Drinking water contaminants and fetal loss in Northern California

项目摘要/摘要 本R03提案的目标是描述按孕周划分的流产和死胎率 在北加州的人口中，并评估对气候变化敏感的饮用水 污染物会增加流产和死产的比率。我们还打算估计一个假设的影响 降低水污染水平对胎儿丢失风险的干预。饮用水与人与人之间的关系 自早期以来，加利福尼亚州一直没有对污染物和流产和死产的风险进行调查 20世纪80年代。随着气候变化威胁到该州的饮用水质量，改善 了解气候敏感型饮用水污染物如何影响生殖健康。 在人群水平上，对胎儿丧失的环境决定因素的研究存在着显著的差距。这是 可能是因为研究早期胎儿丢失的挑战，因为现有的数据来源很难捕捉到 流产。然而，电子健康记录数据可以帮助我们提高对胎儿丢失的了解 怀孕10周和20周时，许多孕妇接受过产前检查，但谁 怀孕不会被记录在出生记录中。 我们建议使用Sutter Health的电子医疗记录来识别怀孕，并将参与者与 每次就诊时使用住宅地址的社区供水系统边界。然后我们将分配水 根据公共水监测收集的年平均污染物水平计算的污染物水平 在加利福尼亚州的水系统层面的信息。该项目的目标是1)描述 加州不同队列中的胎儿丢失，2)评估气候敏感水对个体和混合的影响 污染物对胎儿流失率的影响，以及3)评估是否将所有的水污染物减少到50% 研究队列中观察到的百分位数降低了胎儿丢失的风险。 该研究计划得到了来自加州大学旧金山分校、萨特健康公司、加州大学伯克利分校和 哥伦比亚大学。调查人员有很强的合作历史和工作经验 电子健康记录。他们带来了生殖健康、饮用水污染、 气候变化和环境正义。 这项研究解决了文献中的一个重大差距，并与NIEHS的两个目标保持一致 可供政策制定者用来改善人口健康的证据，以及NICHD的目标 这项工作的目的是帮助确定有效预防健康差距的目标。

PROJECT SUMMARY/ABSTRACT The objective of this R03 proposal is to characterize the rates of miscarriage and stillbirth by gestational week in a Northern California population, and to evaluate whether climate change-sensitive drinking water contaminants increase rates of miscarriage and stillbirth. We also aim to estimate the effects of a hypothetical intervention of reducing water contaminant levels on risk of fetal loss. The relationships between drinking water contaminants and risks of miscarriage and stillbirth have not been investigated in California since the early 1980s. As climate change threatens the quality of drinking water in the state, it is important to better understand how climate-sensitive drinking water contaminants affect reproductive health. There is a significant gap in research on environmental determinants of fetal loss at a population level. This is likely due to the challenges in studying early fetal loss, as existing data sources have difficulty capturing miscarriage. However, electronic health record data can help us improve our knowledge of fetal loss between 10 and 20 weeks of gestation, when many pregnant people have received a prenatal care visit but whose pregnancies would not be captured in birth records. We propose to use Sutter Health’s electronic medical records to identify pregnancies, and link participants to community water system boundaries using residential address at each clinic visit. We will then assign water contaminant levels based on the annual average contaminant levels collected from public water monitoring information at the water system level in California. The goals of this project are to 1) characterize the rate of fetal loss in a diverse California cohort, 2) evaluate the individual and mixture effects of climate-sensitive water contaminants on rates of fetal loss, and 3) assess whether reducing all water contaminants to their 50th percentiles observed in the study cohort reduces the risk of fetal loss. The research plan is supported by a strong team of investigators from UCSF, Sutter Health, UC Berkeley, and Columbia University. The investigators have a strong history of collaboration and experience working with electronic health records. They bring significant expertise in reproductive health, drinking water contaminants, climate change, and environmental justice. This research addresses a significant gap in the literature and aligns with both NIEHS’s goal to generate evidence that can be used by policymakers to improve population health, and NICHD’s goals to understand contributors to pregnancy loss and to help identify targets for effective prevention of health disparities.