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Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) Cohort

Principal Investigator:
Alshawabkeh, Akram; Cordero, Jose F; Meeker, John
Institution:
Northeastern University, University of Puerto Rico Medical Sciences Campus, University of Puerto Rico at Mayaguez, University of Georgia, University of Michigan
Location:
Northern Puerto Rico
Number of Participants::
~1,600 pregnant women with a target of 1,200 mother-child pair
Brief Description::
This is a prospective birth cohort study exploring environmental, clinical, demographic, behavioral, and other factors that contribute to risk of preterm birth in Puerto Rico. Around 1,600 pregnant women were enrolled in the study with the goal of 1,200 mother-child pairs. A separate follow on study, The Center for Research on Early Childhood Exposure and Development in Puerto Rico (CRECE), will assess additional exposures and health outcomes for a subset of the children through age four.
Lifestage of Participants:
Exposure: Prenatal; Adulthood (mother)
Assessment: Infant (0-1 year)
Exposures:
Air Pollutants: Polycyclic aromatic hydrocarbons (PAHs)
Metals: Not specified
Non-Chemical Stress: Extreme weather/climate change; Psychosocial stress
Other Environmental Exposure:
Personal Care/Consumer Products: Parabens; Phenols; Phthalates
Health Outcomes:
Birth Outcomes: Birthweight; Gestational age; Head circumference
Neurological/Cognitive Outcomes:
Biological Sample:
Blood; Placenta; Plasma; Serum; Urine

Related NIEHS-Funded Study Projects

Environmental Exposures and Prenatal Stress Related to Hurricane Maria Among Pregnant Women in Puerto Rico: Characterization and Impact on Birth Outcomes

Principal Investigator:
Watkins, Deborah J
Institution:
University of Michigan at Ann Arbor
Most Recent Award Year:
2018
Lifestage of Participants:
Exposure: Prenatal; Adulthood (mother)
Assessment: Infant (0-1 year, specifically at birth); Adulthood (mother, specifically following after birth)
Exposures:
Air Pollutants: Polycyclic aromatic hydrocarbons (PAHs)
Metals: Not specified
Non-Chemical Stress: Extreme weather/climate change; Hurricane; Psychosocial stress
Personal Care/Consumer Products: Parabens; Phenols; Phthalates
Health Outcomes:
Birth Outcomes: Birthweight; Gestational age; Head circumference
Mental Health Outcomes: Maternal depression
Neurological/Cognitive Outcomes: Not specified
Biological Sample:
Blood (mother); Urine (mother)
Other Participant Data:
Pre- and post-hurricane questionnaire on perceived stress, depression, social support; Post-hurricane questionnaire on hurricane-related experiences; Reported property damage, injury, illness, and lack of resources (electricity, food, clean water, fuel), generator use, drinking water sources, and packaged food consumption
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.
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Project 3: Discovery of Xenobiotics Associated with Preterm Birth

Parent Title:
Puerto Rico Testsite for Exploring Contamination Threats (PROTECT)
Principal Investigator:
Giese, Roger Wallace
Institution:
Northeastern University
Most Recent Award Year:
2014
Lifestage of Participants:
Exposure: Prenatal; Adulthood (mother)
Assessment: Infant (0-1 year, specifically at birth)
Exposures:
Other: Untargeted xenobiotics
Health Outcomes:
Birth Outcomes: Preterm birth
Biological Sample:
Placenta; Placental cell cultures; Urine (mother)
Environmental Sample:
Drinking water sample (tap water); Groundwater
Genes or Other DNA Products Studied:
DNA adducts
Abstract:
The long term goal of this project is to discover xenobiotics that contribute to preterm birth, relying on nontargeted chemical analysis by mass spectrometry. The study is focused on Puerto Rico because the incidence of preterm birth there is the second highest in the world. Three types of samples will be studied: urine, placenta and water. There are five Specific Aims. Specific Aim 1 concerns the urine samples, and studies the hypothesis that preterm urines in Puerto Rico contain a different exposome (xenobiotics or in vivo environmental chemical exposure) than term urines. For this Specific Aim, a large volume (0.5 gallon) of urine as an accumulation of early morning voids is being collected from each pregnant woman, which then is extracted with a porous extraction paddle (stirring "tea bag" filled with 2.0 g of particulate adsorbents). This new technique yields a convenient repository sample (the bag) for shipment, storage, and analysis of aliquots. Specific Aim 2 addresses placenta, since it is the target tissue for postulated environmental chemicals that contribute to preterm birth. Here the hypothesis is that the exposome of women in Puerto Rico (preterm birth rate 17.7%) is different qualitatively or quantitatively than in Boston (preterm birth rate 10.7%). In this Specific Aim, both the organic extractable exposome, and the exposome that has formed DNA adducts, will be tested in placenta. This Specific Aim helps to deal with the possibility that preterm birth is high in Puerto Rico because the exposomes of pregnant women there are high in general without any differences between preterm and term women. Specific Aim 3 focuses on placental cell cultures subjected to oxidative stress and inflammation (that can be caused by xenobiotics), and seeks to learn whether DNA adducts in these stressed cultures are similar to those in preterm placenta from Puerto Rico. Specific Aim 4 seeks to identify pollutants in ground and tap water samples in Puerto Rico, and also corresponding pollutant degradation products when these samples are remediated in Project 5 by electrolysis. Specific Aim 5 proposes to increase the sensitivity, scope, and qualitative capability of current methods for nontargeted chemical analysis by advancing and incorporating derivatization by ionic tagging. The methodology of Specific Aim 5 will be used in the work on Specific Aims 1, 2 and 4. Overall, the project is significant in its potential to help reduce the incidence of preterm birth; in establishing and characterizing by mass spectrometry valuable repository samples from pregnant women from whom extensive demographic information is being collected; and in advancing the usefulness of nontargeted chemical analysis in general for defining the risks from exposure to environmental chemicals.
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Project 1: Molecular Epidemiology Study of Phthalate Exposure and Preterm Birth

