Pregnant women living close to the Gaza Strip, where missile alerts and mad dashes to safe rooms are routine occurrences, are far more likely to miscarry than their counterparts in the center of the country, a new study has revealed.
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Researchers at the Ben Gurion University of the Negev and the Gertner Institute for Epidemiology and Health Policy compared 1,132 pregnant women from Sderot, the western Negev town abutting Gaza, with 1,805 women from Kiryat Gat, which suffers from the same poverty as Sderot but experiences significantly fewer missile strikes.
The researchers, whose findings are published in the scientific journal Psychosomatic Medicine of the American Psychosomatic Society, examined the women's pregnancy follow-ups at Barzilai Medical Center in Ashkelon from 2004-2008. Among the women studied, miscarriage occurred 59 percent more often among the Sderot women than it did among the Kiryat Gat women.
Of all the pregnancies recorded during the research period (3,488 pregnancies among 2,937 women), 193 suffered a miscarriage (5.5 percent). Six percent of the Sderot expectant mothers experienced miscarriages compared to 4.7 percent among expectant mothers from Kiryat Gat.
Over the course of those four years, more than 1,000 Code Red missile alerts were heard in Sderot and its surrounding areas. Five hundred of them were sounded in 2008 alone.
The vast majority of Sderot women who were pregnant from 2004-2008 were exposed to Code Red alerts during their pregnancies, with an estimated 2.2 alerts sounding during the six months preceding the pregnancy and an average of 3.5 during the course of the pregnancy. Only seven women studied did not experience a single alert prior or during their pregnancy. One woman was recorded as having heard no fewer than 31 alerts.
There were also differences in early miscarriages, defined as occurring during or before the 12th week of pregnancy. This was the most common period of miscarriage, with 85 percent of miscarrying women losing their babies during this period. Six percent of Sderot expectant mothers experienced early miscarriages, compared with 3.8 percent of the Kiryat Gat expectant mothers.
The number of late miscarriages, occurring between the 12th and 22nd week of pregnancy, was also higher among Sderot women: 1 percent compared to 0.8 percent in Kiryat Gat.
The study also found that even exposure to Code Red alerts in the six months preceding pregnancy increases the risk of miscarriage.
Additional risk factors for miscarriages that were found in the study included a maternal age of over 35, unmarried mothers and those who had undergone four or more pregnancies.
"The findings exemplify the significantly higher risk of miscarriages in women exposed to life-threatening situations for a prolonged period, whether during or before pregnancy," said the study's head researcher, doctoral student Tamar Weinstock of the department of epidemiology at Ben Gurion University.
Later the researchers investigated whether increased exposure to missile alerts increased the risk of miscarriage among pregnant women from Sderot only, but the findings showed a surprisingly different picture: an equally high rate of miscarriage among women exposed to the greatest number of alerts (10.7 percent) and those exposed to the smallest number (also 10.7 percent) in the course of pregnancy, compared to those exposed to an intermediate number (0.9-1.2 percent).
The researchers believe their findings are linked to disturbances in the regulation of the hormone cortisol, popularly known as the "stress hormone." This hormone, secreted by the adrenal gland in response to ACTH, a hormone released by the pituitary gland in the brain, increases with stress, and is linked to miscarriages both when the level is too high and when it is too low.
"It's possible that women who were not exposed much to alerts, and are unaccustomed to them, are at greater risk of stress and high levels of cortisol, whereas with exposure the hormone level declines, and with intensive exposure it even drops too low, which also increases the risk of miscarriage," Weinstock said.
Also participating in the study, which was supervised by Prof. Ilana Shoham Vardi of the department of epidemiology at BGU, were Prof. Liat Lerner-Geva and Prof. Saralee Glasser of the Gertner Institute, and Prof. Eyal Antebi, director of the department of obstetrics and gynecology at Barzilai. Research was partly funded by the Chief Scientist's Research Fund in the Health Ministry.
The study is the latest in a long list of Israeli research testifying to the consequences of missile strikes in highly populated areas of the country. A BGU study published in Haaretz last November, which examined 154 adolescents from a state school in Sderot, found that about half of them (45.5 percent) exhibited signs of post-traumatic stress disorder (PTSD). Another study published in 2008 in the Journal of the American Academy of Child & Adolescent Psychiatry diagnosed high rates of depression among adolescents from Sderot, and another as-yet unpublished study attests to signs of post-traumatic stress disorder among 33 percent of the toddlers growing up in the city.
In a study published last August in Haaretz, researchers from the Hebrew University and the Herzog Hospital in Jerusalem, Bar Ilan University and the University of Southern California examined students aged 13 to 17 from 72 high schools in the north of the country. They found that a year after the Second Lebanon War signs of post-traumatic stress were present among 6.9 percent of them, with Arabs (9.1 percent) showing more symptoms than Jews (4.1 percent). Another study reported last month, conducted at the University of Haifa, found that women from the north who were exposed to the war in the summer of 2006 and later conceived exhibited higher levels of anxiety about their children than did women from the center of the country, and their children suffered from developmental gaps as well.