{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T01:02:23Z","timestamp":1791594143871,"version":"4.3.4"},"reference-count":56,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,11]],"date-time":"2021-02-11T00:00:00Z","timestamp":1613001600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012856","name":"Alberta Children\u2019s Hospital Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012856","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009192","name":"Alberta Innovates","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009192","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000066","name":"Canadian Child Health Clinician Scientist Program","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000066","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Cuthbertson & Fischer Chair in Pediatric Mental Health"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>In June 2013, the city of Calgary, Alberta and surrounding areas sustained significant flooding which resulted in large scale evacuations and closure of businesses and schools. Floods can increase stress which may negatively impact perinatal outcomes and mental health, but previous research is inconsistent. The objectives of this study are to examine the impact of the flood on pregnancy health, birth outcomes and postpartum mental health.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Linked administrative data from the province of Alberta were used. Outcomes included preterm birth, small for gestational age, a new diagnoses of preeclampsia or gestational hypertension, and a diagnosis of, or drug prescription for, depression or anxiety. Data were analyzed using a quasi-experimental difference in difference design, comparing flooded and non-flooded areas and in affected and unaffected time periods. Multivariable log binomial regression models were used to estimate risk ratios, adjusted for maternal age. Marginal probabilities for the difference in difference term were used to show the potential effect of the flood.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Participants included 18,266 nulliparous women for the pregnancy outcomes, and 26,956 women with infants for the mental health analysis. There were no effects for preterm birth (DID 0.00, CI: -0.02, 0.02), small for gestational age (DID 0.00, CI: -0.02, 0.02), or new cases of preeclampsia (DID 0.00, CI: -0.01, 0.01). There was a small increase in new cases of gestational hypertension (DID 0.02, CI: 0.01, 0.03) in flood affected areas. There were no differences in postpartum anxiety or depression prescriptions or diagnoses.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The Calgary 2013 flood was associated with a minor increase in gestational hypertension and not other health outcomes. Universal prenatal care and magnitude of the disaster may have minimized impacts of the flood on pregnant women.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0246670","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T16:26:26Z","timestamp":1613147186000},"page":"e0246670","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":35,"title":["Birth outcomes, pregnancy complications, and postpartum mental health after the 2013 Calgary flood: A difference in difference analysis"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9749-1955","authenticated-orcid":true,"given":"Erin","family":"Hetherington","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamala","family":"Adhikari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lianne","family":"Tomfohr-Madsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Patten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Metcalfe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,2,11]]},"reference":[{"key":"pone.0246670.ref001","volume-title":"EMDAT: the OFDA\/CRED International Disasters Data Base","author":"Center for Research on the Epidemiology of Disasters","year":"2020"},{"issue":"1","key":"pone.0246670.ref002","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1093\/epirev\/mxi004","article-title":"Global health impacts of floods: epidemiologic evidence","volume":"27","author":"M Ahern","year":"2005","journal-title":"Epidemiologic reviews"},{"issue":"4","key":"pone.0246670.ref003","doi-asserted-by":"crossref","first-page":"e0119929","DOI":"10.1371\/journal.pone.0119929","article-title":"Flooding and mental health: a systematic mapping review","volume":"10","author":"A Fernandez","year":"2015","journal-title":"PloS one"},{"key":"pone.0246670.ref004","article-title":"Intergovernmenal Panel of Climate Change","year":"2015","journal-title":"Climate Change 2014 Synthesis Report"},{"key":"pone.0246670.ref005","unstructured":"Government of Alberta. 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in eight affected counties of New York State","volume":"678","author":"J Xiao","year":"2019","journal-title":"Science of the Total Environment"},{"issue":"1","key":"pone.0246670.ref036","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/1471-2393-9-21","article-title":"Postpartum mental health after Hurricane Katrina: A cohort study","volume":"9","author":"EW Harville","year":"2009","journal-title":"BMC pregnancy and childbirth"},{"issue":"1\u20132","key":"pone.0246670.ref037","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.jad.2011.08.021","article-title":"The impact of the catastrophic earthquake in China\u2019s Sichuan province on the mental health of pregnant women","volume":"136","author":"Z Qu","year":"2012","journal-title":"Journal of affective disorders"},{"issue":"1","key":"pone.0246670.ref038","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12982-015-0042-7","article-title":"County-level hurricane exposure and birth rates: 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medication during pregnancy: does it differ by the class of antidepressant medication prescribed?","volume":"64","author":"K Adhikari","year":"2019","journal-title":"The Canadian Journal of Psychiatry"},{"issue":"2","key":"pone.0246670.ref042","doi-asserted-by":"crossref","first-page":"e35","DOI":"10.1542\/peds.108.2.e35","article-title":"A new and improved population-based Canadian reference for birth weight for gestational age","volume":"108","author":"MS Kramer","year":"2001","journal-title":"Pediatrics"},{"issue":"13","key":"pone.0246670.ref043","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1111\/1471-0528.13254","article-title":"Validation of an obstetric comorbidity index in an external population","volume":"122","author":"A Metcalfe","year":"2015","journal-title":"BJOG: An International Journal of Obstetrics & Gynaecology"},{"issue":"3","key":"pone.0246670.ref044","article-title":"Validation of perinatal data in the Discharge Abstract Database of the Canadian Institute for Health Information","volume":"29","author":"K Joseph","year":"2009","journal-title":"Chronic Diseases and Injuries in Canada"},{"issue":"1","key":"pone.0246670.ref045","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/1471-2377-13-16","article-title":"Mental comorbidity and multiple sclerosis: validating administrative data to support population-based surveillance","volume":"13","author":"RA Marrie","year":"2013","journal-title":"BMC neurology"},{"issue":"4","key":"pone.0246670.ref046","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1017\/S2045796015000463","article-title":"Comparison of the estimated prevalence of mood and\/or anxiety disorders in Canada between self-report and administrative data","volume":"25","author":"S O\u2019Donnell","year":"2016","journal-title":"Epidemiology and psychiatric 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