The majority of households in sub-Saharan Africa rely on solid biomass fuels (charcoal, wood, crop residues) for cooking. Women, as primary cooks, are exposed to harmful pollutants released from the inefficient combustion of these fuels, notably carbon monoxide (CO) and fine particulate matter (PM2.5). Preliminary studies link exposure to such biomass smoke with adverse pregnancy outcomes. In a cohort of Tanzanian pregnant women, the candidate will 1) determine predictors of high measured personal exposure to CO and PM2.5 during pregnancy, 2) identify histologic patterns of placental injury associated with high measured personal exposure to CO and/or PM2.5, and, 3) evaluate the association between measured personal exposure to CO and PM2.5 during pregnancy with birth weight (BW). This project innovatively combines personal air sampling for both CO and PM2.5 with placental examination to investigate exposure-response relationships between biomass combustion products and pregnancy outcome. Multivariate models will be created to identify predictors of high exposure and to evaluate the association between exposure and BW adjusting for other relevant determinants. Patterns of placental injury will be compared between high and low exposure groups to identify the potential pathophysiology underlying in utero injuries. Risk factors for adverse pregnancy outcome and reduced BW in resource-limited settings have focused largely on poor nutrition and infections with relatively little study of environmental perinatal risks. The candidate's proposed research has the potential to focus obstetric attention on a prevalent environmental exposure, household air pollution, and to shift environmental interventions to prenatal care packages. This research is integrally linked with the candidate's training program, which includes didactic coursework, guided readings, and structured mentorship in the areas of 1) environmental exposure assessment and analysis, 2) placental histopathology and biology, and 3) statistical techniques for complex exposure-response modeling using multivariate models. While the candidate's research efforts during the career development period will focus on air pollutants, techniques and methodologies they will learn will be translatable to the evaluation of obstetric risks associated with additional environmental pollutants to which these women are co-exposed. The candidate's ambition is to determine, and thereby catalyze a reduction in, the environmental burden faced by pregnant women in sub-Saharan Africa through independent, evidenced based research. 1 Public Health Relevance: Half of the world's households and over 80 percent of households in sub-Saharan Africa cook with solid biomass fuels (charcoal, wood, crop residues) generating smoke that is a complex mixture of harmful gases and particles. Women and children face the greatest health risks from such household air pollution and preliminary studies suggest that biomass smoke may be especially damaging during pregnancy. This project will characterize prenatal risks of biomass smoke so that interventions can be designed to adequately reduce exposure and thereby improve the health of pregnant women and their babies.

Public Health Relevance

Half of the world's households and over 80 percent of households in sub-Saharan Africa cook with solid biomass fuels (charcoal, wood, crop residues) generating smoke that is a complex mixture of harmful gases and particles. Women and children face the greatest health risks from such household air pollution and preliminary studies suggest that biomass smoke may be especially damaging during pregnancy. This project will characterize prenatal risks of biomass smoke so that interventions can be designed to adequately reduce exposure and thereby improve the health of pregnant women and their babies.

Agency
National Institute of Health (NIH)
Institute
National Institute of Environmental Health Sciences (NIEHS)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23ES021471-03
Application #
8655153
Study Section
Special Emphasis Panel (ZES1-LKB-D (D))
Program Officer
Shreffler, Carol K
Project Start
2012-08-01
Project End
2017-03-31
Budget Start
2014-04-01
Budget End
2015-03-31
Support Year
3
Fiscal Year
2014
Total Cost
$263,359
Indirect Cost
$18,167
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02199
Carter, Ellison; Norris, Christina; Dionisio, Kathie L et al. (2017) Assessing Exposure to Household Air Pollution: A Systematic Review and Pooled Analysis of Carbon Monoxide as a Surrogate Measure of Particulate Matter. Environ Health Perspect 125:076002
Wylie, Blair J; Ae-Ngibise, Kenneth A; Boamah, Ellen A et al. (2017) Urinary Concentrations of Insecticide and Herbicide Metabolites among Pregnant Women in Rural Ghana: A Pilot Study. Int J Environ Res Public Health 14:
Messerlian, Carmen; Mustieles, Vicente; Wylie, Blair J et al. (2017) Ultrasound gel as an unrecognized source of exposure to phthalates and phenols among pregnant women undergoing routine scan. Int J Hyg Environ Health 220:1285-1294
Boatin, Adeline A; Agaba, Elly; Nyongozi, Baltazar et al. (2017) Stage of labor at admission among Ugandan women with a prior cesarean, and its impact on management and delivery outcomes. Int J Gynaecol Obstet 139:14-20
Wylie, B J; Kishashu, Y; Matechi, E et al. (2017) Maternal exposure to carbon monoxide and fine particulate matter during pregnancy in an urban Tanzanian cohort. Indoor Air 27:136-146
Quinn, Ashlinn K; Ae-Ngibise, Kenneth Ayuurebobi; Kinney, Patrick L et al. (2017) Ambulatory monitoring demonstrates an acute association between cookstove-related carbon monoxide and blood pressure in a Ghanaian cohort. Environ Health 16:76
Mugyenyi, Godfrey R; Atukunda, Esther C; Ngonzi, Joseph et al. (2017) Functionality and acceptability of a wireless fetal heart rate monitoring device in term pregnant women in rural Southwestern Uganda. BMC Pregnancy Childbirth 17:178
Wylie, Blair J; Matechi, Emmanuel; Kishashu, Yahya et al. (2017) Placental Pathology Associated with Household Air Pollution in a Cohort of Pregnant Women from Dar es Salaam, Tanzania. Environ Health Perspect 125:134-140
Wylie, Blair J; Hauptman, Marissa; Woolf, Alan D et al. (2016) Insect Repellants During Pregnancy in the Era of the Zika Virus. Obstet Gynecol 128:1111-1115
Quinn, Ashlinn K; Ae-Ngibise, Kenneth Ayuurebobi; Jack, Darby W et al. (2016) Association of Carbon Monoxide exposure with blood pressure among pregnant women in rural Ghana: Evidence from GRAPHS. Int J Hyg Environ Health 219:176-83

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