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

PI: Nikmah Salamia Idris, University of Indonesia - Cipto Mangunkusumo National General Hospital
USG-Supported Partner: Kerstin Klipstein-Grobusch, University Medical Center Utrecht
Project dates: February 2015 - January 2018

Maternal and neonatal morbidity and mortality appear to be a rather intractable problem worldwide, and their Millennium Developmental Goals (MDG 4 & 5) are mostly not achieved. One of the underlying reasons may be that reductions in mortality and morbidity do not solely depend on care access and quality of care, but due to adverse effects of air pollution on communities. In Indonesia, MDGs 4 & 5 have not been reached, while air pollution levels are high, particularly in major cities. Based on recent western observations on pollution and pregnancy outcomes, we aim to assess if prenatal exposure to air pollution increases the risk for pregnancy complications and the risk for adverse maternal and neonatal health. We intend to study this in healthy pregnant women living in and around Jakarta who are being recruited for an ongoing breastfeeding behavior intervention trial (BRAVO). Jakarta is arguably one of the most polluted cities in the world, with large exposure contrasts between many residential areas, making it an ideal setting for such a study. In contrast to many other studies, our proposal aims to measure pollution exposure, i.e., particles and the major gaseous pollutant NO2, at the individual level using sophisticated technology that is in principle available at a large scale. It will also obtain vital organ function measurements in neonatal offspring that are well validated and innovative as their association with air pollution was never investigated before.

The project team will enroll 600 healthy pregnant women early in pregnancy. Long-term measurements of particle matter and the major gaseous pollutant NO2 will be taken in individual homes to obtain pollution exposure levels. Women and offspring will be followed until six months after birth to record pregnancy complications, maternal lung function, neonatal indicators of fetal health, infant function, and structure measurements of the respiratory tract and circulatory tract, and infant disease, particularly infections. The aim is to establish relationships between pollutant exposure in pregnancy and maternal and neonatal health indicators.

The ultimate objective is to answer the above research question, but also put air pollution and health more prominently on the agenda of Indonesian policy makers. Currently, economic considerations are prioritized over long-term health effects of air pollution. A more comprehensive insight into the health consequences provided by local research should raise awareness. This is particularly important if long-term consequences turn out to have a price that outweighs short-term economy.

Part of this initiative is to build research capacity in Indonesia, enabling local partners to develop the necessary tools and skills to effectively address air pollution related to health problems and guide the development and implementation of evidence-based policies. The latter will also be a strong leverage in the work of our USG-supported partner who aims to build research capacity in various African countries, facing similar air pollution and maternal and child health problems as in Southeast Asia.

PH 2-3 Indonesia photo 1PH 2-3 Indonesia photo 2PH 2-3 Indonesia photo 3

Summary of Recent Activities:

As of July 2017, the project activities have mainly been related to data collection and finalizing the electronic database. The data collection process consisted of two main activities. The first was measurement of air pollution and smoking exposure. The second activity was subject enrollment and measurements of health outcomes in pregnant women and infants up to 6 months of age. The research team has enrolled about a quarter of the total 600 mother-infant participants planned. Some babies have completed the 6 month follow up. The rate of enrollment is lower than expected. As planned, the team has conducted several types of air pollution measurements, including devices to measure particulate matter (PM) and NO at multiple sites (traffic, urban, and green sites) in Jakarta; passive nicotine samplers; indoor air pollution measurements; and mobile campaign — using an electric scooter equipped with a measuring device to wander the streets of Jakarta, particularly in the area around mother residences and take air pollution measurements. The study team has enrolled 134 subjects. All primary measurements have been performed until infants reaching 6 months of age and few babies have completed the 6 month follow up. Measurements include: (1) pregnancy to birth: maternal obstetric data, pregnancy induced hypertension, nutritional analysis, maternal lung function, ultrasound to assess fetal growth, placental sampling (only if mothers consented) and birth outcomes; and (2.) Infancy: growth, infection episodes, lung function, and cardiovascular outcomes. In light of these activities, the project has recruited one PhD student to work on the study and have opened opportunities to other postgraduate students of the Faculty of Public Health, University of Indonesia to work on the data for their thesis if it aligns with the main project objectives.

PEER Health Cycle 2 Recipients