Environmental chemical exposures during pregnancy and women's cardio-metabolic health

项目摘要 虽然许多研究致力于探索环境化学品暴露的影响， 怀孕对婴儿和儿童健康的影响，相对较少关注这些潜在的影响， 产妇健康的风险。最近的证据表明，怀孕可能是一个敏感时期的生活 在此期间，化学品暴露可能对心脏代谢疾病风险产生长期影响 在女性中。使用一项充分表征的现有队列研究，该研究于2009年招募了1，410名孕妇， 2014年，我们提出了以下目标：（1）量化环境暴露之间的关系， 怀孕和短期产妇健康结果，包括：产后体重保持，减少 母乳喂养的开始和持续时间，以及糖尿病的发病率;（2）量化环境因素之间的关系， 怀孕期间的暴露和长期产妇健康结果：身体组成、体重轨迹 从怀孕到分娩后约10年，肝脏脂肪、代谢异常和糖尿病，以及 心血管疾病;（3）评估母亲的特征和行为的潜在作用， 怀孕，特别是肥胖和饮食质量，在改变环境化学物质之间的关联， 暴露和结果。妊娠期间的暴露将包括血清全氟烷基和多氟烷基物质 （PFAS）、尿邻苯二甲酸酯代谢物、酚类和对羟基苯甲酸酯、金属、有机磷酸盐阻燃剂，以及 在母亲怀孕期间居住的空气污染物模型。我们计划招募700名 原始研究参与者在产后约10年时返回进行随访。在这次访问中，与会者将 通过空气置换进行全面的代谢健康评估，包括身体成分 体积描记法（BODPOD）、通过口服葡萄糖耐量试验的代谢异常和通过MRI的肝脂肪分数。 将提取医疗记录，以记录糖尿病和心血管疾病事件，并 重建体重轨迹。我们将评估怀孕期间暴露与 使用协变量调整的多变量回归模型对连续、二元或时间- 事件数据。暴露将作为单一污染物和混合物进行评估， 统计方法，包括贝叶斯核机器回归和贝叶斯分层考克斯生存 模型我们假设孕妇怀孕前的体重指数和怀孕期间的饮食质量 将改变环境化学品暴露对心脏代谢结果的影响， 在怀孕期间肥胖或饮食质量差的女性中， 怀孕这项研究的结果将为公共卫生干预提供信息，以确定可能被感染的妇女。 特别是在怀孕期间容易受到环境化学品暴露的影响， 怀孕的环境，以促进后代和母亲的长期健康。

Project Summary While much research has been devoted to exploring the impact of environmental chemical exposures during pregnancy on infant and child health, relatively little attention has focused on the potential influence of these exposures on maternal health. Recent evidence suggests that pregnancy may be a sensitive period in the life course, during which chemical exposures may have long-lasting effects on cardio-metabolic disease risk among women. Using a well-characterized existing cohort study that enrolled 1,410 pregnant women in 2009- 2014, we propose the following aims: (1) quantify the relationship between environmental exposures during pregnancy and short-term maternal health outcomes including: postpartum weight retention, reduced breastfeeding initiation and duration, and incident diabetes; (2) quantify the relationship between environmental exposures during pregnancy and long-term maternal health outcomes: body composition, weight trajectories from pregnancy through ~10 years after parturition, hepatic fat, dysglycemia and incident diabetes, and cardiovascular disease; and (3) evaluate the potential role of maternal characteristics and behaviors during pregnancy, specifically obesity and diet quality, in modifying associations between environmental chemical exposures and outcomes. Exposures during pregnancy will include serum per- and polyfluoroalkyl substances (PFAS), urinary phthalate metabolites, phenols and parabens, metals, organophosphate flame retardants, and modeled air pollutants at the maternal residential address during pregnancy. We propose to recruit 700 of the original study participants to return for a follow-up visit at ~10 years postpartum. At this visit, participants will undergo a comprehensive metabolic health evaluation including body composition via air displacement plethysmography (BOD POD), dysglycemia via oral glucose tolerance test, and hepatic fat fraction via MRI. Medical records will be abstracted to document incident diabetes and cardiovascular disease, and to reconstruct body weight trajectories. We will estimate associations between exposures during pregnancy and maternal outcomes using covariate-adjusted multivariable regression models for continuous, binary, or time-to- event data, as appropriate. Exposures will be evaluated as single pollutants and as mixtures using advanced statistical methods including Bayesian Kernel Machine Regression and Bayesian hierarchical Cox survival models. We hypothesize that maternal body mass index prior to pregnancy and diet quality during pregnancy will modify the effects of environmental chemical exposures on cardio-metabolic outcomes, such that associations will be stronger among women with obesity entering pregnancy or with poor diet quality during pregnancy. The results of this study will inform public health interventions to identify women who may be especially susceptible to the effects of environmental chemical exposures during pregnancy, and to improve the environment of pregnancy to promote the long-term health of both the offspring and the mother.