Parent Title:
Puerto Rico Testsite for Exploring Contamination Threats (PROTECT)
Principal Investigator:
Meeker, John D
Institution:
Northeastern University (Prime); University of Michigan (Sub)
Most Recent Award Year:
2014
Lifestage of Participants:
Exposure: Prenatal; Adulthood (mother)
Assessment: Infant (0-1 year, specifically at birth)
Exposures:
Personal Care/Consumer Products: Phthalates
Health Outcomes:
Birth Outcomes: Preterm birth
Biological Sample:
Plasma (mother); Serum (mother); Urine (mother)
Other Participant Data:
Hormone levels in serum; Measures of oxidative stress and inflmmation in plasma and urine samples; Self-reported modifiable activities and behaviors, such as use of personal care products and dietary patterns
Abstract:
Preterm birth is a significant global health challenge as a leading cause of infant mortality and costly long-term morbidity. Rates of preterm birth in the U.S. have increased in recent decades for reasons that remain uncertain. The recent escalation in preterm births in Puerto Rico is especially alarming, where rates have increased from just above the U.S. average (12%) in 1997 to nearly 18% in 2009. While known risk factors for preterm birth have failed to account for this increase, there is growing evidence that environmental factors may play a key role. However, these factors remain understudied and underappreciated. The proposed project will apply state-of-the-art molecular epidemiological methods to a prospective cohort study of over 1,200 live births designed to explore environmental, clinical, demographic, behavioral and other factors that contribute to preterm birth risk in Puerto Rico. The project also aims to provide much needed information on the potential mechanistic pathways involved in preterm birth as it relates to environmental factors, and data on important predictors of phthalate exposure among pregnant women. Phthalates were chosen as the primary pollutants of interest because they are common contaminants of Superfund sites in Puerto Rico and elsewhere (several phthalates are on the ATSDR Substance Priority List), and recent studies show widespread exposure to phthalates in the U.S. population. In our preliminary work and in recent studies by others, multiple phthalates have been associated with preterm birth, reduced gestational age, and other adverse impacts potentially linked with preterm birth such as oxidative stress, inflammation, and endocrine disruption. Our preliminary data also suggests elevated exposure to certain phthalates in Puerto Rico compared to the U.S. Using data and samples generated by recruitment efforts of the Human Subjects and Sampling Core (Core C) and the Data Management integration provided by Core D, we will collect detailed questionnaire data, clinical information, and measure phthalate metabolites in urine samples collected from pregnant women at multiple time points in pregnancy. We will evaluate phthalate metabolite levels for associations with residence, water sources, water phthalate contamination, diet, activities, and product use to identify determinants of high exposure and opportunities for exposure reduction strategies. Using innovative statistical methods, we will assess the association between exposure to phthalates and risk of preterm birth, both as individual chemicals and as phthalate mixtures. We will also explore relationships between phthalate exposure and biomarkers of oxidative stress, inflammation, and endocrine disruption measured at multiple times during pregnancy to provide data on biologic pathways that may link environmental exposures with early parturition. The proposed study will provide much needed information on preterm birth risk factors in Puerto Rico and a rich resource for future investigations and follow-up. Identifying modifiable environmental risk factors for preterm birth could have huge public health impact since interventions aimed at preventing preterm birth to date remain largely ineffective.
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