Impact of maternal work in the Ecuadorian flower industry on infant development

描述(由调查人员提供)：工业化农业是发展中国家经济中日益重要的组成部分，育龄妇女是这一劳动力的组成部分。工作压力、恶劣的工作条件和职业性农药暴露对女工及其子女的健康的影响是一个紧迫但未得到充分研究的全球公共卫生问题。拟议的研究为在家庭和社区的社会背景下研究厄瓜多尔玫瑰产业的产前暴露对儿童健康的影响提供了一个独特的机会。这项拟议的研究将提供必要的关键先导数据，以设计和实施我们计划的全面流行病学调查，调查产前接触农药对温室花卉工人子女神经行为发育的影响。这项研究将进一步加深我们对接触非持久性、剧毒农药的了解，这些农药已成为美国和全球农业中最常用的农药。与已对厄瓜多尔花卉工作者进行的其他研究不同，这项研究：1)对怀孕期间的孕妇进行纵向跟踪，并评估对发育中的胎儿的农药负担；2)包括母婴互动和刺激、早期情绪调节、母亲压力和其他对儿童发育起主要作用的重要社会和文化因素的敏感措施。使用以社区为基础的研究方法，并在厄瓜多尔与合作调查人员以及社区领导人和成员现有关系的基础上，我们将招募30名怀孕的玫瑰和非玫瑰工作者，并在他们怀孕的第二个月对他们进行跟踪，并对母婴对进行4个月的跟踪。我们将在怀孕期间和分娩时从母亲那里获得接触杀虫剂的生物标志物(尿液、脐带血)。通过母亲访谈，我们将获得有关健康、孕期工作条件、母亲压力水平和抑郁(PSI)、母子互动以及社会人口因素的数据。我们将实施高度敏感的发育筛查和评估测试(ASQ-3，静止面孔范式)，评估4个月大婴儿的认知、运动、语言和社会行为发展，以及早期执行功能。还将对婴儿的生长和营养状况进行测量。我们将量化孕中期(尿液)和孕晚期(尿液和脐带血)的农药暴露水平。我们将评估工作任务是否与农药生物标记物水平相关，这将指导未来的问卷开发。我们将评估农药暴露水平、发育结果和重要混杂变量之间的趋势、相关性和关联，并将评估在这一文化、语言和经济上截然不同的人群中使用我们建议的发育和母体压力评估工具的可行性。 与公共卫生有关：据估计，发展中世界有2亿多儿童没有充分发挥其发展潜力，环境毒物暴露、营养不良、贫困、产妇抑郁和压力以及社会因素等因素都可能导致幼儿丧失发展潜力。了解这些因素如何影响儿童发展，对于在受影响社区制定和启动干预措施以促进更好的儿童健康和发展至关重要。这项以国际社会为基础的协作性初步研究，以及我们正在计划的随后的更大规模的研究，将开始解决这些重要问题。

DESCRIPTION (provided by investigator): Industrial agriculture is an increasingly important component of the economies of developing countries and women of reproductive age are an integral part of this labor force. The impact of job stress, poor working conditions, and occupational pesticide exposure on the health of women workers and their children is a pressing, but under-studied global public health concern. The proposed research presents a unique opportunity to study the impact of prenatal exposures in the Ecuadorian rose industry on child health within the social context of the family and community. The proposed study will provide crucial pilot data needed to design and implement our planned full-scale epidemiologic investigation of the effects of prenatal pesticide exposure on neurobehavioral development among children of greenhouse flower workers. This study will further our understanding of exposure to non-persistent, acutely toxic pesticides, which have become the most commonly used pesticides in agricultural industry in the Unites States and globally. Unlike other studies of Ecuadorian flower workers that have been done, this study: 1) follows pregnant women longitudinally through pregnancy and assesses the pesticide burden on the developing fetus; and 2) includes sensitive measures of maternal- child interaction and stimulation, early emotional regulation, maternal stress, and other important social and cultural factors which play a major role in child development. Using a community-based research approach and building on existing relationships with co-investigators in Ecuador and with community leaders and members, we will recruit and enroll 30 pregnant rose and non-rose workers in their second trimester, follow them through delivery and follow-up the mother-infant pair for 4 months. We will obtain biomarkers of pesticide exposure (urine, cord blood) from the mother during pregnancy and at delivery. Through maternal interviews, we will obtain data on health, working conditions during pregnancy, maternal stress levels and depression (PSI), maternal-child interactions, and socio-demographic factors. We will administer highly sensitive developmental screening and assessment tests (ASQ-3, Still-Face Paradigm) that will assess cognitive, motor, language, and social-behavioral development, and early executive function in infants at 4 months. Infants will also be measured for growth and nutritional status. We will quantify levels of pesticide exposure in mid pregnancy (urine) and late pregnancy (urine and cord blood). We will assess whether job tasks are associated with the pesticide biomarker levels, which will guide future questionnaire development. We will assess trends, correlations, and associations between pesticide exposure levels, developmental outcomes, and important confounding variables and will evaluate the feasibility of using our proposed developmental and maternal stress assessment tools in this culturally, linguistically, and economically distinct population. PUBLIC HEALTH RELEVANCE: It is estimated that over 200 million children in the developing world are not reaching their full developmental potential and factors such as environmental toxic exposure, poor nutrition, poverty, maternal depression and stress, and social factors may all contribute to the loss of developmental potential in young children. Understanding how these factors impact child development is critical for developing and initiating interventions in affected communities that will promote better child health and development. This collaborative, international community-based pilot study, and the subsequent larger study we are planning, will begin to address these important issues.