Project Summary (2020-2025)

Adverse pregnancy outcomes (APOs), such as preterm birth and low birth weight, are a major, costly health problem. Compared to the United States overall, significantly higher rates of preterm birth exist in Puerto Rico, where nearly 11.4 percent of all births in 2017 were preterm. Rates of low birth weight in Puerto Rico are likewise much higher than the U.S. average. Evidence exists that exposure to Superfund chemicals contributes to APOs. Established in 2010, the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) Center uses a holistic system of research, training, and stakeholder engagement to study transport, exposure, health impact, and remediation of contaminants. The focus of this current grant is to study the impact of specific mixtures of environmental contaminants on APOs. The set of mixtures selected for study are environmental agents with potential for adverse health effects in the prenatal period and are consistently found in PROTECT participants. The Human Subjects and Sampling Core (HSSC) provides a single point of contact to obtain data and biological and environmental samples linked to human subjects. In this grant, the HSSC is maintaining and enhancing the infrastructure needed to recruit pregnant women from the northern karst region of Puerto Rico to participate in the program's longitudinal research (Aim 1). The HSSC is building on the experience of partners from the University of Puerto Rico School of Public Health and the University of Georgia, who have recruited cohorts of pregnant women for diverse studies over the last decade. During the prior funding period, the HSSC formed and trained a team of nurses, physicians, support staff, and graduate students who recruited and retained 1,457 pregnant women with over 1,280 followed until they completed pregnancy (including 1,210 live births.) The HSSC now intends to recruit an additional 1,000 participants, ultimately yielding a cohort of over 2,000 complete births. In addition to recruiting, the HSSC systematically collects and shares multiple sources of data. To acquire detailed information on potential predictors of APOs, the HSSC conducts sequential interviews with study subjects, abstracts medical records, and collects biological and environmental samples during pregnancy, delivery, and postpartum (Aim 2). Because many of the projects have the same data or sample needs, a single systematic process for collection and sharing data and samples avoids duplication of effort and decreases the contact time with study subjects. This is a better use of time and available resources and reduces participant burden. The HSSC is processing, archiving, and distributing samples to project investigators and, in collaboration with the Data Management and Analysis Core, maintaining a repository of samples with an integrated database (Aim 3).