Wildfire smoke can increase risk of preterm births. Are Black pregnant Angelenos more vulnerable?

Data cited in this article uses cisgender labels to align with how measures have been defined in original data sources. Additionally, per AfroLA’s style guide, we use Latine instead of Latino or Hispanic to describe those of Latin descent in our original reporting. Here’s why.

The smoke, ash and toxins released during January’s disastrous wildfires have impacted the health of nearly everyone in the Los Angeles Basin, regardless of their proximity to the blazes. The harmful effects of the smoke go beyond irritation to our eyes and lungs, and alarmingly, can lead to an increased risk for premature births.

Black pregnant women of all socioeconomic status already have an increased risk of preterm births and pregnancy complications. The lingering smoke and airborne toxins may worsen the risks for Black pregnant Angelenos and their infants.

“I’m always on high alert,” said Dr. Rashida N’gouamba, an African American obstetrician and gynecologist, who has been practicing for nearly two decades. 

The smoke and stress of displacement due to the fires add to those concerns, but she said she’s hopeful that Black women won’t fare poorly.

“We won’t know until the numbers come out, but it could just be my optimism,” said N’gouamba. 

Related read: Doctor first, fire survivor second

She has cared for more than 5,000 patients since starting her private practice in Pasadena in 2019. She also spends time on-call for deliveries at three area hospitals, including Huntington Hospital, also in Pasadena.

N’gouamba was born in Sierra Madre and spent part of her youth in Altadena. She lost her current home, as well as her Altadena childhood house, in the Eaton Fire fire on Jan. 7.

Yet, she returned to work the next day.

“Babies don’t stop,” said N’gouamba, “And I needed something that felt like home. As much time as I’ve spent in the hospital, weirdly enough, it feels like home.”

She has delivered more than a dozen babies since the fires erupted.

N’gouamba’s practice includes a diverse patient population, with about 30-40% Black women, 30% East Asian women and another third who self-identify as white or Latine. 

She is also the mother of two former preterm infants, at 26 weeks and 28 weeks, who are now ages12 and 5.

Babies born at 37 weeks or earlier are preterm, compared to full-term at 38 to 40 weeks gestation. The final weeks of pregnancy are important for the baby’s organs to mature fully. Babies born too soon are at risk for breathing problems, infections, feeding difficulties, brain injury, developmental delays, and even death. 

More premature births among Black women

In Los Angeles County from 2021 to 2023, about 1 in 10 babies from a single-child pregnancy was preterm (versus multiples like twins, triplets). The rates for premature birth were highest for Black Angelenos at 12.5% of babies born, compared to 8% for white residents. For Latine, Indigenous and Asian American Pacific Islander residents, the rates hovered around the overall county average. Nationwide, Black pregnant women have the highest rates of preterm infants at about 1 in 7 births. For other racial/ethnic minority groups, the rates are two to three times higher than for white pregnant women. 

The racial disparities for prematurity and pregnancy complications among Black mothers and infants, compared to whites, have persisted for decades. Although the reasons are complex and not fully understood, systemic and medical racism cannot be overestimated. Higher levels of maternal education and socioeconomic status do not lessen the disparities, underscoring the role of discrimination, according to a report from KFF, formerly named the Kaiser Family Foundation.

A few of the identified factors for the disparities include lower rates of insurance, living in poor neighborhoods with less access to resources or medical care, chronic diseases such as preexisting hypertension and obesity, maternal age (teenage or older than 35) and stress. In addition, Black women are nearly twice as likely as white women (10% compared to 5%) to have late or no prenatal care.

“There’s definitely something in the air. I have nasal irritation and headaches,”
said Silva Stepanian, 32, a multiracial law clerk and patient of N’gouamba.

Stepanian is 29 weeks pregnant with her second child. She, her husband and 20-month-old son were evacuated for a week, which was stressful. Her Sierra Madre house survived but is covered with smoke and ash.

“Initially, I wasn’t as concerned. Now, I’m more concerned because it’s an invisible risk,” said Stepanian.

Exposure to pollution is linked to higher rates of premature births, small infant size and pregnancy complications. In Los Angeles, people of color are more likely than white residents to live in low-income communities. Those neighborhoods are more likely to be close to sources of pollution, such as oil refineries, freeways and manufacturers.

The impact of L.A.’s air pollution

Despite significant improvement in L.A.’s air quality in the past 30 years, in 2023 the area did not meet air quality standards, as set by the Environmental Protection Agency. Los Angeles County has some of the worst air pollution in the nation, suffering through high concentrations of particulate matter called PM₁₀ and PM_2.5, as well as more days of ozone pollution than other U.S. cities. PM₁₀ refers to particulate matter 10 micrometers in size, such as dust or pollen. PM_2.5 particles measure 2.5 micrometers. For comparison, a grain of sand is 90 micrometers. Life-sustaining oxygen molecules are about one-tenth the size of PM_2.5.

Both PM₁₀ and PM_2.5 can be inhaled, and cause irritation in the airways and lungs.

“The smaller, more harmful PM_2.5 [particles] are a mixture of pollutants, and they can penetrate deep into the lungs,” said Roxana Khalili, a postdoc in Environmental Health Sciences  of the Keck School of Medicine of USC.

Khalili’s research is looking at the impact of wildfire smoke upon birth outcomes and children’s health.

She said the miniscule PM_2.5 particles can cross the strict barriers of the placenta, cause inflammation and starve the baby of oxygen and nutrients. 

A review of births in 137 countries found that exposure to PM_2.5 was associated with an increased risk of stillbirth. More PM_2.5 exposure led to higher risk, in the report in the journal Nature. 

he firestorms that ravaged the Pacific Palisades and Altadena/Pasadena areas are the most destructive and expensive in L.A. history. In 2024, those areas had few days with poor quality air. With the January fires, the air quality index (AQI) across Los Angeles has been variable, ranging from poor to good. However, the AQI does not account for all toxins or large particle pollutants, such as ash. 

“Urban wildfires are different from wildlands (fires), because they contain a mixture of materials with houses and buildings burning (like) metals, plastics and more toxic components,” said Khalili.

Pregnant people, children, the elderly and individuals with respiratory or cardiac diseases are especially vulnerable to wildfire smoke.

It is too soon to know the health effects of the January wildfires, but there are actions to help decrease your risks.

N’gouamba encourages her pregnant patients to take steps that help them feel safe and minimize their stress, even if it means not returning to the area right away. 

Stepanian’s baby girl is due April 13, and she is worried about the long-term effects of the fires and toxins in the smoke and ash.

“Our health and wellbeing are what’s important,” said Stepanian. “I want our government to have as much transparency as possible and take measures to safeguard that.”