Environmental exposures and prenatal stress related to Hurricane Maria among pregnant women in Puerto Rico: Characterization and impact on birth outcomes

项目总结/摘要 飓风玛丽亚是80多年来袭击波多黎各的最强大的飓风， 清理工作进展缓慢得令人痛苦。玛丽亚两个月后，岛上60%的地区仍然没有电力供应， 波多黎各人仍在努力寻找足够的住房、清洁水和食物。 在玛丽亚之前， 波多黎各的污染已经很广泛，玛丽亚造成的洪水和破坏可能 加剧了这些情况。这可能会导致大量接触一系列危险物质， 对许多波多黎各人来说。延长的恢复期也可能增加了对 由于广泛使用气体动力发电机，使用不确定的水， 饮用水，烹饪和洗涤的来源，以及罐头和包装食品的消费增加，所有 对健康有潜在影响。经历创伤性自然灾害本身也可能产生长期影响， 对身体和心理健康的影响。妊娠期间暴露于此类事件与以下因素有关： 早产、低出生体重和其他不良出生结果的风险增加。然而，没有以前的 研究评估了飓风前后化学暴露和压力的测量结果， 同样的人口，因此确定了具体的、可改变的、与飓风有关的不良出生风险因素 结果是不可能的。 拟议的研究将利用一个正在进行的纵向出生队列，波多黎各试验场， 探索污染威胁（Exploring Contamination Threats，简称CRIT），93名参与者在飓风玛丽亚（Hurricane Maria）来袭时怀孕。 登陆了这项研究的目标是：1）评估与飓风有关的一系列风险， 污染物（金属、多环芳烃（PAH）、邻苯二甲酸酯、苯酚、对羟基苯甲酸酯），以及 心理压力，在飓风玛丽亚袭击时怀孕的CITT参与者中， 2）确定与飓风有关的风险和压力的来源，以及3）评估这些风险和压力的影响 暴露对出生结果的影响，如早产、胎龄和出生体重。现有生物 样本和产前数据，包括暴露的尿液生物标志物和关于母亲压力的问卷 和抑郁症，将用于拟议的工作。 另外，飓风后的尿样，压力 还将收集一份关于飓风经验的调查表。之前 飓风玛丽亚，波多黎各的早产率已经是美国和世界上最高的， 因此，确定需要帮助的个人，以及在这个高度脆弱的环境中可改变的风险因素， 人口及时到位至关重要。

PROJECT SUMMARY / ABSTRACT Hurricane Maria was the most powerful hurricane to hit Puerto Rico in over 80 years, and recovery and clean-up has been painfully slow. Two months after Maria, 60% of the island is still without electricity and many Puerto Ricans are still struggling to find adequate housing, clean water, and food. Prior to Maria, environmental contamination in Puerto Rico was already extensive, and flooding and damage caused by Maria likely exacerbated these conditions. This has potentially resulted in considerable exposure to a range of hazardous substances for many Puerto Ricans. The extended recovery period has also likely increased exposures to environmental contaminants due to extensive use of gas powered generators, use of water from uncertain sources for drinking, cooking, and washing, and increased consumption of canned and packaged foods, all with potential impacts on health. Experiencing a traumatic natural disaster can itself also have long-term physical and psychological health effects. Exposure to such events during pregnancy has been associated with increased risk of preterm birth, low birth weight, and other adverse birth outcomes. However, no previous studies have evaluated measures of both chemical exposure and stress both before and after the hurricane in the same population, so identification of specific, modifiable, hurricane-related risk factors for adverse birth outcomes has not been possible. The proposed research will leverage an ongoing longitudinal birth cohort, the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT), in which 93 participants were pregnant when Hurricane Maria made landfall. The goals of this research are to 1) assess hurricane-related exposure to a range of contaminants (metals, polycyclic aromatic hydrocarbons (PAHs), phthalates, phenols, parabens), and psychological stress, among PROTECT participants who were pregnant when Hurricane Maria struck the island, 2) identify sources of hurricane-related exposures and stress, and 3) evaluate the effects of these exposures on birth outcomes, such as preterm birth, gestational age, and birth weight. Existing biological samples and prenatal data, including urinary biomarkers of exposure and questionnaires on maternal stress and depression, will be utilized in the proposed work. In addition, post-hurricane urine samples, stress questionnaires, and an additional questionnaire on hurricane-related experiences will be collected. Prior to Hurricane Maria, Puerto Rico’s preterm birth rate was already among the highest within the U.S. and the world, so identifying individuals in need of help, as well as modifiable risk factors within this highly vulnerable population in a timely manner is critical.