Environmental and Social Health Determinants of Pregnancy Outcomes Related to COVID-19 Pandemic

COVID-19大流行对孕妇来说是一个独特的挑战。不良妊娠结局（例如 妊娠糖尿病、先兆子痫和子痫、早产、产前抑郁症和产后抑郁症 抑郁症）可能会因COVID-19大流行而恶化。最近的一些研究表明， < 2.5 µm的细颗粒物（PM2.5）和二氧化氮（NO2）可能会增加对SARS的易感性- CoV-2感染，疾病严重程度和一般人群的死亡率。有理由假设， 环境空气污染可能会增加与COVID-19相关的不良妊娠结局的风险 流行病但空气污染的影响加上母亲的合并症和社会人口 与COVID-19大流行相关的不良妊娠结局的决定因素尚未确定。这 一个时间敏感的竞争性修订将扩大空气污染和怀孕的母研究的范围 复杂城市环境中的并发症：风险、异质性和机制（R 01 ES 030353） 研究空气污染与COVID-19大流行相关的主要不良孕产妇结局的关系 在Kaiser电子健康记录数据库中的大量不同孕妇人群中， 永久南加州（目标1），并进一步研究SARS-CoV-2感染的作用，预先存在的 comorbidity，和社会人口因素对这些协会（目标2）。我们有一个多学科的团队 具有环境暴露评估、环境流行病学、母胎医学、 和生物统计学来研究具体目标。据我们所知，这是第一次研究，以确定 空气污染与COVID-19大流行相关的不良妊娠结局之间的关联。拟议 研究有几个主要的创新和方法优势，包括1）大（67,000交付期间， 2019冠状病毒病疫情及疫情前45，000宗分娩）及多元化人口（大部分来自 种族和少数民族群体）; 2）高质量、前瞻性记录和时间分辨的个体水平 结果和潜在影响因素的临床数据，包括基于以下数据的COVID-19病例数据： 孕妇的普遍筛查; 3）调查空气污染暴露与 产前和产后抑郁症; 4）SARS-CoV-2感染的效应修改分析， 5）高时空分辨率PM2.5暴露估计基于 密集的地面传感器网络数据;以及6）彻底检查来自 个体层面的母体因素（如吸烟、体力活动）和其他环境暴露（如 热浪和绿色空间）。这项研究将产生关于空气污染对环境影响的新知识。 与2019冠状病毒病疫情相关的不良孕产妇结局。由于空气污染是一个可改变的风险因素， 研究可以帮助推进干预措施，以减少与COVID-19相关的不良妊娠结局 流行病

The COVID-19 pandemic is uniquely challenging for pregnant women. Adverse pregnancy outcomes (e.g. gestational diabetes, pre-eclampsia & eclampsia, preterm birth, antepartum depression, and postpartum depression) are likely worsened by the COVID-19 pandemic. A few recent studies have shown that ambient fine particulate matter < 2.5 µm (PM2.5) and nitrogen dioxide (NO2) may increase the susceptibility to SARS- CoV-2 infection, severity of illness, and mortality in the general population. It is reasonable to hypothesize that ambient air pollution may likely increase the risk of adverse pregnancy outcomes related to COVID-19 pandemic. But the effect of air pollution coupled with maternal comorbidities and sociodemographic determinants on adverse pregnancy outcomes related to COVID-19 pandemic has not been established. This time-sensitive competing revision will extend the scope of the parent study of Air Pollution and Pregnancy Complications in Complex Urban Environments: Risks, Heterogeneity, and Mechanisms (R01ES030353) by examining associations of air pollution with major adverse maternal outcomes related to COVID-19 pandemic among the large diverse pregnant women population from the electronic health record database of Kaiser Permanente Southern California (Aim 1), and further studying the role of SARS-CoV-2 infection, preexisting comorbidity, and sociodemographic factors on these associations (Aim 2). We have a multi-disciplinary team with expertise in environmental exposure assessment, environmental epidemiology, maternal-fetal medicine, and biostatistics to examine the specific aims. To our knowledge, this is the first study to determine the association of air pollution with adverse pregnancy outcomes related to COVID-19 pandemic. The proposed study has several major innovations and methodological strengths, including 1) large (67,000 deliveries during the COVID-19 pandemic and 45,000 deliveries before the pandemic) and diverse population (the majority from racial and ethnic minority groups); 2) high quality, prospectively-recorded, and time-resolved individual-level clinical data for both outcomes and potential effect modifiers, including COVID-19 case data based on universal screening of pregnant women; 3) investigation associations between air pollution exposure and antepartum and postpartum depression; 4) analysis of effect modification by SARS-CoV-2 infection, comorbidity, and sociodemographic factors; 5) high spatiotemporal resolution PM2.5 exposure estimates based on dense ground-level senor network data; and 6) thorough examination of potential confounding from individual-level maternal factors (e.g. smoking, physical activity) and other environment exposures (e.g. heatwave and green space). This study will generate new knowledge about the impact of air pollution on adverse maternal outcomes related to COVID-19 pandemic. As air pollution is a modifiable risk factor, this study can help advance interventions to reduce the adverse pregnancy outcomes related to COVID-19 pandemic.