Hurricane Harvey and the risk of spontaneous preterm and early-term birth

Abstract

Background: Hurricane Harvey made landfall in August 2017 and resulted in catastrophic flooding in Houston, Texas. Prior studies of hurricanes and preterm birth have found conflicting results. We tested the hypotheses that exposure to Hurricane Harvey was associated with a higher risk of spontaneous pre- and early-term birth and assessed vulnerable subpopulations.

Methods: We conducted a retrospective study of singleton births using administrative birth records in the nine-county greater Houston area from 2015 to 2019. We estimated the likelihood of pre- and early-term births using logistic regression, comparing births occurring during or within 1, 2, or 4 weeks of Hurricane Harvey to unexposed reference periods encompassing the same dates 2 years prior and after. Stratified models assessed effect modification by degree of flooding, birth parent age, high- vs. low-risk pregnancy, race/ethnicity, and prenatal care.

Results: Among 15,564 births, we found no association between exposure to Hurricane Harvey and spontaneous preterm birth within 1 week adjusted (odds ratio [OR], 1.06; 95% confidence interval [CI] = 0.91, 1.25) but a 14% higher odds of spontaneous early-term birth (OR, 1.14; 95% CI = 1.04, 1.25). The odds of early-term birth were even higher in neighborhoods with severe flooding (OR, 1.21; 95% CI = 1.05, 1.38), segregated neighborhoods (OR, 1.23; 95% CI = 1.03, 1.47), and among foreign-born Hispanics (OR, 1.21; 95% CI = 1.04, 1.53) and pregnant people receiving no prenatal care (OR, 1.37; 95% CI = 1.03, 1.82). Effect estimates were attenuated or null when considering 2-week or 4-week lags to define exposure.

Conclusions: Hurricane Harvey was associated with higher odds of spontaneous early-term birth up to 1 week later, especially among socially marginalized populations.

Figure 1.

Hurricane Harvey’s storm track and cumulative precipitation (mm) levels in counties designated for relief assistance by the US Federal Emergency Management Agency from August 25–29, 2017. Bolded boundaries indicate Houston MSA counties included in the main analysis (N = 9): Austin, Brazoria, Chamber, Fort Bend, Galveston, Harris, Liberty, Montgomery, Waller. Dotted boundaries indicate additional counties included in the sensitivity analysis (N = 9) that experienced >600 mm of precipitation during the study period or windspeed >64 knots: Aransas, Bee, Calhoun, Goliad, Jefferson, Nueces, Refugio, San Patricio, Victoria.

Figure 2.

Illustration of the primary exposure definition comparing births during or within 1 week of Hurricane Harvey to births occurring during the same dates 2 years before or after the storm. Secondary analyses considered births within 2 weeks and 4 weeks of the hurricane.

Figure 3.

Odds ratios and confidence intervals of spontaneous (A) preterm and (B) early-term birth associated with exposure to Hurricane Harvey.

Figure 4.

Adjusted odds ratios and confidence intervals of spontaneous early-term birth associated with exposure to Hurricane Harvey (1-week lag) by potentially vulnerable subgroups.