Residential Air Pollution and Preeclampsia

描述(由申请人提供)：先兆子痫是一种疾病，其特征是在怀孕的后半段出现新的高血压和蛋白尿，影响3-8%的妊娠。它是孕产妇和胎儿发病率和死亡率的主要原因，分娩仍然是唯一已知的治疗方法。细颗粒物(PM2.5)空气污染已令人信服地与心血管疾病和死亡风险增加有关，其中交通污染被确定为关键来源。母亲暴露在空气污染中也可能与胎儿生长较慢、出生体重较低、早产风险较高以及出生时胎龄较小有关。先兆子痫是导致早产和胎龄过小的主要原因之一，因此可能是导致这些结果的早期事件。然而，很少有研究评估空气污染和先兆子痫风险之间的联系。为了严格处理这一假设，我们提出了一项新的双管齐下的方法，包括：1)一项大型队列研究，基于2002至2011年间罗德岛妇婴医院88,000名单胎出生的详细管理和生命记录数据，包括&GT；4,000名被诊断为先兆子痫的出院患者；2)在该队列中嵌套的大型病例对照研究(1000例/1000对照)，详细审查从产前护理到分娩的医疗记录，以首次获得以下数据：a)整个妊娠期间的产妇住院时间，以及b)先兆子痫的临床特征和发病时间。在这两项研究中，我们将使用卫星和地面监测提供信息的新的高分辨率(1公里网格)时空模型来估计怀孕期间居民暴露在PM2.5中，并通过扩展我们经过验证的黑碳时空模型来估计居民暴露于交通来源的污染。因此，拟议的项目结合了以前研究的最强特点，并提供了新颖的改进。考虑到无处不在的环境空气污染暴露，先兆子痫对公共卫生的重要性，提示性的初步流行病学证据，以及暴露与先兆子痫之间的联系在生物学上的合理性，这一假说值得进一步评估，并改进评估暴露、健康结果及其相互关系的方法。

DESCRIPTION (provided by applicant): Preeclampsia is a disease characterized by new onset of hypertension and proteinuria during the second half of pregnancy, affecting 3-8% of pregnancies. It is a leading cause of maternal and fetal morbidity and mortality, and delivery remains the only known treatment.!Fine particulate matter (PM2.5) air pollution has been persuasively linked to increased risk of cardiovascular morbidity and mortality, with pollution from traffic identified as a key source. Maternal exposure to air pollution may also be associated with slower fetal growth, lower birth weight, and higher risk of preterm birth and small size for gestational age at birth. Preeclampsia is one of the leading causes of preterm birth and small size for gestational age, and thus may be an early event leading to these outcomes. However, few studies have evaluated the association between air pollution and risk of preeclampsia. To rigorously address this hypothesis, we propose a novel two-pronged approach consisting of: 1) a large cohort study based on detailed administrative and vital records data on 88,000 singleton births between 2002 and 2011 at the Women and Infants Hospital of Rhode Island, including >4,000 patients with a discharge diagnosis of preeclampsia, and 2) a large, case-control study (1000 cases/1000 controls) nested within this cohort with detailed review of medical records from prenatal care to delivery to obtain, for the first time, data on: a) maternal residential histry throughout the pregnancy, and b) clinical features and timing of onset of preeclampsia. In both studies we will estimate residential exposure to PM2.5 throughout pregnancy using a novel, high-resolution (1 km grid) spatial-temporal model informed by both satellite and ground based monitoring, and residential exposure to pollution derived from traffic sources by extending our validated spatial-temporal model of black carbon. Thus, the proposed project combines the strongest features of previous studies and offers novel refinements. Given ubiquitous exposure to ambient air pollution, the public health importance of preeclampsia, suggestive preliminary epidemiologic evidence, and the biologic plausibility of a link between exposure and preeclampsia, this hypothesis warrants further evaluation with improved methods for assessing exposures, health outcomes, and their interrelationships.