Air Pollution Exposure during Pregnancy, Maternal Glycemia, and OffspringGrowth

 描述(申请人提供)：儿童肥胖症是一种全球性流行病，并伴有昂贵的并发症。在美国，肥胖率在过去40年里增长了两倍。饮食、体力活动和遗传因素不能解释体重的所有变化，而且很难改变。因此，确定环境触发因素和可行的公共卫生干预措施 这是政策上的当务之急。该研究小组先前的数据表明，产前暴露在空气污染中与母亲高血糖和胎儿生长减慢有关。矛盾的是，我们还证明了更大的产前交通污染与婴儿出生后超重体重增加之间的关联，从而导致婴儿肥胖的风险更高。在我的指导团队的指导下，在这个为期5年的K23职业发展奖期间，候选人将利用来自两个预期的母亲和孩子纵向队列的数据(Viva项目，n=2,128和新汉普郡出生队列研究(NHBCS)，n=1,500)，通过三个相互关联的项目来扩展这项先前的工作。首席调查员将：(1)研究出生前暴露在环境空气污染中是整个儿童期体重快速增长和儿童期中期中心脂肪增加的风险因素。(2)考虑出生前空气污染暴露与肥胖相关激素生物标志物的关系，包括儿童时期的瘦素、脂联素和胰岛素抵抗。(3)描述新英格兰农村地区与室内空气污染源相关的暴露和习惯，并估计怀孕期间室内燃烧木材与母亲高血糖、胎儿生长和儿童早期体重增加的关联程度。拟议的培训计划将建立在我的儿科内分泌学临床培训和生物统计学和流行病学基础知识的基础上，以提供以下方面的正式培训：(1)环境暴露评估，(2)分析复杂暴露-反应关系所需的统计技术，以及(3)领导研究团队所需的实用技能。候选人将利用波士顿儿童医院、人口医学系(哈佛医学院和哈佛朝圣者医疗保健)、哈佛公共卫生学院和达特茅斯儿童环境健康和疾病预防研究中心的丰富资源来进行拟议的分析。这些研究和培训将为她开始作为一名独立内科研究员的职业生涯奠定必要的科学框架，研究环境毒物对儿童健康的影响，重点是肥胖和胰岛素抵抗。

 DESCRIPTION (provided by applicant): Childhood obesity is a global epidemic with costly comorbidities. In the US, the rate of obesity has tripled over the past 40 years. Diet, physical activity, and genetics do not explain all of the variability in weight, and moreover can be difficut to modify. Identifying environmental triggers and feasible public health interventions is therefore a policy imperative. Prior data from this team has suggested an association of prenatal exposure to air pollution with maternal hyperglycemia and reduced fetal growth. Paradoxically we have also demonstrated an association between greater prenatal traffic-related pollution and excess infant weight gain after birth, leading to higher risk for obesity in infancy. With the guidance of my mentoring team, during this 5 year K23 career development award, the Candidate will leverage data from two prospective longitudinal cohorts of mothers and children (Project Viva, n=2,128 and the New Hampshire Birth Cohort Study (NHBCS), n=1,500) to extend this prior work through three inter-related projects. The Principal Investigator will: (1) examine prenatal exposure to ambient air pollution as a risk factor for rapid weight trajectories throughout childhood and central fat accrual in mid-childhood. (2) consider the relationship of prenatal air pollution exposure with obesity-associated hormonal biomarkers, including leptin, adiponectin, and insulin resistance in childhood. (3) characterize exposures and habits related to indoor sources of air pollution in rural New England and estimate the extent to which indoor wood burning during pregnancy is associated with maternal hyperglycemia, fetal growth, and offspring weight gain in early childhood. The training plan proposed will build upon my clinical training in pediatric endocrinology and basic knowledge of biostatistics and epidemiology to provide formal training in (1) environmental exposure assessment, (2) statistical techniques necessary to analyze complex exposure-response relationships, and (3) the practical skills necessary to lead a research team. The Candidate will leverage the wealth of resources available at Boston Children's Hospital, the Department of Population Medicine (Harvard Medical School and Harvard Pilgrim Health Care), the Harvard School of Public Health, and the Dartmouth Children's Environmental Health and Disease Prevention Research Center to conduct the proposed analyses. These studies and training will lay the necessary scientific framework to launch her career as an independent physician researcher studying the impact of environmental toxicants on children's health, with a focus on obesity and insulin resistance.