“Expecting in the Smoke: Should Los Angeles Moms-to-Be Pack Up and Leave?”

Following five days of an unyielding fire outbreak in Los Angeles County, health professionals are cautioning that the region’s smoke levels present distinct dangers to expectant mothers and their unborn offspring.

What steps should pregnant residents of L.A. take?

Primarily, physicians recommend adhering to local emergency instructions regarding evacuation, as advised by Dr. Allison Bryant, a maternal fetal medicine expert from Mass General Hospital who leads the American College of OB/GYN (ACOG) Committee on obstetric care practices.

In addition to observing evacuation notifications, Bryant advised following Centers for Disease Control and Prevention guidance, which suggests that pregnant individuals should remain indoors as much as feasible, keeping windows and doors sealed. They should utilize HVAC systems with filters or portable air purifiers and don N95 masks when outdoor exposure is unavoidable. Maintaining their prenatal appointments as much as possible and revising delivery plans if evacuation is required are also crucial, she noted.

Being prepared for emergencies is vital as well. The CDC recommends storing a seven- to ten-day supply of prescription drugs and prenatal supplements. This collection can be packed in a go-bag with necessary items such as clothing, medical documents, and insurance details.

The CDC’s recommendations align closely with new guidance issued by ACOG recently, which particularly assists expectant individuals during emergencies. While many of the precautions echo general public health recommendations, those who are pregnant must consider additional factors related to prenatal care and delivery preparation.

“What distinguishes pregnant individuals is the knowledge that they will require medical attention in the not-so-distant future,” Bryant stated.

Studies indicate that infants born to mothers subjected to wildfires may be smaller than average, with the impact potentially being most significant during later stages of pregnancy, Bryant explained. However, the dangers extend beyond just smoke exposure. Pregnancy inherently increases physical vulnerability due to alterations in breathing patterns, heart activity, and mucus membranes, which can amplify the adverse effects of smoke and air contamination.

“Throughout pregnancy, everyone’s mucus membranes — the lining inside the nose and mouth — are more functioning and swollen,” Bryant elaborated.

This inherent rise in congestion may cause pregnant individuals to endure more severe symptoms from smoke exposure compared to others in their household.

Although the risks do not significantly differ by trimester, pregnancy itself heightens susceptibility to respiratory issues, as described by Dr. Joseph Ouzounian, chair of obstetrics and gynecology at USC’s Keck School of Medicine.

“Pregnant individuals will breathe more quickly than non-pregnant individuals,” he stated. “The heart and cardiovascular system are exerting more effort as, to some extent, they are supporting two lives rather than just one.”

Short-term exposure for a few days is usually not harmful if precautions, such as wearing N95 masks, are practiced, Ouzounian mentioned. However, extended exposure necessitates more decisive measures. Prolonged contact with environmental toxins could adversely affect fetal development.

With winds anticipated to escalate again on Sunday and potentially reach 50 to 60 mph in mountainous and foothill areas by Tuesday, respite from poor air quality may not arrive soon. Following public health recommendations should be adequate for most, but Ouzounian indicated that individuals not near their delivery date, who cannot ensure proper air quality at home, might want to explore temporary relocation.

“If exposure is expected to last more than a few days, then one should contemplate either finding a location with better air quality or remaining indoors with air filtration systems or purifiers,” he advised.

Some of Ouzounian’s patients are leaving the area, including a woman who resided in a mandatory evacuation zone and has temporarily moved to Orange County, where she has already registered with a new physician. While most of his patients are staying where they are, he anticipates that if the fires continue or escalate over the coming weeks, more patients will look into transferring their care.

Dr. Christina Han, a professor of clinical obstetrics and gynecology at UCLA’s David Geffen School of Medicine, has patients who are also making plans to move to Arizona, San Diego, and Northern California. This is particularly true for those who have lost their residences and realize they will not be able to rebuild within the timeframe of their pregnancy.

“Everyone has a unique situation currently, so we must engage in shared decision-making to navigate this situation with them,” Han stated.

She stresses that patients ought to consult their OB-GYN prior to relocating, as doctors can facilitate connections to care in their new area.

“It can be challenging to find an OB at the last minute, so they should leverage their OB-GYN’s network,” she advised. “OB-GYNs maintain a close network, and many of us are aware of other doctors’ locations across the country and can likely reach out for assistance.”

Although studies on wildfire exposure’s effects on pregnancy are not conclusive, Han emphasized that pregnant individuals adhering to straightforward safety measures will be alright. Her most essential recommendation?

“Wearing [an N95] mask is extremely significant,” Han remarked, “probably more critical than taking prenatal supplements at this moment.”