Air Pollution and Pregnancy Complications in Complex Urban Environments: Risks, Heterogeneity, and Mechanisms

复杂城市环境中的空气污染和妊娠并发症：风险、异质性和机制

• 批准号: 10398024
• 负责人: Darios Getahun
• 金额: $ 57.26万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10398024
• 关键词: Accounting; Address; Adverse effects; Affect; Air; Air Pollutants; Air Pollution; Asthma; Birth; Birth Certificates; Blood Pressure; Body mass index; California; Cardiovascular Diseases; Characteristics; Classification; Clinical; Clinical Data; Complex; Confidence Intervals; County; Data; Development; Diagnosis; Ear; Eclampsia; Electronic Health Record; Employment; Environmental Exposure; Environmental Risk Factor; Event; Exposure to; Fetal Death; Fetus; Gestational Diabetes; Health protection; Heterogeneity; Humidity; Individual; Infection; Intervention; Knowledge; Link; Live Birth; Maternal Exposure; Measures; Mediating; Mediation; Mediator of activation protein; Metabolic Diseases; Methods; Modeling; Modification; Mothers; Neighborhoods; Noise; Nose; Occupations; Odds Ratio; Outcome; Particulate Matter; Pathway interactions; Patient Self-Report; Perinatal mortality demographics; Pharyngeal structure; Physical activity; Postpartum Period; Pre-Eclampsia; Predisposition; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy Rate; Pregnant Women; Recording of previous events; Records; Regression Analysis; Research; Resources; Respiratory Tract Infections; Risk; Role; Smoking; Socioeconomic Factors; Socioeconomic Status; Statistical Methods; Taxes; Temperature; Test Result; Time; Upper Respiratory Infections; Weather; adverse birth outcomes; adverse pregnancy outcome; base; built environment; cohort; comorbidity; design; fetal; gestational weight gain; high risk; maternal comorbidity; maternal condition; member; novel; offspring; parity; perinatal morbidity; perinatal outcomes; pollutant; pregnancy hypertension; prepregnancy; pressure; primary outcome; prospective; secondary analysis; spatiotemporal; time use; urban setting; walkability

Pregnancy complications (e.g. gestational diabetes [GDM], gestational hypertension [GHTN], and pre- eclampsia & eclampsia [PE/E] are major causes of perinatal morbidity and mortality. Studies have examined associations of air pollution with pregnancy complications, but have major limitations, including 1) reliance on birth certificates or billing/claims data where information may be missing or of questionable validity to ascertain outcomes and co-morbidities; 2) limited consideration of effect confounding and/or modification by other environmental factors; 3) air pollution exposure misclassification due to lack of residential address history; 4) focus on individual air pollutants rather than air pollutant mixtures; 5) lack of focus on the heterogeneity of the risk from air pollution by time and place of exposures, maternal conditions, other environmental factors, and sub-types of outcomes; 6) lack of understanding of the mediation pathways linking maternal co-morbidity with outcomes. We propose a 4-year study to address these limitations and advance knowledge of the impact of air pollutant mixture on pregnancy complications. We will leverage state-of-the-art spatiotemporal air pollution modeling and novel statistical methods that examine both individual and composite exposure profiles with a longitudinal (pre-conception through postpartum) pregnancy cohort of ~400,000 singleton pregnancies in 2008-2018 that result in a live birth or fetal death after 20 weeks gestation that have prospectively-recorded high quality clinical data and residential addresses from the electronic health record (EHR) of Kaiser Permanente Southern California members in 8 southern California counties. Primary outcomes are GHTN, PE/E, GDM. We will estimate individual-level air pollutant exposures (particulate matter and its composition and traffic-related pollutants using sophisticated spatiotemporal models), weather (air temperature, relative humidity, pressure), and built environment measures (greenness, walkability, noise, neighborhood resources) based on prospectively-recorded maternal addresses. Covariates we will examine include maternal comorbidities; history of previous pregnancies and outcomes; individual and contextual socioeconomic status (SES) indicators; employment during pregnancy and job classification; self-reported physical activity and smoking. Complementary statistical methods will be used to evaluate effects of exposure to a mixture of air pollutants while accounting for co-exposure to weather, built environment, and SES. We will examine effect modifications by SES, maternal factors, and other environmental exposures, and the potential mediating role of maternal factors on associations between air pollution and the outcomes. We will elucidate risk of pregnancy complications from air pollution exposure, heterogeneity of risk due to SES, maternal conditions, and other environmental factors, potential underlying mechanisms, susceptible sub-populations, and time windows of susceptibility. Identification of modifiable environmental risk factors and high-risk subpopulation may help to design targeted interventions to reduce these risks and associated adverse maternal and fetal outcomes.

妊娠并发症（例如妊娠糖尿病[GDM]，妊娠高血压[GHTN]和前 子痫和eClampsia [pe/e]是围产期发病率和死亡率的主要原因。研究检查了 空气污染与妊娠并发症的关联，但有重大局限性，包括1）依赖 出生证明或计费/索赔数据可能缺少信息或可疑有效性以确定 结果和合并症； 2）有限考虑效果的混淆和/或其他修改 环境因素； 3）由于缺乏住宅地址历史，空气污染暴露误差误分类； 4） 专注于单个空气污染物而不是空气污染物混合物； 5）缺乏对异质性的关注 遭受暴露时间和地点的空气污染风险，产妇状况，其他环境因素以及 结果的子类型； 6）缺乏对将母体合并症与与之联系的调解途径的了解 结果。我们提出了一项为期4年的研究，以解决这些局限性并提高有关影响的知识 空气污染物混合物在妊娠并发症中。我们将利用最新的时空空气污染 建模和新颖的统计方法，这些方法都检查了个人和复合暴露概况 纵向（通过产后征收前）怀孕左右，约有40万个单胎怀孕 2008-2018导致20周妊娠后现场出生或胎儿死亡已预期录制 Kaiser的电子健康记录（EHR）的高质量临床数据和住宅地址 南加州8个县的南加州长期成员。主要结果是GHTN， pe/e，gdm。我们将估算个体水平的空气污染物暴露（颗粒物及其组成 使用复杂的时空模型和与交通相关的污染物），天气（空气温度，相对 湿度，压力）和建筑环境措施（绿色，步行性，噪音，邻里资源） 基于前瞻性录制的孕产妇地址。我们将研究的协变量包括孕产妇 合并症；以前的怀孕和结局的历史；个人和上下文的社会经济地位 （SES）指标；怀孕和工作分类期间的就业；自我报告的体育活动和 吸烟。互补的统计方法将用于评估暴露于空气混合物的影响 污染物在考虑到天气，建筑环境和SES的共同暴露时。我们将检查效果 SES，母体因素和其他环境暴露的修改以及潜在的中介作用 孕产妇关于空气污染与结果之间的关联因素。我们将阐明怀孕的风险 空气污染的并发症，由于SES引起的风险异质性，孕妇状况和其他 环境因素，潜在的潜在机制，易感子人群和时间窗口 敏感性。确定可修改的环境风险因素和高风险亚群可能有助于 设计有针对性的干预措施，以降低这些风险以及相关的不良母体和胎儿结果。