to promote maternal mental well-being.

Figure 2

Proposed interventions to promote healthy pregnancy outcomes and reduce maternal stress before and during pregnancy, and after delivery. (A) Preconception period: (1) Providing health education in schools, colleges, and awareness programs to prepare women for their reproductive life; (2) Providing counseling on nutrition and lifestyle modification; (3) Educational webinars and counseling for young couples planning pregnancy; (B) Pregnancy and perinatal period: (4) Mental health counseling during each antenatal visit; (5) Mobile health clinics for public awareness, diagnosis, referrals, and emergency care in remote areas; (6) Practicing relaxing activities such as listening to music, reading a book, knitting, gardening, walking in a park, puzzle-solving, and setting goals. Providing free pregnancy handbooks (with easy-to-understand pictorial information) in public places such as supermarkets, shops, bus stops, and train stations; (7) Spending time with a pet animal; (8) Watching pregnancy health documentaries or a comedy show with the family to lighten up the mood; (9) Practicing pregnancy yoga, meditation, and moderate exercises; (10) Massage therapy for both the parents; (11) Socializing with other pregnant women and sharing each other's feelings; (C) Postpartum period: (12) Encouraging regular neonatal health check-ups; (13) Maternal and paternal stress counseling and guidance for mind exercises, relaxing activities to mitigate the stress; (14) Expressing inner thoughts through painting, expressive writing; (15) Joining nursing mothers' groups and other social support groups on social media and sharing each other's experiences.