Abstract
BackgroundThe developing fetus is susceptible to environmental insults. Studying the effects of environmental exposures on fetal growth is essential for understanding the causal pathway between prenatal exposures and pregnancy outcomes. Here we describe the Haifa Pregnancy Cohort Study (HPCS) and discuss challenges and opportunities in applying “big data” paradigm.MethodsMaccabi Healthcare Services (MHS), is the second largest Israeli health maintenance organization (HMO) providing care services to two million beneficiaries. The HPCS cohort potentially includes ~750,000 newborns born between 1998 and 2017. We will estimate daily exposures to air pollutants, temperature and greenness, using satellite-based data and models. We hypothesize that residents of Haifa have higher exposures to environmental pollutants and that in pregnant women this higher exposure is associated with poorer fetal growth. We will evaluate outcomes such as birth-weight, head-circumference and gestational age at birth. We will adjust for pregnancy complications such as pre-eclampsia and gestational diabetes and parental variables, such as maternal weight, age and smoking habits as potential confounders. In addition, we will conduct a multi-tiered field study, nested within this population, among 150 pregnant women residing in two geographical regions-one in the polluted Haifa area, and one in a relatively unpolluted area in central Israel. Blood and urinary samples will be collected, as well as personal and indoor exposure to air pollution.DiscussionEvaluating environmental exposures of pregnant women and assessing in utero growth over the course of the pregnancy during different exposure windows, is of great scientific and public health interest. Recent advances in data collection and analysis pose great promise to provide insights into contribution of environment to the health of the developing fetus, but also pose major challenges and pitfalls, such as data management, proper statistical framework and integration of data in the population-based study and selectiveness in the nested field study. Yet the continuing follow-up of the study cohort, integrating data from different services, health-promotion, and eventually, application later in real life of our main promises. Our study aims to meet these challenges and to provide evidence of the environmental exposures associated with fetal growth.
Highlights
The developing fetus is susceptible to environmental insults
We designed the Haifa Pregnancy Cohort Study (HPCS) to achieve two goals: (i) Examine whether differences in environmental exposures during different stages of pregnancy are independently associated with fetal growth, controlling for a plethora of personal, obstetrical, medical and sociodemographic characteristics of both parents in a large population of pregnant women and (ii) Evaluate and compare multiple environmental exposures including human biomonitoring and personal exposure to air pollution in a nested panel of 150 pregnant women, members of Maccabi Healthcare Services (MHS)
The Rehovot area was chosen based on lower expected exposure to air pollution originating from industrial sources while comparable in socio-demographic characteristics and access to healthcare in a population residing in urban areas of similar magnitude, with similar proportion of MHS
Summary
Study population Maccabi Healthcare Services (MHS), the second largest Israeli health maintenance organization (HMO) provides primary care services to two million beneficiaries (~25% of the Israeli population). Exposure assessment We will estimate daily exposures to air pollutants, ambient temperature and greenness (NDVI), using satellite based data and models. We will estimate daily 1 km PM2.5 concentration levels for all grid cells in the study including the challenging to model Haifa region. Exposure assessment: Human bio-monitoring Urine, serum and blood samples will be obtained from the 150 pregnant women three times, in each trimester of pregnancy. The Rehovot area was chosen based on lower expected exposure to air pollution originating from industrial sources while comparable in socio-demographic characteristics and access to healthcare in a population residing in urban areas of similar magnitude, with similar proportion of MHS. We will further examine interactions between PM2.5 and other potential predictors such as high ambient temperatures
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