Mycotoxin Exposure in Pregnancy and Birth Outcomes in Zimbabwe

津巴布韦妊娠和分娩结果中的霉菌毒素暴露

• 批准号: 8822411
• 负责人: REBECCA J STOLTZFUS
• 金额: $ 31.04万
• 依托单位: CORNELL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-01-15 至 2016-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8822411
• 关键词: Affect; Aflatoxin M1; Aflatoxins; Africa; Africa South of the Sahara; Age; Age-Months; Albumins; Anemia; Animal Model; Biological Markers; Birth; Carcinogens; Child; Child health care; Chinese People; Communities; Developed Countries; Developing Countries; Development; Environment; Environmental Pollution; Exposure to; Family; Fetal Growth; Fetal Growth Retardation; Fetus; Food; Food Safety; Foundations; Fumonisins; Funding; Gestational Age; Goals; Growth and Development function; HIV; Harvest; Health; Household; Human; Hygiene; Infant; Infant Health; Insulin-Like Growth Factor I; Intervention; Joints; Knowledge; Lead; Life; Link; Liver; Low Birth Weight Infant; Maize; Malignant neoplasm of liver; Maternal Exposure; Maternal and Child Health; Measures; Molds; Mothers; Mycotoxins; Outcome; Placenta; Placental Insufficiency; Policies; Population; Population Study; Populations at Risk; Pregnancy; Pregnancy Outcome; Pregnancy Trimesters; Pregnancy loss; Pregnant Women; Premature Birth; Premature Labor; Prevalence; Public Health; Rain; Randomized Controlled Trials; Recruitment Activity; Relative (related person); Reporting; Research; Research Infrastructure; Risk; Rural; Sampling; Sanitation; Severities; Small for Gestational Age Infant; Source; Spontaneous abortion; Surveys; System; Testing; Toxic effect; Toxin; Water; Woman; Zimbabwe; base; cohort; critical period; cytotoxic; data management; deoxynivalenol; efficacy trial; feeding; fetal; high risk; immune activation; improved; in utero; infancy; infant nutrition; maternal serum; novel; premature; public health relevance; reproductive; screening; stillbirth; urinary; Affect; Aflatoxin M1; Aflatoxins; Africa; Africa South of the Sahara; Age; Age-Months; Albumins; Anemia; Animal Model; Biological Markers; Birth; Carcinogens; Child; Child health care; Chinese People; Communities; Developed Countries; Developing Countries; Development; Environment; Environmental Pollution; Exposure to; Family; Fetal Growth; Fetal Growth Retardation; Fetus; Food; Food Safety; Foundations; Fumonisins; Funding; Gestational Age; Goals; Growth and Development function; HIV; Harvest; Health; Household; Human; Hygiene; Infant; Infant Health; Insulin-Like Growth Factor I; Intervention; Joints; Knowledge; Lead; Life; Link; Liver; Low Birth Weight Infant; Maize; Malignant neoplasm of liver; Maternal Exposure; Maternal and Child Health; Measures; Molds; Mothers; Mycotoxins; Outcome; Placenta; Placental Insufficiency; Policies; Population; Population Study; Populations at Risk; Pregnancy; Pregnancy Outcome; Pregnancy Trimesters; Pregnancy loss; Pregnant Women; Premature Birth; Premature Labor; Prevalence; Public Health; Rain; Randomized Controlled Trials; Recruitment Activity; Relative (related person); Reporting; Research; Research Infrastructure; Risk; Rural; Sampling; Sanitation; Severities; Small for Gestational Age Infant; Source; Spontaneous abortion; Surveys; System; Testing; Toxic effect; Toxin; Water; Woman; Zimbabwe; base; cohort; critical period; cytotoxic; data management; deoxynivalenol; efficacy trial; feeding; fetal; high risk; immune activation; improved; in utero; infancy; infant nutrition; maternal serum; novel; premature; public health relevance; reproductive; screening; stillbirth; urinary

