Environmental Influences on Child Health Outcomes in Puerto Rico (ECHO-PRO)

项目摘要：在危重胎儿时期暴露在复杂的环境应激源中 儿童发育期是公共卫生的一个重要但研究不足的领域，特别是在 再加上心理社会因素和其他可能改变这些暴露影响的因素。现有研究 通常调查单一毒物或暴露的影响，因此不能反映儿童 同时体验各种曝光组合。 为了解决这一差距，拟议的环境对波多黎各儿童健康结果的影响 (ECHO-PRO)将利用波多黎各活跃的出生队列并在此基础上再接再厉(“保护”，P42ES017198) 最近启动了婴儿/儿童后续行动(“CRECE”，P50ES026049)。ECHO-PRO将提供数据和 为570对已参加保护/CREE队列的母婴以及 再招募1100名孕妇，多生990个孩子，总共有1560对母子 (研究完成后保留率为88%)，并将数据和生物样品整合到回声中 财团。 为了实现这一点，我们将利用我们成熟的保护/认证基础设施和我们的经验 在招募、跟踪、样本和数据收集、管理和分析方面，(A)招募孕妇 妇女，(B)通过以下途径收集和分析孕期、出生时和每年探视儿童时的生物样本 5岁，以及(C)收集通过以下途径收集的详细人口统计、健康和暴露信息 怀孕期间、出生时和每年探视儿童时的问卷、评估和病历摘要 一直到5岁。 此外，多学科的ECHO-PRO团队将研究(使用新的统计方法进行分析 指混合物)多重环境暴露和暴露混合物的影响；特别是 接触常见混合物(母亲、宫内和/或儿童早期)之间的关系 环境污染物(空气污染、金属、多环芳烃、邻苯二甲酸盐、 酚类、对羟基苯甲酸酯)，以及它们在四种回声上的机械中介和修饰因子 结果领域：(1)不利的分娩结果，包括早产、胎儿发育迟缓和出生 缺陷，(2)肥胖，包括母亲孕期血糖和儿童肥胖的衡量标准，以及 心脏代谢健康，(3)神经发育，包括儿童个人-社会、适应性、运动、 沟通和认知能力；(4)呼吸健康，包括衡量儿童心肺功能 花纹、肺体积和呼吸道症状。最后，ECHO-PRO将整合和比较数据 通过我们的队列获得的总体回声数据，以更好地了解环境对 波多黎各和美国本土的儿童健康状况。

PROJECT SUMMARY: Exposure to a complex mix of environmental stressors during critical fetal and childhood development periods is an important yet understudied area of public health, particularly when coupled with psychosocial and other factors that may modify the effects of these exposures. Existing studies usually investigate the effect of single toxicants or exposures and so do not reflect the reality that children experience combinations of exposures simultaneously. To address this gap, the proposed Environmental Influences on Child Health Outcomes in Puerto Rico (ECHO-PRO) will leverage and build upon an active birth cohort in Puerto Rico (“PROTECT”, P42ES017198) that has recently initiated infant/child follow-up (“CRECE”, P50ES026049). ECHO-PRO will provide data and biospecimens for 570 mother-child pairs already participating in the PROTECT/CRECE cohort, as well as recruit an additional 1100 pregnant women, yielding 990 more children, for a total of 1560 mother-child pairs (88% retention by completion of study) with data and biospecimens to be integrated into the ECHO Consortium. To accomplish this, we will use our established, proven PROTECT/CRECE infrastructure and our experience in recruitment, follow up, sample and data collection, management and analysis, to (a) recruit pregnant women, (b) collect and analyze biological samples during pregnancy, at birth and at annual child visits through age 5, and (c) collect detailed demographic, health, and exposure information collected through questionnaires, evaluations and medical record abstraction during pregnancy, at birth and at annual child visits through age 5. In addition, the multidisciplinary ECHO-PRO team will study (using novel statistical methods for analysis of mixtures) the impact of multiple environmental exposures and exposure mixtures; specifically the relationship between exposure (maternal, in utero and/or during early childhood) to common mixtures of environmental contaminants (air pollution, metals, polycyclic aromatic hydrocarbons, phthalates, phenols, parabens), as well as their mechanistic mediators and modifying factors, on the four ECHO outcome domains: (1) adverse birth outcomes, including preterm birth, reduced fetal growth, and birth defects, (2) obesity, including maternal gestational glycemia and measures of child adiposity and cardiometabolic health, (3) neurodevelopment, including measures of child personal-social, adaptive, motor, communication and cognitive abilities and (4) respiratory health, including measures of child cardiorespiratory patterning, lung volume, and respiratory symptoms. Finally, ECHO-PRO will integrate and compare data obtained through our cohort with the overall ECHO data to better understand the environmental influences on child health outcomes in Puerto Rico and the U.S. mainland.