Effects of the September 11, 2001 disaster on pregnancy outcomes: a systematic review

Authors

  • ARNE OHLSSON,

    1. Department of Pediatrics, Mount Sinai Hospital and Departments of Pediatrics, Obstetrics and Gynecology and Health Policy, Management and Evaluation, University of Toronto
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  • PRAKESH S. SHAH,

    1. Department of Pediatrics, Mount Sinai Hospital and Departments of Pediatrics and Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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  • the Knowledge Synthesis Group of Determinants of Preterm/LBW births


  • The members of the Knowledge Synthesis Group on Determinants of LBW/preterm births are as follows: Vibhuti Shah, Kellie E. Murphy, Fran Scott, Joseph Beyene, University of Toronto, Toronto; Sarah D McDonald, Eileen Hutton, McMaster University, Hamilton; Christine Newburn-Cook, University of Alberta, Edmonton; Corine Frick, University of Calgary, Calgary; Victoria Allen, Dalhousie University, Halifax, Canada.

  • Conflict of interest
    The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Correspondence
Dr. Arne Ohlsson, Professor Emeritus, Department of Pediatrics Mount Sinai Hospital and Departments of Pediatrics, Obstetrics and Gynecology, and Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. E-mail: aohlsson@mtsinai.on.ca

Abstract

Background. The terrorist explosions of the World Trade Center in New York City and the other events on the Pentagon and in Pennsylvania on 11 September 2001 were stressful events that affected people around the world. Pregnant women and their offspring are especially vulnerable during and after such a terrorist attack. The objective was to systematically review the risks of adverse pregnancy outcomes after the terrorist attacks on Sept 11, 2001. Methods. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) criteria were used for reporting of this review. Statistical analyses were performed using RevMan 5.0. Results. Ten reports of low-to-moderate risk of methodological bias were included. There was increased risks of infants with birthweight of 1,500 g–1,999 g (adjusted odds ratio [AOR] 1.67 [95%CI 1.11–2.52]) and small-for-gestational age births (AOR 1.90; 95%CI 1.05–3.46) in New York. There was increased risks of low birthweight (relative risk 2.25; 95%CI 1.29–3.90) and preterm births (relative risk 1.50; 95%CI 1.06–2.14) among ethnically Arabic women living in California There was a reduction in birthweight by 276 g and in head circumference by 1 cm when DNA adducts, a marker for environmental toxin exposure, were doubled in maternal blood. In Holland, a 48-g reduction in birthweight was reported. Conclusions. The World Trade Center disaster influenced pregnancy outcomes in New York, among ethnically Arab women living in California and among Dutch women. The adverse outcomes are likely due to environmental pollution and stress in New York, ethnic harassment in California and communal bereavement and stress in Holland.

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