Preterm birth, the leading cause of neonatal mortality in the U.S., is also associated with a number of chronic health conditions and developmental disabilities that cause lifelong consequences. In Puerto Rico, the preterm birth rate is 17.7% of live births. At 50% above the U.S. average, it is the highest rate of any U.S. jurisdiction, below only Malawi (18.1%) globally. Our investigations suggest that the increase in preterm birth rates in Puerto Rico cannot be explained by changes in obstetric practices, and that there is strong evidence that exposure to hazardous chemicals contributes to preterm birth. Puerto Rico has 16 active Superfund sites and 200+ hazardous waste sites. Risk of exposure to contamination is high as many of these sites are unlined landfills that overlie karst aquifers which present highly susceptible pathways for exposure to contamination. Established in 2010, the Puerto Rico Testsite for Exploring Contamination Threats Center (PROTECT) uses a holistic system of research, training and stakeholder engagement to study transport, exposure, health impact and remediation of contaminants, with particular attention to chlorinated solvents and phthalates commonly found at Superfund sites, as both suspect and model agents in the high preterm birth rates in Puerto Rico. The Human Subjects and Sampling Core (Core C) provides a single point of contact to obtain data and biological samples from study subjects and environmental samples linked to human subjects. This Core builds on the experience and skills of the UPR School of Public Health and the UPR Medical Sciences Campus in recruiting cohorts of pregnant women for diverse studies over the last decade. During the current funding period Core C formed and trained a team of nurses, physicians, support staff and graduate students to recruit 480 pregnant women. The team is on track to recruit 800 women by the end of year 4. This will continue in the proposed renewal for an additional 1000 study participants; ultimately yielding a cohort of 1,200+ live births needed for the projects. Detailed information on potential predictors of preterm birth is collected through standardized questionnaires administered three times during pregnancy and through systematic abstraction of medical record data. Biological samples are collected from pregnant women, and tap water samples are collected from their homes. All biological samples are processed by Core C, stored at -80oC and prepared for shipment. Using laboratory sample tracking software, researchers in Core C and the projects have real-time access to the sample/aliquot location in specific freezers and laboratories, sample volumes available, and information on sample chain of custody and previous or planned uses. Groundwater samples are collected throughout the year in collaboration with the U.S. Geological Survey and Project 4. Groundwater and tap water samples are analyzed for water quality and contaminants by Project 4. Batches of samples are shipped to investigators for analysis as required by individual projects. Data collected is exported to the Data Management Core for integration of all data sets to enable analysis and data mining by end-users.
The Human Subjects and Sampling core provides human subjects data, human biological specimens, and environmental samples to multiple projects in the program to facilitate much-needed research on environmental contamination in Puerto Rico and environmental and other contributors to preterm birth. Knowledge gained through this research will inform effective public health strategies for preventing preterm births in Puerto Rico and the US, and strategies to reduce exposures to environmental contaminants among pregnant women.
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