Stress, Lead, Iron Deficiency and Neurodevelopment

描述（由申请人提供）：社会压力、缺铁性贫血和铅暴露都是幼儿神经发育不良的环境风险因素。这三个因素在墨西哥或美国的贫困社区都非常普遍。关于慢性社会压力和人类神经发育的人类流行病学研究很少。此外，以前的儿童发育和神经毒物的研究通常分析了社会压力的协变量标志物作为神经发育的独立预测因子;因此，在他们的数据分析中只考虑社会因素作为潜在的混杂因素。有生物学上的理由相信压力会增强缺铁性贫血和铅中毒的毒性。如果是这样的话，那么理解这种关系可能是设计有效的公共卫生干预措施，旨在改善神经发育的关键，并可能解释缺乏有效的预防/治疗方案铅中毒和缺铁。需要进行一项大样本量的前瞻性队列研究，以解决联合应激/缺铁性贫血和联合应激/铅暴露在预测婴儿发育中的潜在倍增效应。本次重新提交包括自上次申请以来在120对母婴中进行的压力-铅/压力-贫血相互作用的试点研究的新数据，这证明了研究的可行性和假设相互作用的证据。在这个应用程序中，我们将测量产妇的压力水平，婴儿缺铁性贫血和铅暴露在一个队列的母婴对生活在墨西哥城和纵向测量产妇的压力，铁存储，铅暴露，唾液皮质醇和神经发育开始产前和产后3年延长。该项目将确定产前和产后母亲压力对预测婴儿发育的独立影响，以及母亲压力/缺铁和母亲压力/铅中毒对预测婴儿发育的多重联合影响。

DESCRIPTION (provided by applicant): Social stressors, iron deficiency anemia, and lead exposure are all environmental risk factors for poor neurodevelopment in young children. All three factors are highly prevalent in poor communities, whether in Mexico or the U.S. There are scant human epidemiologic studies on chronic social stress and human neurodevelopment. In addition, previous studies of child development and neurotoxicants have typically analyzed covariate markers of social stress as independent predictors of neurodevelopment; and thus, only considered social factors as potential confounders in their data analysis. There are biological reasons to believe that stress potentiates the toxicity of iron deficiency anemia and lead poisoning. If so, then understanding this relationship may be the key to designing effective public health interventions designed to improve neurodevelopment and may explain the lack of effectiveness of prevention/treatment regimens for lead poisoning and iron deficiency. A prospective cohort study with a large sample size is needed to address the potential multiplicative effects of combined stress/iron deficiency anemia and combined stress/lead exposure in predicting infant development. This resubmission includes new data from a pilot study of stress-lead/stress-anemia interactions in 120 mother infant pairs conducted since the prior application, which demonstrates study feasibility and evidence for the hypothesized interactions. In this application we will measure maternal stress levels, infant iron deficiency anemia and lead exposure in a cohort of mother-infant pairs living in Mexico City and longitudinally measure maternal stress, iron stores, lead exposure, salivary cortisol and neurodevelopment beginning pre-natally and extending 3 years post-partum. This project will determine the independent effect of pre- and post-partum maternal stress in predicting infant development, and the multiplicative joint effects of maternal stress/iron deficiency and maternal stress/lead poisoning in predicting infant development.