Bio-Specimen Assessment of Fire Effects (B-SAFE) Pregnancy Study

摘要 2018年11月8日，北加州巴特县发生营火。这是最致命的一次 加州历史上最具破坏性的野火，烧毁面积超过153,336英亩，86人确认死亡，超过 18500座建筑物被毁，其中包括近14000座住宅。超过5万人被疏散。这场大火 不同寻常的不仅是它的规模和蔓延到城市地区的速度，而且是在广阔的地区 笼罩在烟雾中，持续了两个星期，直到第一次降雨。野火冒出的烟雾 烟羽迅速蔓延到加州北部的大片地区，空气质量指数处于危险状态 加州北部大部分地区连续两周的水平，颗粒物浓度为2.5微米(PM2.5) 达到该地区有记录以来的最高水平，包括萨克拉门托等大城市地区， 奥克兰、旧金山和圣何塞，数百万人受到影响，其中包括约10万名孕妇。确实有 人们普遍担心这些城市野火对健康的潜在影响，以及如何减轻其影响， 特别是在弱势群体中，如孕妇及其发育中的孩子。暴露在极端环境中 近两周来，野火PM2.5水平对大多数无法离开北方的人来说是不健康的 城市野火烟雾的独特成分使加州雪上加霜。一系列潜在的有毒物质 挥发性有机化合物可能会随着广泛使用的化学品的高温燃烧而释放 建筑结构和室内陈设，如溶剂、胶水、金属、甲醛和卤素。 此外，像其他灾难一样，本质上是不可预测的自然力量，威胁着人类和 财产，野火可能会导致情绪和心理社会痛苦，并可能产生长期后果，如 持续的创伤后应激症状和抑郁。暴露在污染物和压力下 如果在关键时期实施联合行动，可能会产生严重的长期发展后果 怀孕了。R21的目标是迅速建立处于不同阶段的女性队列 在营火中怀孕和他们的孩子，收集生物样本和调查信息，将使用 在未来确定暴露负荷、机械反应、健康生物标记物和发育的研究中 结果。该队列将有两个符合资格的分支：a)居住在我们的目标区域内离火灾最近的人 并在可行的驾驶距离内亲自怀孕、分娩、产后探视和未来的随访- 北加州在营火中怀孕的妇女将完成一项在线调查并 邮寄生物标本。从卫星和地面估算参与者近地表野火PM2.5暴露量 监测数据、潜在的暴露减少行为和居住方面将根据以下方面进行检查 母体症状、应激生物标记物、儿童胎龄和出生体重。这群人和 通过这项提议建立的生物信息库将支持未来的研究，以了解并尽量减少 未来野火的发展影响，因为它们在数量、持续时间和强度上都在增加。

Abstract On November 8th, 2018, the Camp Fire erupted in Northern California's Butte County. It was the deadliest and most devastating wildfire in California history, with over 153,336 acres burned, 86 confirmed fatalities, over 18,500 structures destroyed including nearly 14,000 residences. Over 50,000 people were evacuated. This fire was unusual not only in its scale and the rapidity of its spread to urban areas, but also in the vast area blanketed in smoke that followed for a defined window of two weeks until the first rainfall. The wildfire smoke plume spread quickly across vast areas of Northern California, and the air quality index was at hazardous levels for most of Northern California for two weeks, with particulate matter <2.5 µm (PM2.5) concentrations reaching the highest levels ever recorded in the region, including large metropolitan areas like Sacramento, Oakland, San Francisco, and San Jose, affecting millions, including ~100,000 pregnant women. There are widespread concerns about potential health impacts of these urban wildfires and how to mitigate their effects, especially in vulnerable populations like pregnant women and their developing children. Exposure to extremely unhealthy levels of wildfire PM2.5 for nearly two weeks for the majority who were unable to leave Northern California are compounded by the unique composition of urban wildfire smoke. An array of potentially toxic volatile organic compounds may be released with high temperature combustion of chemicals widely used in building construction and interior furnishings, such as solvents, glues, metals, formaldehydes, and halogens. Additionally, like other disasters that act as inherently unpredictable forces of nature that threaten person and property, wildfires can induce emotional and psychosocial distress and potentially long-term consequences like persistent post-traumatic stress symptoms and depression. Exposures to contaminants and stress in combination could have serious long-term developmental consequences if delivered during critical periods in pregnancy. The goal of this R21 is to rapidly establish a cohort of women who were at different stages of pregnancy during the Camp Fire and their children, collect biosamples and survey information that will be used in future studies to determine exposure loads, mechanistic responses, health biomarkers and developmental outcomes. The cohort will have two eligibility arms: a) those residing within our target area closest to the fire and within a feasible driving distance for in-person pregnancy, delivery, and postnatal visits and future follow- up and b) women in Northern California pregnant during the Camp Fire who will complete an online survey and mail in biospecimens. Participant near-surface wildfire PM2.5 exposure estimated from satellite and ground monitor data, potential exposure-reducing behaviors, and residence aspects will be examined in relation to maternal symptoms, stress biomarkers, and child gestational age and birthweight. The cohort and biorepository established through this proposal will support future studies to understand and minimize the developmental effects of future wildfires, as they increase in number, duration, and intensity.