Michael Welton is Post-Doctoral Research Fellow & Teaching Associate in the College of Public Health at University of Georgia. Welton works with the Human Subjects & Sampling Core within PROTECT  as well as the Human Subjects Core in CRECE, and has been working on the NIH funded ZIP Study (Zika in Infants and Pregnancy) for the past 2.5 years. Welton travels from Georgia to Puerto Rico on a monthly basis to work directly with the team to implement study activities. Most recently, Welton has been awarded a grant by the National Institute of Environmental Health Sciences (NIEHS) to conduct research on Hurricane Maria’s impacts on preterm birth on the island. His research will include PROTECT and ZIP participants, and will hone in on how the traumatic experiences of the hurricane and the prolonged recovery affected birth outcomes.

Marked disparities in maternal health and pregnancy outcomes have existed between Puerto Rico and the mainland U.S. prior to Hurricanes Irma & Maria passing through the Caribbean in September 2017. In recent years, Puerto Ricans had a 23% higher rate of preterm birth, a 35% higher rate of low birth weight in babies, and 38% higher infant mortality rate [1]. Additionally, the teen birth rate in Puerto Rico was 67% higher and the rate of unintended pregnancy was 75% higher than in the U.S. as a whole [2, 3]. It is not unreasonable to expect these disparities to widen as it has been shown that planned and unplanned pregnancies have both been shown to increase following a natural disaster.

The overarching goal of this study is to assess the impact of Hurricane Irma and Maria on preterm birth and other pregnancy outcomes. In this study Welton aims to recruit 400 ZIP and PROTECT participants who were pregnant during or within the 6 month following hurricane Irma and/or Maria. The questionnaires that will be administered will include questions about hurricane experience specifically related to Puerto Rico and also contain two scales that were used following hurricanes Katrina and Sandy: The Traumatic Exposure severity scale (TESS) and Hurricane Related Traumatic Experiences (HURTE). These questionnaire assess traumatic exposures related to Resource Loss, Damage to Home and Goods, Personal Harm, Concern for Significant Others, and Exposure to the Grotesque.


In the 21st century, climatology models have been used to predict increases in tropical cyclone activity. Expectant and new mothers are a vulnerable part of any population and need special consideration in preparing for future natural disasters in order to help protect the public’s health from extreme weather events. Since Hurricane Maria’s path directly impacted the communities in which the PROTECT and ZIP participants live and currently, there is very little known about the impact of natural disaster on perinatal health; the infrastructure of PROTECT and ZIP offers a unique opportunity to learn more about the relationship of hurricane disasters and adverse pregnancy outcomes. Luckily, Welton’s research will ultimately help inform future post-event recovery and healthcare needs. This study, although conducted in Puerto Rico, has implications for populations in all hurricane prone areas in the United States, more specifically the Atlantic and Pacific regions and will contribute towards both the CRECE and PROTECT Center’s goals.

Congrats, Michael! The PROTECT and CRECE teams are proud of this major achievement.

  1. March of Dimes, Peristats: State Data Puerto Rico. 2016. https://www.marchofdimes.org/peristats/Peristats.aspx
  2. Centers for Disease Control and Prevention (CDC), Women’s Health Statisitcs: Puerto Rico. 2016.
  3. William D. Mosher, J.J., Joyce C. Abma, Intended and Unintended Births in the United States: 1982–2010. National Health Statistics Reports, 2012. (55).