MATERNAL-NEONATAL HEALTH OUTCOMES, RISK AND RESILIENCE FOLLOWING HURRICANES IRMA AND MARIA IN THE US VIRGIN ISLANDS: A MIXED METHODS STUDY

Background: Hurricanes Irma and Maria struck the United States Virgin Islands (USVI) in September 2017 causing widespread destruction. The impact of these Hurricanes on adverse maternal and neonatal outcomes in the USVI is unknown. Objective: The purpose of this dissertation was to understand the impact of Hurricanes Irma and Maria on adverse maternal and neonatal health and outcomes in the USVI. The two study aims were to: 1) examine the association between hurricane exposure and no prenatal care (NPC), hypertensive disorders of pregnancy (HDP), preterm birth (PTB), cesarean birth (CB), small for gestational age (SGA) and low birth weight (LBW); and 2) understand the experience of managing pregnancy and birth, including factors of risk and resilience, after hurricane exposure. Methods: This was a convergent mixed methods study. The quantitative phase incorporated an interrupted time series analysis of USVI birth data. The qualitative phase included interviews with women (N = 18) who were pregnant during or within two months after the hurricanes. An adapted conceptual framework of risk and resilience guided this study. Results: The USVI experienced a significant decrease in the trend of SGA (B=-0.347; p =.037) and an increase in the trend of PTB (B= 0.364; p =.004) in the post-hurricanes period. There was no change in the level or trend in the rates of HDP, CB, and LBW. The qualitative phase revealed themes detailing risk factors including poor nutrition, stress, lack of support, physical/environmental hazards, and negative impacts on ambulatory and inpatient maternity care. Themes of resilience emerged as personal coping strategies, abundant support, and the continuity of high-quality maternity care. Women with high-risk pregnancies reported that their maternity providers recommended relocation to the mainland US, likely driving the decrease in trend of SGA. Stress characterized women’s experiences, potentially contributing to the increase in trend of PTB. Conclusion: It is vital that maternity providers, departments of health, and hospitals understand the potential maternal-neonatal health effects of hurricane exposure. Collaborative hurricane preparedness and response plans and policies should focus on providing anticipatory guidance, maintaining continuity of prenatal care, mental health support, and relocation assistance to women experiencing high-risk pregnancies