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