Effects of air pollution in early life on infant and maternal health

Partnership for Enhanced Engagement in Research /PEER Study (Cycle 2)

Study outline

Nikmah Salamia Idris/Wahyuni IndawatiChild Health Department Faculty of Medicine University of Indonesia

Background information

• PEER application call (March 2014), maternal/child health themes

• Motivation:

• Increasing evidence points at adverse effects throughout life of air pollution.

• Jakarta is one of the most polluted cities in the world. Need more evidence on the effects of heavy air pollutant exposure

• Limited evidence on neonatal lung function, infection and long-term effect on child health

• Approved in August 2014

Occurrence relations studied

Early life air pollutant exposure (including smoking)

Primary outcomesMaternal lung functionHypertension disorder in pregnancyInfant lung functionInfection episodes in early Infancy

ConfoundersMaternal age

SESMaternal nutritional status

etc.

Secondary outcomesPrematurity/gestational agechorioamnionitisMaternal retinal vasculature*Birth sizeBirth asphyxiaNeonatal cardiovascular health (blood pressure, cardiac function/structures, aIMT)

Scheme of the nesting BRAVO study (n =708)

Sites involvedBudi KemuliaanSenen/Kenari

Jatinegara primary care centre

Study flow

Air pollutant measurements

• PM 2.5, Black Carbon, NOX

• Methods

• Questionnaires for habits, work activities, travel history

• Site sampling (static) measurements and mobile campaign (land regression methods)

• Personal badge to measure NOx

Air pollutant measurements methods

Air pollutant measurements

PM 2.5, NOx

• NOx

• Black Carbon

• Particulate Matter 2,5

(PM 2.5) is an aerodynamic diameter of less than 2.5 micro-meter

Subject criteria

Pregnant Women Trimester I-Baby age 6 Months. In Budi Kemuliaan Hospital; Senen primary care; Jatinegara Primary Care and Cempaka Putih primary care; (a prospective cohort)

Methods

• Questionnaires for habits, work

activities, travel history

• Site sampling (static) measurements

and mobile campaign (land regression

methods)

• Personal badge to measure NO

Site sampling (static) measurements

• Site selection: traffic, urban background, regional background, green, water, industrial, reference

• We use google earth and GIS to select the study area

• In site selection we have some criteria so we may reduce the bias when the measure is starting.

• Device used in this measurement will be put in around the subject’s house

• The device will be put inside a box

• The device will be connected to the electricity during 2 weeks

• We will put devices which will measure the air around the subject’s house, it will be there 2 weeks and it will be taken in the next week to lab.

Study Area

Mobile campaign (land regression methods)

This measurement use mobile devices which will be carried to the

whole study area

This mobile devices will be carried by our team. They will drive

electric motorcycles and take the devices together with them. The

devices will measure the air around the area which driver have

been through.

Personal badge to measure NO

Devices used in this measurement will be put in subject’s clothes

This devices will be put in subject’s clothes then it will measure

the air around the subject

This devices will be put in inside the bag so the subject could

carry it together with them for 96 hours

Tobacco exposure measurements

• Second-hand smoking (in pregnancy and after birth)

• Questionnaire (modified from current BRAVO questionnaire)

• Analysis in BRAVO subjects: increased second-hand smoking exposure in pregnancy is associated with an approximately 300 grams decrease in birth weight

• Passive nicotine sampler

• Method : Questionnaire

questionnaires

Outcome measurements

• Primary outcomes

• Neonatal lung function: portable lung function device

• Infection rate: ICD 10 standardised physician diagnosis

• Hypertension disorder in pregnancy

• Maternal lung function

• Secondary outcomes: birth size, preterm birth, asphyxia, maternal and neonatal mortality

• Exploratory outcomes: chorioamnionitis (histologic criteria), maternal retinal vasculature, neonatal cardiovascular health (cardiac status, abdominal intima media thickness)

Lung function device

Vascular ultrasoundIntima media thickness, distensibility, elastic modulus

Key personnel

Name Institution Role

Nikmah S Idris Paediatrician (cardiology) - University of Indonesia PI

Cuno S.P.M Uiterwaal A/Prof in Clinical Epidemiology UMC Utrecht Co-PI/Tutor

Diederick E. Grobbee Professor in Epidemiology/Global Health - UMC Utrecht Co-PI/Tutor

Sudigdo Sastroasmoro

Prof in Paediatrics - University of Indonesia Co-PI/Tutor

Bert Brunekreef Prof in Environmental Science - UMC Utrecht Co-PI

Gerard Hoek A/Prof in Environmental Science - UMC Utrecht Co-PI

Kerstin Klipstein-Goburg

A/Prof in Epidemiology - UMC Utrecht USG-funded partner

Wahyuni Indawati Paediatrician (respirology) - University of Indonesia Co-PI

Ari Prayitno Paediatrician (ID) - University of Indonesia Co-PI

Nina Dwi Putri Paediatrician (ID) - University of Indonesia Co-PI

Michael CheungA/Prof in Paediatric Cardiology - University of

MelbourneCo-PI/Tutor

David Burgner Prof in Paediatric ID - University of Melbourne Co-PI/Tutor

Time line

Thank You