Environmental exposures and prenatal stress related to Hurricane Maria among pregnant women in Puerto Rico: Characterization and impact on birth outcomes

项目摘要/摘要 飓风玛丽亚是80多年来袭击波多黎各的最强飓风，恢复和 清理工作一直缓慢得令人痛苦。玛丽亚去世两个月后，该岛60%的地区仍然断电，许多人 波多黎各人仍在努力寻找足够的住房、清洁的水和食物。 在玛丽亚之前，环境 波多黎各的污染范围已经很广，玛丽亚可能会造成洪水和破坏 加剧了这些状况。这可能导致大量接触到一系列危险的 对许多波多黎各人来说是一种物质。延长的恢复期也可能增加了对 由于大量使用燃气发电机造成的环境污染，使用水的情况不确定 饮用、烹饪和洗涤的来源，以及罐头和包装食品消费的增加，所有这些 对健康有潜在影响。经历一场创伤性的自然灾害本身也会有长期的 对身心健康的影响。在怀孕期间暴露于此类事件与 增加早产、低出生体重和其他不良出生结局的风险。然而，以前没有 研究评估了飓风前后化学物质暴露和压力的测量方法 同样的人群，因此确定特定的、可改变的、与飓风相关的不利出生风险因素 结果是不可能的。 拟议的研究将利用正在进行的纵向出生队列，波多黎各测试网站 探索污染威胁(保护)，其中93名参与者在飓风玛丽亚时怀孕 登陆了。这项研究的目标是1)评估与飓风相关的一系列 污染物(金属、多环芳烃(PAHs)、邻苯二甲酸盐、苯酚、对羟基苯甲酸酯)和 在飓风玛丽亚袭击时怀孕的保护参与者中的心理压力 岛屿，2)确定与飓风有关的暴露和压力的来源，3)评估这些影响 暴露于出生结局，如早产、胎龄和出生体重。现有生物 样本和产前数据，包括接触尿液生物标记物和关于母亲压力的问卷 和抑郁，将在拟议的工作中使用。 此外，飓风过后的尿样，压力 还将收集一份关于飓风相关经历的调查问卷。在.之前 飓风玛丽亚，波多黎各的早产率已经是美国和世界上最高的之一， 因此，确定需要帮助的个人，以及高度脆弱的内部的可修改的风险因素 及时满足人口需求是至关重要的。

PROJECT SUMMARY / ABSTRACT Hurricane Maria was the most powerful hurricane to hit Puerto Rico in over 80 years, and recovery and clean-up has been painfully slow. Two months after Maria, 60% of the island is still without electricity and many Puerto Ricans are still struggling to find adequate housing, clean water, and food. Prior to Maria, environmental contamination in Puerto Rico was already extensive, and flooding and damage caused by Maria likely exacerbated these conditions. This has potentially resulted in considerable exposure to a range of hazardous substances for many Puerto Ricans. The extended recovery period has also likely increased exposures to environmental contaminants due to extensive use of gas powered generators, use of water from uncertain sources for drinking, cooking, and washing, and increased consumption of canned and packaged foods, all with potential impacts on health. Experiencing a traumatic natural disaster can itself also have long-term physical and psychological health effects. Exposure to such events during pregnancy has been associated with increased risk of preterm birth, low birth weight, and other adverse birth outcomes. However, no previous studies have evaluated measures of both chemical exposure and stress both before and after the hurricane in the same population, so identification of specific, modifiable, hurricane-related risk factors for adverse birth outcomes has not been possible. The proposed research will leverage an ongoing longitudinal birth cohort, the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT), in which 93 participants were pregnant when Hurricane Maria made landfall. The goals of this research are to 1) assess hurricane-related exposure to a range of contaminants (metals, polycyclic aromatic hydrocarbons (PAHs), phthalates, phenols, parabens), and psychological stress, among PROTECT participants who were pregnant when Hurricane Maria struck the island, 2) identify sources of hurricane-related exposures and stress, and 3) evaluate the effects of these exposures on birth outcomes, such as preterm birth, gestational age, and birth weight. Existing biological samples and prenatal data, including urinary biomarkers of exposure and questionnaires on maternal stress and depression, will be utilized in the proposed work. In addition, post-hurricane urine samples, stress questionnaires, and an additional questionnaire on hurricane-related experiences will be collected. Prior to Hurricane Maria, Puerto Rico’s preterm birth rate was already among the highest within the U.S. and the world, so identifying individuals in need of help, as well as modifiable risk factors within this highly vulnerable population in a timely manner is critical.