R01HD114056

ADVERSE HEALTH OUTCOMES FROM EXTREME HEAT, AIR POLLUTION, AND MEDICATIONS IN LOW-INCOME PREGNANT WOMEN AND THEIR OFFSPRING - CLIMATE CHANGE CONSTITUTES “THE SINGLE BIGGEST HEALTH THREAT FACING HUMANITY”. CLIMATE CHANGE EXACERBATES HEAT-RELATED MORBIDITY AND MORTALITY DUE TO MORE FREQUENT, LONGER AND EXTREME HEAT EVENTS. IT ALSO INCREASES WILDFIRE OCCURRENCE AND WORSENS AIR POLLUTION, WHICH IS LINKED TO THROMBOEMBOLIC AND BLEEDING EVENTS. THE HEALTH IMPACTS OF EXTREME HEAT AND AIR POLLUTION WILL ONLY INTENSIFY AS A RESULT OF THE CHANGING CLIMATE. CERTAIN SUBGROUPS ARE DISPROPORTIONATELY AFFECTED, INCLUDING LOW-INCOME POPULATIONS. PREGNANT WOMEN AND THEIR CHILDREN, ESPECIALLY THOSE FROM LOW-INCOME COMMUNITIES, ARE PARTICULARLY VULNERABLE TO HARMS FROM EXTREME HEAT AND AIR POLLUTION, NOT ONLY DUE TO PHYSIOLOGIC CHANGES DURING PREGNANCY AND SOCIAL VULNERABILITY, BUT ALSO BECAUSE OF THE MEDICATIONS THAT ARE TAKEN IN PREGNANCY TO TREAT CHRONIC DISEASES, MENTAL HEALTH CONDITIONS, AND PREGNANCY COMPLICATIONS. NEARLY TWO-THIRDS OF PREGNANT WOMEN IN THE US TAKE AT LEAST ONE PRESCRIPTION DRUG OTHER THAN VITAMINS, AND MEDICATION USE IS LIKELY TO PLAY AN IMPORTANT ROLE IN MODIFYING THE HEALTH EFFECTS OF HEAT AND AIR POLLUTION AND/OR FURTHER INCREASING MORBIDITY IN VULNERABLE PREGNANT PATIENTS AND THEIR OFFSPRING. HOWEVER, THE CURRENT EVIDENCE ASSESSING ADVERSE PERINATAL OUTCOMES IN RELATION TO HEAT AND AIR POLLUTION LACKS ADEQUATE CONSIDERATION OF INDIVIDUAL-LEVEL FACTORS INCLUDING MEDICATION USE AND INTERACTIONS BETWEEN MEDICATIONS AND OTHER RISK FACTORS. WHILE THE CDC RECENTLY PUBLISHED GUIDANCE FOR HEAT AND MEDICATIONS RECOGNIZING THE SIGNIFICANCE OF ENVIRONMENT-MEDICATION INTERACTIONS, EVIDENCE IS STILL LIMITED, ESPECIALLY FOR PREGNANT WOMEN. IN THE PRESENT PROPOSAL, AN INTERDISCIPLINARY TEAM OF EXPERTS IN CLIMATOLOGY, ENVIRONMENTAL AND PHARMACOEPIDEMIOLOGY, OBSTETRICS, CONGENITAL ABNORMALITIES, DATA SCIENCE, AND BIOSTATISTICS WILL WORK CLOSELY TO DESIGN A SERIES OF OBSERVATIONAL EPIDEMIOLOGIC STUDIES. WE WILL LINK TEMPERATURE/HUMIDITY AND AIR POLLUTION DATA WITH NATIONAL MEDICAID DATA AS WELL AS BIRTH REGISTRY DATA FROM NEW JERSEY, MASSACHUSETTS AND CALIFORNIA AND ANALYZE THE LINKED DATA USING THE STATE-OF-THE ART STUDY DESIGNS AND ANALYTIC METHODS. OUR STUDY AIMS TO: (1) ASSESS THE INDEPENDENT AND SYNERGISTIC EFFECTS OF EXTREME HEAT AND PRESCRIPTION OPIOIDS AND OTHER HEAT-SENSITIZING MEDICATIONS ON HEAT-RELATED ADVERSE EVENTS IN LOW-INCOME PREGNANT WOMEN; (2) ASSESS THE INDEPENDENT AND SYNERGISTIC EFFECTS OF AIR POLLUTION, I.E., PARTICULATE MATTER (PM2.5), AND MEDICATIONS ASSOCIATED WITH THROMBOEMBOLIC AND BLEEDING EVENTS ON THESE OUTCOMES; AND (3) ASSESS THE INDEPENDENT AND SYNERGISTIC EFFECTS OF EXTREME HEAT/AIR POLLUTION AND POTENTIALLY TERATOGENIC MEDICATIONS ON THE INCIDENCE OF CONGENITAL ABNORMALITIES. THE RESULTS OF OUR STUDY WILL QUANTIFY THE EFFECTS OF EXTREME HEAT AND AIR POLLUTION EXPOSURE AND THEIR POTENTIAL INTERACTIONS WITH MEDICATION USE IN LOW-INCOME PREGNANT WOMEN WHILE ALSO SHEDDING LIGHT ON POTENTIAL MECHANISMS THAT CONFER INCREASED RISK TO CERTAIN INDIVIDUALS. THE EVIDENCE GENERATED FROM OUR STUDY WILL HAVE A DIRECT IMPACT IN SHAPING ADAPTATION STRATEGIES AND POLICIES FOR CLIMATE CHANGE TO PROTECT VULNERABLE POPULATIONS FROM THE EFFECTS OF EXTREME HEAT AND AIR POLLUTION.

