Intrauterine exposure to tobacco smoke, DNA methylation, and vision disorders in preschool children - Project Summary
Vision disorders in early childhood, such as strabismus, amblyopia and high hyperopia, can significantly impair
the development of visual, motor, and cognitive functions. There is a need for better understanding of their
disease etiology which remains mostly unknown and methods for early identification of these disorders, which
still remain undetected in many children until their older ages when response to treatment is worse. Maternal
smoking during pregnancy (MSP), especially sustained smoking that persisted into third trimester, has been
consistently associated with several pediatric vision disorders including hyperopia, strabismus, and bilateral
amblyopia, and nicotine is considered as a key chemical responsible for the effects. The broad impact of MSP
on multiple vision disorders indicates that disturbance of intrauterine environment and fetal development may
play an important role in the development of vision disorders that occur very early in life. However, intrauterine
exposure to tobacco smoke or nicotine are not well captured by self-reported MSP, due to under-reporting,
exposure to overlooked sources of smoke or nicotine (e.g., environmental tobacco smoke, nicotine
replacement therapy), and variation in the uptake and metabolism of tobacco smoke by the mother and in the
fetal response to intrauterine disturbance. Objective and reliable measures of biologically effective dose of
intrauterine exposure to tobacco smoke or early biological effects of this exposure are needed. There have
been major advances in identifying specific genomic loci that are differentially methylated in newborns in
response to MSP and accumulating evidence linking alterations to DNA methylation at birth with childhood
diseases and outcomes such as low birth weight. These led us to hypothesize that epigenetic changes can
alter the development of the vision system in the fetus, leading to the development of vision disorders in early
childhood. To test this hypothesis, we propose to conduct a case-control study nested within the Multiethnic
Pediatric Eye Disease Study (MEPEDS) and retrieve neonatal dried blood spots (DBSs) that had been
collected by the California State’s Genetic Disease Screening Program from MEPEDS children at their birth.
Using these biospecimens, we will 1) assess the relationship of cotinine level in DBS and tobacco dosimeter
based on DNA methylation marks, in comparison to self-reported MSP, with strabismus, bilateral decreased
visual acuity, and hyperopia in 1508 preschool children; and 2) investigate epigenetic susceptibility loci for
hyperopia by comparing DNA methylation in neonatal DBS from 508 cases and an equal number of random
controls. Findings from this proposed study will have a great impact on assessing population and individual
risks from intrauterine exposure to different sources of tobacco smoke, understanding underlying biological
mechanisms, early screening of pediatric vision disorders, and preventing adverse impacts of these vision
disorders.