Air quality and your child

I awaited this year’s summer season with concern. My daughter was getting married in August and family and friends were traveling across the country to attend the wedding at Glacier National Park. Last year at this time, we were covered in smoke and ash as highlighted by KPAX on August 11, 2017. We were fortunate, the closest fires started in the region within hours of the end of the wedding reception. Our friends posted many images on Facebook and social media and flew home. I have since returned to work. I continue to see pregnant women daily and rarely is the subject of their safety from the fires or the air quality raised. That led me to research the impact of poor air quality on reproductive outcomes and search for potential interventions.

Poor air quality has significant impact on pregnant women and young children. There is a high risk for low birth weight, preterm delivery, preeclampsia. Theoretical risks include an increased chance for development of autism and decreased fertility. All exposed are at higher risk for developing and worsening asthma with its inherent risk for complications in pregnancy. AirNow is a government agency that monitors air quality in embassies and consulates around the world. They consider pregnant women a vulnerable population at risk for potentially life-threatening effects due to air pollution due to wildfires. [AirNow.gov]. This is only worsened in women who smoke cigarettes or marijuana, our exposed to second hand smoke. Those with preexisting asthma or chronic lung disease (COPD) are at very high risk. Age, susceptibility, heart disease, pretexting lung disease such also increase the risk of complications.

There are many ways to protect your home and family including:

• Follow the air quality index (AQI). The AQI is readily available on the internet. The higher the number, the worse the air quality. AQI of 0-50 is good, 51-100 is moderate (yellow), 101-150 is unhealthy for sensitive groups including all pregnant women (orange) and 151-200 is unhealthy for everyone (Red).
• For people in a safe location, reduce physical activity. People who are exercising can increase their intake of air by 10-20 fold. Stay inside in a safe place with doors and windows closed. This will reduce exposure by 1/3 or more.
• Reduce indoor air pollution such as cigarettes, gas, propane, wood burning stoves and furnaces, aerosol sprays, frying or boiling meet indoors, burning candles or incense, and vacuuming. Vacuuming may actually increase the particulate levels in your home.
• Obtain a HEPA air purifier [(high efficiency particulate air) check consumerreports.org]. These range in price, so it is important that you understand what you are purchasing and how it may help you.
• Maintain your heating and cooling equipment, changing your air filters regularly.
• Minimize use of candles, incense and wood fires
• Use exhaust fans in kitchen, bath and laundry
• Don’t store chemicals, solvents or pesticides near your living quarters
• Consider air purifying plants such as spider and snake plants
• Use your vent whenever you cook and avoid frying and or broiling.
• Check for mold: check humidity levels, promptly fix leaky roofs, windows and pipes, thoroughly clean and dry after flooding or leaking. Ventilate showers, laundry or cooking areas. (CDC facts about mold, 2018). If mold is growing, you need to clean it up and fix the moisture problem. You can do this yourself or call a mold removal specialist.
• Use carbon monoxide and smoke detectors and remember to check your batteries.
• If you have central air condition, set it to recirculate or close outdoor intakes to avoid bringing smoky air into your home. Consider upgrading your air filter to HEPA with the highest MERV rating suitable to your system.

In the case of evacuation, you must go.

Please consider leaving your home sooner, if an evacuation is a possibility. Hopefully, you can stay with families and friends in a safe place. If not and you are admitted to a shelter, make sure to tell the staff you are pregnant. Seek prenatal care even if it is not your usual provider. Also, take your prescription medications with you and take them as directed. Same for your children’s medical care. If you can’t take prescription medications with you, ask the health care providers at the shelter for assistance in getting them. Make sure any new health care providers know your medical issues and medication history. You should bring your insurance card and any medical records with you. Please make sure to drink lots of water. Avoid breathing smoke and fumes as much as possible and rest as much as possible (CDC Reproductive Health 2018). Avoid exercise. As a temporizing measure, you may consider using a mask. These are of questionable value and vary significantly depending on the type and the filter. It may be dangerous to place an adult size mask on an infant or toddler. Be careful and contact the fire department with questions.

The majority of times, pregnant women and their families who are exposed will do well. Remember to check in with your prenatal providers for usual care and with any specific concerns. If your or your family members are experiencing shortness of breath, difficulty breathing, insomnia, anxiousness or other issues, contact your health care provider or seek emergency care, sooner than later.

Following a smoke event, you will want to clear your home. Be careful, you do not want to use common measures that will re-suspend particles into the air. Use a wet mop, wet dusting, and a HEPA filtered vacuum, if available. Portable air filters using HEPA and electrostatic precipitators (ESPs) may help. They will remove particulates from the air. Spend time in designated clean air shelters, when available.

There are many local resources available including: KRH.org, Flatheadhealth.org, and Montanawildfiresmoke.org. As always, we are always available to answer your questions or concerns at Montana Perinatal Center. Good luck with the fire season and please be safe.

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By Debra Guinn, MD, maternal-fetal specialist, Montana Perinatal Center

Maternal-fetal medicine specialist Debra Guinn, MD, joined Kalispell Regional Healthcare in June 2015, opening the Montana Perinatal Center to care for mothers with high-risk pregnancies and perform diagnostic ultrasound, prenatal diagnosis and fetal therapy. She works together with obstetrical providers, neonatologists, pediatricians, nurses and anesthesiologists to develop an optimal plan of care to promote the health and well-being of both mothers and unborn children. Dr. Guinn serves as the medical director for Kalispell Regional Medical Center’s maternal and fetal medicine program.