The burgeoning impact of climate change is increasingly manifesting in myriad health challenges worldwide, and one of the most insidious emerging threats is the exposure of vulnerable populations to wildfire smoke. A recent landmark study led by Dr. Michel Boudreaux, Associate Professor of Health Policy and Management at the University of Maryland, sheds light on a critical yet under-examined aspect of this crisis: the readiness—or lack thereof—of the United States perinatal healthcare system to serve pregnant individuals and newborns affected by wildfire smoke exposure. Published in the journal Medical Care, this research maps the intersection of environmental hazards with health system infrastructure, revealing significant gaps that demand urgent attention.
Wildfires, once confined to particular regions, have escalated in frequency, scale, and severity in recent years, propelled by changing climate patterns characterized by prolonged droughts, escalating temperatures, and disrupted precipitation cycles. These fires generate massive plumes of smoke, rich in fine particulate matter (PM2.5) and toxic chemical compounds that can travel vast distances across states and regions. Consequently, even populations located far from active fires experience prolonged exposure to degraded air quality, raising serious public health concerns, especially for sensitive groups such as pregnant individuals and infants.
Prenatal exposure to air pollutants, particularly PM2.5, has been associated with adverse birth outcomes including preterm birth, low birth weight, and congenital anomalies. These associations are understood through mechanisms involving systemic inflammation, oxidative stress, and vascular dysfunction precipitated by inhaled toxins. Furthermore, emerging evidence indicates that wildfire smoke constituents can exacerbate hypertensive disorders during pregnancy, contribute to gestational diabetes, and amplify cardiovascular risks. Despite these findings, infrastructure capable of managing the nuanced needs of perinatal care recipients during wildfire events remains insufficiently characterized, especially considering the growing intensity and geographic spread of wildfires.
Dr. Boudreaux’s study innovatively integrates satellite-derived wildfire smoke data spanning five years (2016-2020) from the National Oceanic and Atmospheric Administration (NOAA) with comprehensive county-level healthcare resource metrics. By correlating the incidence and duration of wildfire smoke plumes with demographic indicators and healthcare capacity variables—including the availability of obstetricians-gynecologists (OB-GYNs), family practice physicians, maternity hospitals, and neonatal intensive care units (NICUs)—the research provides a multifaceted overview of systemic readiness. This methodological framework is essential in identifying disparities not just in exposure risk but also in care accessibility.
Analysis reveals stark heterogeneity across U.S. counties regarding wildfire smoke exposure. High-risk regions on the West Coast, Northern Rockies, and parts of the Midwest experience chronic exposure ranging from 10 to over 35 smoke-days annually, defined by elevated PM2.5 measures. In high-risk counties, annual average PM2.5 concentrations more than double—from approximately 3.0 micrograms per cubic meter in low-risk areas to 6.6 micrograms per cubic meter. These elevated pollutant levels pose a chronic respiratory insult, disproportionately impacting reproductive-age women and their infants within these zones.
Critically, the study highlights that counties with the highest exposure levels are paradoxically those with the least healthcare infrastructure to mitigate resulting perinatal health risks. High-risk counties report a median of zero OB-GYNs per 10,000 births, in stark contrast to 61 OB-GYNs in low-risk counties. Distance to maternity care and NICU facilities similarly escalates, with mothers in high-risk counties traveling a median of 22 miles to reach a maternity hospital and 72 miles for neonatal intensive care. These distances not only delay emergency and routine care but also exacerbate health inequities, especially in rural or socioeconomically disadvantaged communities.
Adjusting for confounding sociodemographic variables such as race, age, poverty, insurance status, and rurality attenuates but does not eliminate these disparities. This indicates that the burden on high-risk communities extends beyond these typical markers of healthcare vulnerability. The cumulative effect of environmental exposure compounded by resource scarcity presents a formidable challenge for clinicians and policymakers alike, underscoring the urgent need for targeted interventions.
From a public health standpoint, mitigation strategies are multifarious but must be tailored to meet the demands of the perinatal population. Interventions including the establishment of clean air refuges, distribution of respirators and air filtration devices, and home sealing techniques offer immediate relief from smoke exposure. However, these measures are insufficient without concurrent system-level enhancements that ensure timely access to specialized obstetric and neonatal care during and after wildfire events, particularly in geographically isolated regions.
The study’s implications resonate beyond environmental health and perinatal medicine, intersecting with wider themes of health equity, disaster preparedness, and climate justice. Pregnant people and infants represent a physiologically vulnerable demographic whose health outcomes can be profoundly influenced by systemic environmental stressors. The increased hypertensive disorders, gestational diabetes, and cardiovascular complications noted among exposed populations are also reflective of pervasive systemic inflammation triggered by air pollutants, which have long-term implications for maternal and child health.
Moreover, the research urges policymakers to incorporate the geographic distribution of wildfire risk and healthcare resources into broader climate adaptation frameworks. This includes investing in healthcare workforce expansion, enhancing telemedicine capabilities to provide remote perinatal support, and incorporating environmental risk assessments into prenatal care protocols. Failure to do so risks widening the chasm between environmental health threats and healthcare responses, perpetuating avoidable adverse outcomes for a generation born into a changing climate.
As wildfires continue to devastate ecosystems and communities, this research offers a sobering reminder of the interconnected nature of environmental hazards and healthcare infrastructure. The perinatal period, a critical window for life-long health trajectories, demands focused attention for pollution impact mitigation and system preparedness. The findings advocate a multidisciplinary coalition among environmental scientists, healthcare providers, and policymakers to develop resilient, equitable perinatal health systems equipped for climate-induced challenges.
Ultimately, Dr. Boudreaux and colleagues’ study is a clarion call for proactive engagement with the realities posed by climate change on vulnerable populations. It underscores the necessity of integrating environmental exposure data with healthcare resource planning, fostering innovations that bridge gaps in access and quality of perinatal care. By illuminating both the scope of exposure and the breadth of systemic inadequacies, the research paves a path for transformative policy reforms essential to safeguarding the health of pregnant women and infants in an era of unprecedented environmental upheaval.
Subject of Research: Perinatal healthcare system capacity and wildfire smoke exposure impacts on pregnant individuals and infants in the United States
Article Title: Perinatal Resources and Wildfire Smoke
News Publication Date: May 20, 2025
Web References:
https://journals.lww.com/lww-medicalcare/abstract/2025/06000/perinatal_resources_and_wildfire_smoke.2.aspx
Keywords: Health and medicine, Climate change
