Evaluating the effect of water fluoridation on adverse birth outcomes

项目摘要/摘要 这项K99/R00提案的目的是评估社区水氟化对有害物质的影响 加州的出生结局并确定是否有特别容易患上这种疾病的亚群 孕期接触氟化物。已经在供水中添加了氟化物，以促进 自1945年以来一直在美国，但对妊娠结局的影响从未被评估过。 孕妇和宫内胎儿暴露在氟化物中可能会增加早产和小儿麻痹的风险。 胎龄。其他国家的少量研究表明，患癌症的风险增加 出生结局与饮用天然高氟化物的水有关，有证据表明 摄入氟化物会影响甲状腺功能和心血管系统，这两个方面都发挥着重要作用 在调节和维持健康怀孕方面的作用。自1995年以来，加利福尼亚州一直要求供水系统与AT 至少10,000个服务连接来为他们的水加氟，但系统只需要实施 一旦资金分配到位，就会实施氟化计划。因此，存在着大量的可变性 在过去的25年里，哪些供水系统添加了氟化物，以及它们何时添加了氟化物。 我们将利用加州水加氟实践中的这种变化来(1)确定变化的影响 2006-2017年间在水中加氟对不良生育结局的影响和(2)评估是否有 母亲/胎儿特征和环境共同暴露的异质性暴露效应。 此外，我们将使用ECHO.CA.IL妊娠队列，该队列由孕妇和他们的 旧金山和伊利诺伊州的儿童，以(3a)评估母亲第二次尿氟是否 妊娠三个月与胎龄减少或出生时出生体重与胎龄z分数降低有关 以及(3b)根据母亲/胎儿的特征评估暴露是否存在异质性影响，以及 环境共同暴露。 这项研究计划得到了旧金山大学杰出的指导团队和培训计划的支持 加利福尼亚州，弗朗西斯科。拟议的项目以申请者在围产期流行病学和 提供新的统计方法方面的培训，以确定不同的暴露影响和教育 妊娠和分娩的生物过程，环境化学品的暴露评估，以及 向政策制定者转化科学发现。综合研究和培训计划将使 转变为独立研究与政策相关的社会和环境因素的候选人 塑造围产期健康。 这项研究与NIEHS的战略目标一致，即评估暴露组对健康的影响，确定个人 易受环境危害的影响，利用数据科学技术，并生成可以 被政策制定者用来改善人口健康。

Project Summary/Abstract The objective of this K99/R00 proposal is to estimate the effect of community water fluoridation on adverse birth outcomes in California and identify whether there are subpopulations who are especially vulnerable to fluoride exposure during pregnancy. Fluoride has been added to water supplies to promote dental health in the United States since 1945, but the impacts on pregnancy outcomes have never been assessed. It is possible that maternal and in-utero fetal exposure to fluoride increases risk of preterm birth and small-for- gestational age. A small number of studies in other countries suggest there is an increased risk of adverse birth outcomes associated with drinking water with naturally high levels of fluoride, and evidence suggests fluoride consumption can affect thyroid function and cardiovascular systems, both of which play important roles in regulating and maintaining a healthy pregnancy. Since 1995, California has required water systems with at least 10,000 service connections to fluoridate their water, but systems were only required to implement a fluoridation program once the funds were allocated. Therefore, there is a substantial amount of variability in which water systems have added fluoride over the last 25 years, and when they did so. We will leverage this variation in water fluoridation practices in California to (1) identify the effects of changes in water fluoridation on adverse birth outcomes during 2006-2017 and (2) evaluate whether there are heterogeneous exposure effects by maternal/fetal characteristics and environmental co-exposures. Furthermore, we will use the ECHO.CA.IL pregnancy cohort, which is composed of pregnant women and their children in San Francisco and Illinois, to (3a) assess whether maternal urinary fluoride during the second trimester is associated with reduced gestational age or lower birthweight-for-gestational-age-z-scores at birth and (3b) evaluate whether there are heterogeneous effects of exposure by maternal/fetal characteristics and environmental co-exposures. The research plan is bolstered by an exceptional mentorship team and training plan at the University of San Francisco, California. The proposed project builds on the applicant’s background in perinatal epidemiology and provides training in new statistical methods to identify heterogeneous exposure effects and education in the biological processes of gestation and parturition, exposure assessment of environmental chemicals, and translating scientific findings to policymakers. The combined research and training plans will enable the candidate to transition into an independent researcher of policy-relevant social and environmental factors that shape perinatal health. This research aligns with NIEHS’s strategic goals to evaluate health effects of the exposome, identify individual susceptibilities to environmental hazards, utilize data science techniques, and generate evidence that can be utilized by policymakers to improve population health.