Where There’s Smoke, There’s Less Maternity Care

Chart of the Day: New Study Maps Maternity Care Gaps in Smoke-Prone U.S. Counties

July 23, 2025

By:

Christine Weeks

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Illustration is adapted from Figure 1 of the study.

A first-ever study co-authored by LDI Senior Fellow Scott Lorch and led by Michel Boudreaux of the University of Maryland documented perinatal health care resources in communities prone to wildfire smoke. Wildfire smoke is hazardous to everyone, but pregnant people and their infants are particularly vulnerable. Prenatal smoke exposure has been linked to adverse birth outcomes, including low birth weight and pre-term birth. Pollutants in wildfire smoke raise the risks of hypertensive disorders of pregnancy, gestational diabetes, and cardiovascular events.

A map based on the study findings shows the distribution of the relative smoke-risk classifications in 3,108 U.S. counties from 2016 to 2020, superimposed with the locations of maternity care hospitals and NICUs. Counties with moderate or high risk of wildfire smoke exposure have fewer specialized maternity and neonatal health care resources than low-risk counties. High-risk counties are more likely to lack a maternity care hospital and a Neonatal Intensive Care Unit (NICU). According to the researchers, these high-risk areas are home to about 7.3 million reproductive-age women who experience over 460,000 births annually. Another 20 million women who have 1.1 million births every year live in counties with moderate smoke exposure.

High smoke exposure compounds existing infrastructure challenges. The median number of obstetrician-gynecologists was found to be zero in high-risk counties. Family physicians filled gaps, but the lack of obstetric specialists raises concerns for high-risk pregnancies. Maternity services in these areas are typically small, remote, and low-volume, which may affect their ability to triage and transfer patients with complications.

Addressing the Risks of Wildfire Smoke Exposure

Millions of women of reproductive age and their infants will require timely health care in smoke-affected areas. Proactive adjustments to care delivery and funding policies can help ensure more protection for perinatal populations.

Potential actions include:

Public health interventions, including clean air shelters, home air sealing, and distribution of respirators and air filters, can help protect people. A Medicaid Section 1115 waiver in Oregon provides a promising model for financing and deploying these climate-related measures.
The Health Professional Shortage Area (HPSA) and Medically Underserved Area (MUA) designations could be updated to include wildfire smoke exposure.
Provider and facility capacity can be strengthened through investments in patient transfer and transport infrastructure, particularly for obstetric emergencies in remote areas.
Community education initiatives could support informed decision-making during smoke events.

As the risk of wildfires grows, policymakers and clinicians must account for the resulting environmental health challenges when designing health system responses.

The study “Perinatal Resources and Wildfire Smoke” was published in Medical Care on May 12, 2025 by Michel Boudreaux, Maranna Yoder, Evan Ellicott, Molly Passarella, and Scott Lorch.