Ambient Air Pollution, Weather, and Placental Abruption (APWA)

摘要 胎盘早剥导致出血、缺血和胎儿缺氧，给双方带来巨大的健康负担。 母亲和新生儿。了解这种毁灭性产科并发症的病因的努力已经失败- 指指点点。该项目将描绘与环境有关的中断途径，并确定POL的影响。 与急性胎盘早剥和慢性胎盘早剥有关的突变诱因。考虑到四分之一的分离案例 有急性病因，15%的早产可能在未来怀孕时复发，环境触发因素的作用是 非常重要，但尚未探索的机会，了解这种神秘的产科顺应性的病理生理学- 阳离子。该项目将利用高分辨率暴露和健康结果数据，旨在发展出生联系 数据库将包括与死产和活产有关的医院出院情况--#年住院妇女的婴儿死亡 加利福尼亚州、佛罗里达州、马萨诸塞州、密歇根州和南卡罗来纳州(估计出生1600万人，包括155,000人早产 2000-2016年间)。对于每一次怀孕，我们将分配平均每天环境中的细颗粒物暴露。 空气动力学直径PM2.5(≤)，其成分(元素碳和有机碳、硫酸盐、硝酸盐、 以及气态污染物(二氧化氮和臭氧)，使用时空分辨模型 预测每个住宅位置的暴露情况。我们还将为每个住宅分配平均日气温、湿度- 气温、露点、热浪和大气压力。该项目将专注于理清相对贡献 通过双向、时间分层的情况，对环境空气污染和与天气有关的情况进行急性中断- 交叉设计，以及使用队列设计的慢性支撑的早剥。我们将应用分布式LAG 线性和非线性模型用于识别暴露的临界窗口，贝叶斯核机回归用于表征 基于多污染物暴露的关联，以及通过缺血的因果交互-中介分解分析 胎盘疾病(先兆子痫、胎儿发育障碍)。我们将考虑个人和邻里层面的控制- 创始人来自住宅人口普查区域。所有关联都将针对同时暴露和结果进行更正 错误分类，以及通过回归对产妇住所流动造成的暴露测量误差 校准方法。无处不在的空气污染和天气暴露及其对不利环境的潜在影响 围产期结局，以及支持这些关联的初步数据，提供了前所未有的机会 处理空气污染和与天气有关的暴露对胎盘早剥的不利影响的影响 相关产科并发症。该项目与研究的两个主要关键领域--共同曝光和数据科学--保持一致 ENCE和大数据-在NIH的2018-2023年战略目标中概述-国家环境健康科学研究所。

ABSTRACT Placental abruption results in hemorrhage, ischemia, and fetal hypoxia, placing a tremendous health burden on both the mother and the newborn. Efforts to understand the etiology of this devastating obstetrical complication have been disap- pointing. This project will delineate environmentally-associated pathways to abruption and determine the impact of pol- lutant triggers that are implicated in acute versus chronic placental abruption. Given that one-fourth of all abruption cases have an acute etiology and 15% of abruptions may recur in future pregnancies, the role of environmental triggers is a critically important, yet unexplored, opportunity to understand the pathophysiology of this enigmatic obstetrical compli- cation. The project will capitalize on high resolution exposure and health outcome data as it aims to develop a birth linkage database that will include hospital discharges linked to both stillbirths and live births-infant deaths to resident women in California, Florida, Massachusetts, Michigan, and South Carolina (estimated 16 million births, including 155,000 abruption cases) between 2000–2016. For each pregnancy we will assign average daily ambient exposure to fine particulate matter with an aerodynamic diameter ≤2.5 µm (PM2.5), its constituents (elemental carbon and organic carbon, sulfate, nitrate, and ammonium), as well as gaseous pollutants (nitrogen dioxide and ozone), using spatiotemporally resolved models that predict exposure for each residential location. We will also assign every residence with average daily temperature, humid- ity, dew point, heat waves, and atmospheric air pressure. The project will focus on disentangling the relative contributions of ambient air pollution and weather-related conditions on acute abruption through a bi-directional, time-stratified case- crossover design, and those of abruptions with chronic underpinnings using a cohort design. We will apply distributed lag linear and non-linear models to identify critical windows of exposure, Bayesian Kernel Machine Regression to characterize associations based on multi-pollutant exposures, and causal interaction-mediation decomposition analyses through ischemic placental disease (preeclampsia, fetal growth disturbances). We will consider individual– and neighborhood–level con- founders derived from residential census tracts. All associations will be corrected for simultaneous exposure and outcome misclassification, as well as for exposure measurement error owing to maternal residential mobility through a regression calibration approach. The ubiquitous nature of air pollution and weather exposures and their potential impact on adverse perinatal outcomes, as well as the preliminary data supporting the associations, presents unprecedented opportunities to address implications of the adverse impact of air pollution and weather-related exposures on placental abruption and related obstetrical complications. This project aligns with 2 major critical areas of research–Co-exposures, and Data Sci- ence and Big Data–outlined in the 2018-2023 strategic goals of NIH-National Institute of Environmental Health Sciences.