DESCRIPTION (provided by applicant): Intrauterine insults can increase the risk of adverse birth outcomes, including miscarriage, prematurity, stillbirth and low birth weight. Mycotoxins are produced by molds that contaminate staple foods. One family of mycotoxins, aflatoxins (AF), has been widely studied and is known to cause liver cancer. Two other mycotoxins, fumonisin (FUM) and deoxynivalenol (DON) are often co-contaminants with AF in maize. All three mycotoxins have been shown to cross the placenta and may affect the fetus during critical periods of growth and development; however, none of these toxins or their combination has been rigorously studied with regard to pregnancy outcomes. The objective of this application is to characterize pregnancy exposure to multiple mycotoxins and its relation to birth outcomes in rural Zimbabwe. Our over-arching hypothesis is that AF exposure, alone or in combination with FUM and DON, is an important cause of adverse birth outcomes (poor fetal growth, miscarriage, stillbirth and preterm birth) globally. Our approach takes advantage of a large pregnancy cohort with outstanding field, lab and data management funded by the Bill & Melinda Gates Foundation (BMGF): the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial. Birth outcomes (miscarriage, stillbirth, prematurity, small-for-gestational age and stunted-for-gestational age) are already being measured, and we have strong evidence that mycotoxin exposures are prevalent and significant in this study population. The SHINE trial, an ongoing community-based trial of 4800 mother-infant pairs recruited during the first half of pregnancy in two rural districs of Zimbabwe. SHINE is a factorial cluster-randomized controlled trial investigating the independent and combined effects of improved water, sanitation and hygiene (WASH) and/or improved infant and young child feeding (IYCF) on stunting and anemia at 18 months of age. In this proposal, we leverage the existing SHINE infrastructure to assess mycotoxin exposure during pregnancy. Specific Aim 1 is to describe the prevalence and severity of multiple mycotoxin exposures in a large representative sample of pregnant women in rural Zimbabwe. Specific Aim 2 will characterize the relationship between maternal serum aflatoxin-albumin concentration during pregnancy and adverse birth outcomes [preterm birth, low birth weight (LBW), small-for-gestational age (SGA) and short-for-gestational age] in HIV-negative mothers Specific Aim 3 will explore the joint exposures of FUM, DON and AF in relation to risk of preterm birth. The proposed research will generate novel information about the burden of multiple mycotoxins (AF, FUM, DON) during pregnancy and the relative contribution of aflatoxin exposure to adverse birth outcomes. This evidence will provide foundations for future research exploring the potential mechanisms linking mycotoxin exposure to adverse birth outcomes and provide a rationale for the development and targeting of interventions to reduce mycotoxin exposure during pregnancy.

描述（由申请人提供）：宫内侮辱可以增加出生不良后果的风险，包括流产，早产，死产和低出生体重。霉菌毒素是 由污染主食食物的霉菌产生。霉菌毒素的一个家族Aflatoxin（AF）已被广泛研究，已知会引起肝癌。另外两种霉菌毒素，即富莫诺（FUM）和脱氧烯醇（DON）通常是与玉米中AF的共同毒素。所有三种霉菌毒素均已证明可以越过胎盘，并可能在生长和发育的关键时期影响胎儿。但是，这些毒素或它们的组合都没有在妊娠结局方面进行严格研究。该应用的目的是表征妊娠暴露于多种霉菌毒素及其与津巴布韦农村地区的出生结果的关系。我们的整理假设是，在全球范围内，AF暴露是单独或与FUM和DON结合的AF暴露是不良出生结果（胎儿生长，流产，死产和早产）的重要原因。 我们的方法利用了由Bill＆Melinda Gates Foundation（BMGF）资助的杰出领域，实验室和数据管理的大型怀孕队列：卫生卫生婴儿营养效能（Shine）试验。出生结果（流产，死产，早产，小胎龄和胎龄发育不良）已经被衡量，我们有强有力的证据表明，霉菌毒素暴露在这项研究人群中是普遍存在的，并且在这项研究人群中很重要。 Shine Trial是一项持续的基于社区的试验，该试验在津巴布韦的两个乡村分心中，在怀孕上半年招募了4800个母亲对。 Shine是一项阶乘聚类的对照试验，研究了改善水，卫生和卫生（WASH）的独立和综合作用和/或改善的婴儿和幼儿喂养（IYCF）在18个月大时发育迟缓和贫血。 在此提案中，我们利用现有的Shine基础设施来评估怀孕期间的霉菌毒素暴露。具体目的1是描述津巴布韦农村孕妇的大量代表性样本中多种霉菌毒素暴露的患病率和严重程度。具体目标2将表征孕妇血清黄曲毒素 - 珠蛋白在怀孕期间的浓度和不良的出生结果[早产，低出生体重（LBW），小孕年（SGA）和短期妊娠年龄和HIV阴性母亲在特定的目标3将探索fum fum和Af Priperation fifortive fiforpription the HIV-MOTHER MOTHER 3将探索fum fum和Af fiforation for in Af fiforation。拟议的研究将产生有关怀孕期间多种霉菌毒素（AF，FUM，DON）负担的新信息，以及黄曲霉毒素暴露于不良出生结果的相对贡献。该证据将为未来的研究提供基础，探讨将霉菌毒素暴露与不良出生结果联系起来的潜在机制，并为开发和靶向干预措施提供了降低怀孕期间霉菌毒素暴露的基本原理。