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

环境空气污染、天气和胎盘早剥 (APWA)

• 批准号: 10487587
• 负责人: Cande V. Ananth
• 金额: $ 64.27万
• 依托单位: RBHS-ROBERT WOOD JOHNSON MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-10 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10487587
• 关键词: Abruptio Placentae; Acute; Address; Affect; Air Pollutants; Air Pollution; Air Pressure; Ammonium; Area; Big Data; Biological; Birth; Blood flow; Caliber; Calibration; California; Carbon; Censuses; Chronic; Conceptions; Crossover Design; Data; Data Science; Databases; Discipline of obstetrics; Etiology; Event; Exposure to; Fetal Growth; Fetal Growth Retardation; Fetal Heart Rate; First Pregnancy Trimester; Florida; Functional disorder; Future; Gestational Diabetes; Goals; Health; Heat Waves; Hemorrhage; High temperature of physical object; Hospitals; Humidity; Individual; Inflammatory; Inhalation; Ischemia; Link; Live Birth; Location; Massachusetts; Measurement; Mediating; Mediation; Michigan; Mothers; National Institute of Environmental Health Sciences; Nature; Neighborhoods; Newborn Infant; Nitrates; Nitrogen Dioxide; Non-linear Models; Outcome; Ozone; Particulate Matter; Partner in relationship; Pathway interactions; Physiological; Placenta; Placenta Diseases; Pre-Eclampsia; Pregnancy; Pregnant Women; Premature Birth; Premature Rupture Fetal Membranes; Process; Public Health; Research; Residential Mobility; Resolution; Risk; Risk Factors; Role; Severities; Socioeconomic Status; South Carolina; Sulfate; Temperature; Time; United States National Institutes of Health; Ursidae Family; Uterine Contraction; Weather; Woman; ambient air pollution; base; cohort; cold temperature; design; early pregnancy; extreme heat; fetus hypoxia; fine particles; implantation; infant death; obstetrical complication; perinatal outcomes; policy implication; pollutant; population based; predictive modeling; premature; prepregnancy; residence; spatiotemporal; stem; stillbirth; thrombotic

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.

摘要 胎盘脱垂导致出血、缺血和胎儿缺氧，对胎儿和新生儿造成巨大的健康负担。 母亲和新生儿努力了解这一毁灭性的产科并发症的病因已经失望- 指点。该项目将描绘与环境相关的路径，以避免和确定污染的影响， 与急性和慢性胎盘脱垂有关的潜在触发因素。鉴于四分之一的自杀案件 由于胎盘早剥的病因是急性的，并且15%的胎盘早剥可能会在未来的怀孕中复发，因此环境触发因素的作用是一个重要因素。 至关重要的，但未经探索的，机会来了解这种神秘的产科并发症的病理生理学， 阳离子该项目将利用高分辨率暴露和健康结果数据，因为它旨在建立出生联系 该数据库将包括与死产和活产有关的医院出院情况， 加州、佛罗里达、马萨诸塞州、密歇根州和南卡罗来纳州（估计有1600万新生儿，其中包括155，000名新生儿 2000年至2016年之间。对于每次怀孕，我们将指定平均每日环境暴露于细颗粒物 空气动力学直径≤2.5 µm（PM2.5），其成分（元素碳和有机碳，硫酸盐，硝酸盐， 和氨），以及气态污染物（二氧化氮和臭氧），使用时空分辨模型， 预测每个居住地点的暴露量。我们还会给每个住处分配平均日气温，湿度- 温度、露点、热浪和大气压力。该项目将侧重于理清 环境空气污染和与天气有关的条件对急性呼吸道疾病的影响，通过双向、时间分层的情况- 交叉设计，以及使用队列设计的慢性基础的预防。我们将应用分布滞后 线性和非线性模型来识别暴露的关键窗口，贝叶斯核机器回归来表征 基于多污染物暴露的关联，以及通过缺血性脑卒中的因果相互作用-介导分解分析， 胎盘疾病（先兆子痫、胎儿生长障碍）。我们将考虑个人和社区层面的欺诈行为 创始人来自居民普查区。所有关联都将得到纠正，以同时暴露和结果 错误分类，以及暴露测量错误，由于产妇居住的流动性，通过回归 校准方法空气污染和天气暴露的普遍性及其对不利环境的潜在影响 围产期的结果，以及支持协会的初步数据，提供了前所未有的机会， 解决空气污染和天气相关暴露对胎盘保护的不利影响， 相关的产科并发症。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。 环境与大数据--NIH-国家环境健康科学研究所2018-2023年战略目标中概述的。