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The Heat Is On: Climate Change Implications for Pregnant Women with Sickle Cell Disease
Rachelle Chanmany Pastor1, Lisa Roberts1, Akshat Jain2
1School of Nursing, Loma Linda University, Loma Linda, California, United States.
Insights
Pregnant individuals with sickle cell disease (SCD) face heightened risks from climate change, particularly extreme heat and dehydration. More research is crucial to understand and mitigate these impacts on maternal health.
Area of Science:
- Environmental Health
- Hematology
- Maternal-Fetal Medicine
Background:
- Sickle cell disease (SCD) is a prevalent genetic blood disorder in the US, disproportionately affecting African Americans.
- Pregnancy in individuals with SCD carries significantly higher risks of complications, including up to a 10-fold increased risk of maternal mortality.
- Physiological changes during pregnancy exacerbate SCD complications like vaso-occlusive episodes (VOEs) and infections, with dehydration being a major trigger.
Purpose of the Study:
- To review current literature on the impact of climate change on pregnant individuals with SCD.
- To identify knowledge gaps regarding the intersection of climate change, extreme heat, and SCD risks in pregnancy.
- To highlight the need for further research and clinical guidance for this vulnerable population.
Main Methods:
- A comprehensive literature search was conducted in PubMed, Embase, and Google Scholar for studies published between 2019 and 2024.
- The search focused on human subjects and retrieved 477 studies.
- After screening, 20 relevant articles were analyzed to assess the evidence.
Main Results:
- Current evidence directly linking climate change impacts to increased risks for pregnant individuals with SCD is notably lacking.
- Elevated temperatures associated with climate change can increase core body temperature, blood hyperosmolality, and dehydration, all risk factors for SCD complications.
- Existing SCD clinical guidelines emphasize dehydration prevention, underscoring the importance of managing environmental exposures.
Conclusions:
- There is a critical need for further research to investigate the specific risks climate change poses to pregnant individuals with SCD.
- Clinicians must educate this high-risk group about the dangers of dehydration and extreme heat exposure.
- Mitigating climate change-related risks requires a proactive approach to patient education and potentially new clinical strategies.
Abstract:
Sickle cell disease (SCD), a serious, chronic blood disorder is the most common genetic blood disease in the United States affecting 100,000 people and disproportionately affecting the African American population. Pregnancy is particularly risky for people with SCD due to higher risk of developing pregnancy-related complications compared with people without the disease. For African American pregnant women with SCD, the risk of maternal morbidity and mortality is up to 10 times higher. Physiological changes during pregnancy increase the risk of vaso-occlusive episodes (VOEs), acute chest syndrome, venous thromboembolic events, and infections. Dehydration increases risk as it triggers sickling of red blood cells, leading to painful VOEs and further increasing the risk of aforementioned complications. Climate change, observed since the mid-20th century, is evidenced by the increasing trend of global temperature, hurricanes, floods, and heat waves. Climate changes can profoundly impact people with SCD, as elevated temperatures result in increased core body temperatures, blood hyperosmolality, and dehydration. Assisted by a research librarian, a literature search was undertaken of major databases (PubMed, Embase, and Google Scholar), with delimiters of publication between 2019 and 2024 and human subjects, and 477 studies were retrieved. After meticulous screening, 20 relevant articles were analyzed. Evidence linking climate change impact to increased risk for pregnant people with SCD is lacking. Further research is needed to examine the phenomenon and mitigate this unique risk of climate change. SCD clinical guidelines stress the importance of preventing dehydration. Clinicians play a critical role in educating this vulnerable population about risks, including dehydration and exposure to extreme heat.
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