Pregnancy Exposures to Chemical Mixtures and Later Metabolic Health and Endocrine Function Among Women in the Puerto Rico PROTECT Cohort

一项迅速增长的研究表明，接触常见的环境化学物质可以破坏 影响内分泌和代谢功能，并对妊娠结局和儿童发育产生负面影响。研究 还表明，某些妊娠状况(如先兆子痫)和结局(如早产) 与母亲晚年的健康状况不佳有关。然而，对这些关系的研究还很缺乏。 怀孕期间的暴露与母亲后来的健康之间的关系，以及怀孕结果如何影响这些 联想。与美国本土相比，波多黎各的许多发病率都很高， 包括早产和II型糖尿病。波多黎各也有广泛污染的历史。 增加了人类对一系列污染物的暴露。我们在北部海岸建立了保护队列 研究孕期接触一系列环境化学物质的影响 不良妊娠结局。我们已经开发了一个令人难以置信的丰富的暴露数据集，生物标志物 中间效果、问卷和健康记录信息。Protect也是一个参与的队列 在新建立的全美范围内的ECHO研究中，跟踪出生在保护范围内的儿童的发展。 我们建议在这个庞大的数据集的基础上，继续在PROTECT招聘，以及反复 在回声跟踪访问期间与参与者联系，以调查状态和纵向轨迹 1000名孕妇孕后5年内的代谢健康和内分泌功能 在波多黎各。我们有在怀孕期间反复采集的尿液样本的暴露生物标记物数据 邻苯二甲酸盐代谢物、酚/对羟基苯甲酸酯和多环芳烃代谢物，以及在两个尿液中测量的17种金属 还有鲜血。在这项研究中，收集了关于在6个月、1岁、2岁时保护母亲的新数据和样本 在分娩后5年，我们的目标是：1)确定孕妇在怀孕期间是否接触到 与新陈代谢健康的衡量标准和轨迹相关(即，身体尺寸、身体成分、身体状况 体力、临床诊断、血压、血糖、胰岛素、血脂、糖化血红蛋白)在短期和长期 分娩后的跟踪评估；2)调查产妇在分娩期间暴露的关系 妊娠和内分泌功能的纵向测量(例如，雌二醇、睾酮、SHBG、FSH和 AMH)在分娩后的后续评估中；以及3)探索关联的效果修改 从妊娠并发症的前两个目标看妊娠暴露与后来妇女的健康 (妊娠期糖尿病、先兆子痫、早产)和/或社会决定因素(社会经济地位、 社会支持、抑郁、压力、生活经历和其他)和其他身体健康决定因素 (体型、体力活动、母乳喂养、多囊卵巢综合征、月经模式等)。这个 这项研究的预期结果是提供关于以下影响的新的和亟需的信息 怀孕暴露、妊娠结局和社会因素对妇女健康的影响。

A rapidly growing body of research shows that exposure to common environmental chemicals can disrupt endocrine and metabolic function, and negatively impact pregnancy outcomes and child development. Studies also demonstrate that certain pregnancy conditions (e.g., preeclampsia) and outcomes (e.g., preterm birth) are associated with adverse health later in the life of the mother. However, research is lacking on the relationships between exposures in pregnancy and later health of the mother, and how pregnancy outcomes impact those associations. Puerto Rico suffers from elevated rates of numerous morbidities compared to the mainland U.S., including preterm birth and Type II diabetes. Puerto Rico also has a history of extensive contamination with increased human exposure to a range of pollutants. We established the PROTECT cohort in the northern coast of Puerto Rico to study the impacts of exposure to an array of environmental chemicals during gestation and adverse pregnancy outcomes. We have developed an incredibly rich dataset on exposures, biomarkers of intermediate effects, questionnaires, and health record information. PROTECT is also a participating cohort within the newly established US-wide ECHO study, following the development of children born into PROTECT. We propose building upon this vast dataset and continued recruitment in PROTECT, along with the repeated participant contact during the ECHO follow-up visits, to investigate status and longitudinal trajectories of maternal metabolic health and endocrine function for up to five years following pregnancy among 1000 women in Puerto Rico. We have exposure biomarker data from repeated samples collected in pregnancy on urinary phthalate metabolites, phenols/parabens, and PAH metabolites, as well as 17 metals measured in both urine and blood. In this study, with new data and sample collection on PROTECT mothers at 6 months, 1 year, 2 years, and 5 years following delivery, we aim to: 1) Determine whether maternal exposures during pregnancy are associated with measures and trajectories of metabolic health (i.e., body size, body composition, physical strength, clinical diagnoses, blood pressure, and blood glucose, insulin, lipids, HbA1c) in short- and long-term follow-up assessments after delivery; 2) Investigate the relationships between maternal exposures during pregnancy and longitudinal measures of endocrine function (e.g., estradiol, testosterone, SHBG, FSH and AMH) in the follow-up assessments after delivery; and 3) Explore effect modification of the associations between pregnancy exposures and later women’s health from the first two aims by pregnancy complications (gestational diabetes, preeclampsia, preterm birth), and/or by social determinants (socioeconomic status, social support, depression, stress, life experiences, and others) and other physical determinants of health (body size, physical activity, breast feeding, polycystic ovarian syndrome, menstrual patterns, and others). The expected outcomes of this study are to provide new and much needed information on the impacts of pregnancy exposures, pregnancy outcomes, and social factors on women’s health.