Rutgers The State University Of New Jersey

TO CONDUCT AND SUPPORT LABORATORY RESEARCH, CLINICAL TRIALS, AND STUDIES WITH PEOPLE THAT EXPLORE HEALTH PROCESSES. NICHD RESEARCHERS EXAMINE GROWTH AND DEVELOPMENT, BIOLOGIC AND REPRODUCTIVE FUNCTIONS, BEHAVIOR PATTERNS, AND POPULATION DYNAMICS TO PROTECT AND MAINTAIN THE HEALTH OF ALL PEOPLE. TO EXAMINE THE IMPACT OF DISABILITIES, DISEASES, AND DEFECTS ON THE LIVES OF INDIVIDUALS. WITH THIS INFORMATION, THE NICHD HOPES TO RESTORE, INCREASE, AND MAXIMIZE THE CAPABILITIES OF PEOPLE AFFECTED BY DISEASE AND INJURY. TO SPONSOR TRAINING PROGRAMS FOR SCIENTISTS, DOCTORS, AND RESEARCHERS TO ENSURE THAT NICHD RESEARCH CAN CONTINUE. BY TRAINING THESE PROFESSIONALS IN THE LATEST RESEARCH METHODS AND TECHNOLOGIES, THE NICHD WILL BE ABLE TO CONDUCT ITS RESEARCH AND MAKE HEALTH RESEARCH PROGRESS UNTIL ALL CHILDREN, ADULTS, FAMILIES, AND POPULATIONS ENJOY GOOD HEALTH. THE MISSION OF THE NICHD IS TO ENSURE THAT EVERY PERSON IS BORN HEALTHY AND WANTED, THAT WOMEN SUFFER NO HARMFUL EFFECTS FROM REPRODUCTIVE PROCESSES, AND THAT ALL CHILDREN HAVE THE CHANCE TO ACHIEVE THEIR FULL POTENTIAL FOR HEALTHY AND PRODUCTIVE LIVES, FREE FROM DISEASE OR DISABILITY, AND TO ENSURE THE HEALTH, PRODUCTIVITY, INDEPENDENCE, AND WELL-BEING OF ALL PEOPLE THROUGH OPTIMAL REHABILITATION.

93.113 - Environmental Health

National Institute of Child Health and Human Development (NICHD) [HHS - NIH]

National Institute of Environmental Health Sciences (NIEHS) [HHS - NIH]

New Jersey United States

State-Wide

NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed) (PA-20-185)