Prenatal Environment And Child Health (PEACH) in ECHO

《ECHO》中的产前环境与儿童健康(桃子) 摘要 很少有可修饰的因素被确定可以改善神经发育(ND)结果。其中一个因素是， 补充叶酸(SFA)，在怀孕前和怀孕后第一周服用，可降低神经风险 在随机试验中，管子缺陷(NTD)减少高达70%，启动强制性粮食强化和指南 对于可能或已经怀孕的人的SFA摄入量，随后血液叶酸增加 浓度和降低NTD患病率。虽然通常被认为是公共卫生的成功，但其影响 在美国境内的亚群中并不均匀分布，西班牙裔人口风险更高 对于NTDS，更有可能处于次优叶酸状态，而不太可能服用SFA。更进一步，生物 这种保护背后的机制仍不清楚。自那以后，产前SFA和充足的叶酸状况 与改善的行为和语言结果、更高的执行功能和降低 注意力缺陷/多动障碍(ADHD)、自闭症谱系障碍(ASD)及其相关特征。高 叶酸/SFA也被证明可以减轻与几种污染物暴露相关的增加的风险 在研究中代表性不足和/或更有可能处于次优状态的群体中更为普遍 叶酸状态，不太可能达到SFA的建议摄入量。一个例子是个人使用的增塑剂 护理产品在西班牙裔人群中更普遍，并与新城疫风险增加有关， 用产前SFA进行减重。在理解和执行SFA措施方面需要有许多差距 旨在最大限度地增加SFA干预措施对公共卫生的影响：1)如何 SFA开始的时间及其与血液叶酸的关系在不同的亚群中是不同的？2)其他什么孩子 健康结果与产前SFA和血液叶酸有关？3)这些关系有何不同 SFA摄入的时间和剂量？4)SFA和叶酸浓度的剂量和时间与 不同遗传、环境和营养背景的人改善的儿童结果是不同的？ 5)概念周围的SFA/叶酸状态是否改变了环境污染物之间的联系，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 妊娠期SFA和次优叶酸状态在子宫内改变途径？7)这些生物是如何 途径与已知的ND途径有关？8)受孕伴侣的先入性叶酸状况如何相关 胎盘表观遗传学和孩子的结局？我们拥有强大的团队，在生殖， 环境和营养流行病学、相互作用、表观遗传学和新城疫评估，以及充足的 体验社区合作伙伴，将在北加州招募740个预期家庭，代表 不同的种族、民族、社会经济、遗传和环境背景，以丰富回声队列 传统上，参与者在弥补这些差距并得出以下结论的研究中代表性不足 为公共卫生政策提供大量信息，以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.