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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