Prenatal Environment And Child Health (PEACH) in ECHO

ECHO产前环境和儿童健康（PEACH） 摘要 很少有可修改的因素已被确定，改善神经发育（ND）的结果。其中一个因素， 补充叶酸（SFA），在怀孕前和怀孕后的第一周， 在随机试验中，试管缺陷（NTD）高达70%，启动强制性粮食强化和指南 对于可能或已经怀孕的人摄入SFA，随后血液叶酸增加 浓度和降低NTD患病率。虽然一般被认为是公共卫生的成功， 在美国的亚群中分布不均匀，西班牙裔人群的风险更高 对于NTD，更可能有次优叶酸状态，并且不太可能服用SFA。此外，生物 这种保护背后的机制尚不清楚。产前SFA和足够的叶酸状态已经成为 与改善的行为和语言结果，更高的执行功能和降低的风险， 注意力缺陷/多动障碍（ADHD）、自闭症谱系障碍（ASD）和相关特征。高 叶酸/SFA也被证明可以降低与几种污染物暴露相关的风险增加 在研究中代表性不足和/或更有可能具有次优 叶酸状态和不太可能满足SFA摄入量的建议。一个实例包括个人应用中的增塑剂。 护理产品在西班牙裔人群中更普遍，并与ND风险增加有关， 减毒的产前SFA。需要消除在理解和执行标准财务附件措施方面存在的许多差距， 解决，以增加公共卫生影响的SFA干预措施，以充分发挥其潜力：1）如何 SFA启动的时间及其与血液叶酸的相关性在不同亚群中有何不同？2)什么另一个孩子 健康结果与产前SFA和血液叶酸有关？3)这些关联如何区别于 SFA摄入的时间和剂量？4)SFA和叶酸浓度的剂量和时间如何与 不同遗传、环境和营养背景的人，其改善的儿童结局不同？ 5)围受孕期SFA/叶酸状态是否改变了环境污染物之间的关系，包括 新的化学物质，和ND的结果，包括行为问题和高度自闭症特征？6)什么生物 在子宫内通过围受孕期SFA和次优叶酸状态改变途径？7)这些生物 与已知的ND途径有关的途径？8)怀孕伴侣的孕前叶酸水平与 胎盘表观遗传学和孩子的结果有什么关系我们强大的团队在生殖、生殖健康、 环境和营养流行病学，相互作用，表观遗传学和ND评估，加上充足的 经验从事社区合作伙伴，将招募740个期待家庭在北方加州代表 不同的种族，民族，社会经济，遗传和环境背景，以丰富ECHO队列， 参与者传统上在研究中代表不足，以解决这些差距，并产生将 为公共卫生政策提供大量信息，以便更有效地改善儿童发展成果。

Prenatal Environment And Child Health (PEACH) in ECHO Abstract Few modifiable factors have been identified that improve neurodevelopmental (ND) outcomes. One such factor, supplemental folic acid (SFA), taken before and during the first weeks post-conception, reduced risk for neural tube defects (NTDs) by up to 70% in randomized trials, initiating mandatory food grain fortification and guidelines for SFA intake for people who could or had become pregnant, with subsequent increases in blood folate concentrations and reduced NTD prevalence. While generally regarded as a public health success, the impacts have not been evenly distributed across sub-populations within the US, with Hispanic populations at higher risk for NTDs, more likely to have suboptimal folate status, and less likely to take SFA. Further, the biologic mechanisms behind this protection remain unclear. Prenatal SFA and adequate folate status has since been associated with improved behavioral and language outcomes, higher executive functioning, and reduced risk for attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and associated traits. High folate/SFA has also been shown to attenuate increased risks associated with several contaminant exposures that are more prevalent in groups that are under-represented in research and/or more likely to have sub-optimal folate status and less likely to meet SFA intake recommendations. One example includes plasticizers in personal care products that are more prevalent in Hispanic populations and are linked to increased ND risk which is attenuated with prenatal SFA. Many gaps in understanding and implementation of SFA measures need to be addressed to increase the public health impact of SFA interventions to their fullest potential: 1) How does the timing of SFA initiation and its association with blood folate differ across subpopulations? 2) What other child health outcomes are associated with prenatal SFA and blood folate? 3) How do these associations differ by the timing and dose of SFA intake? 4) How do doses and timing of SFA and folate concentrations linked with improved child outcomes differ across people with different genetic, environmental, and nutritional backgrounds? 5) Does periconceptional SFA/folate status modify associations between environmental contaminants, including novel chemicals, and ND outcomes including behavioral problems and high autistic traits? 6) What biologic pathways are modified in utero by periconceptional SFA and suboptimal folate status? 7) How do those biologic pathways relate to known ND pathways? 8) How does the conceiving partner's preconception folate status relate to placenta epigenetics and the child's outcomes? Our strong team with relevant expertise in reproductive, environmental and nutritional epidemiology, interactions, epigenetics and ND assessment, plus ample experience engaging community partners, will recruit 740 expecting families in Northern California representing diverse racial, ethnic, socioeconomic, genetic and environmental backgrounds to enrich the ECHO cohort with participants traditionally underrepresented in research to address these gaps and produce findings that will substantially inform public health policies for more effective improvement of child developmental outcomes.