Project 2-3 Indonesia

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

co-PI: Frida Soesanti and Nina Dwi Putri (former PI Nikmah Salamia Idris deceased, August 2019), University of Indonesia - Cipto Mangunkusumo National General Hospital
USG-Supported Partner: Kerstin Klipstein-Grobusch, University Medical Center Utrecht
Project dates: February 2015 - August 2020

In Memoriam: On August 6, 2019, PEER received word that Dr. Nikmah Salamia Idris had passed away after a two-year illness. The staff of the PEER Program and its sponsors at the U.S. Agency for International Development offer their deepest condolences to her family, friends, and co-workers. She was a dedicated researcher whose work has helped many women and children, and its impacts will continue to be felt in the future despite her untimely passing. Dr. Nikmah will be remembered as a treasured friend and colleague--may she rest in peace.

Project Overview

Maternal and neonatal morbidity and mortality appear to be an intractable problem worldwide. One of the underlying reasons may be that reductions in mortality and morbidity depend not only on care access and quality of care but also on adverse effects of air pollution on communities. In Indonesia, air pollution levels are high, particularly in major cities. This PEER team aimed to assess if prenatal exposure to air pollution increases the risk for pregnancy complications and the risk for adverse maternal and neonatal health. The researchers studied this question in healthy pregnant women living in and around Jakarta 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.

The researchers took long-term measurements of particulate matter and the major gaseous pollutant NO₂ in individual homes to obtain pollution exposure levels. Women and offspring were followed until six months after birth to record pregnancy complications, maternal lung function, neonatal indicators of fetal health, infant function, structural measurements of the respiratory and circulatory tracts, and infant diseases, particularly infections. The PEER team sought to establish relationships between pollutant exposure in pregnancy and maternal and neonatal health indicators.

The project also aimed to put air pollution and health more prominently on the agenda of Indonesian policy makers, offering a more comprehensive insight into the health consequences provided by local research, and build research capacity in Indonesia.

Final Summary of Project Activities

The PEER team undertook several types of air pollution measurements, including installing devices to measure particulate matter and NO₂ at multiple sites in Jakarta city. The sampling mechanisms included one reference site, which will measure air pollution level throughout the year; an electric scooter equipped with a measuring device to take measures around Jakarta, particularly in the area around mothers’ residences; and passive nicotine samplers installed in a random subset of homes (50 pregnant women). The researchers surveyed pregnant women to investigate domestic smoking habits and sent the passive sampler papers to the Netherlands to be analyzed.

Among the health outcome measurements researchers collected were maternal obstetric data, pregnancy-induced hypertension, nutritional analysis, maternal lung function, fetal growth, hair and nail sampling, vaginal swab sampling, placental and blood cord sampling (only if mothers consented), and birth outcomes. Health outcome measurements for the infants included growth, infection episodes, lung function, and cardiovascular outcomes. The researchers followed up with mothers and infants over the course of several years.

The PEER team also presented workshops on air pollution measurements, use of a mobile app to measure infection episodes in infants, placental sampling, and spirometer training. The group developed both local and international collaborations with healthcare providers, researchers, and academic institutions and maintained a website on their research activities. The PI and team also received two additional grants, worth a total of $22,000, related to the work. Their 2023 paper (see citation below) presented their findings, including an association between maternal exposure to soot and NO_x during pregnancy and reduced length of babies at birth.

Publication

Frida Soesanti, Cuno S.P.M. Uiterwaal, Kees Meliefste, Jie Chen, Bert Brunekreef, Nikmah S. Idris, Diederick E. Grobbee, Kerstin Klipstein‑Grobusch, and Gerard Hoek. 2023. The effect of exposure to traffic related air pollutants in pregnancy on birth anthropometry: a cohort study in a heavily polluted low‑middle income country. Environmental Health 22:22. https://doi.org/10.1186/s12940-023-00973-0

PEER Health Cycle 2 Recipients