PROJECT SUMMARY: Exposure to a complex mix of environmental stressors during critical fetal and
childhood development periods is an important yet understudied area of public health, particularly when
coupled with psychosocial and other factors that may modify the effects of these exposures. Existing studies
usually investigate the effect of single toxicants or exposures and so do not reflect the reality that children
experience combinations of exposures simultaneously.
To address this gap, the proposed Environmental Influences on Child Health Outcomes in Puerto Rico
(ECHO-PRO) will leverage and build upon an active birth cohort in Puerto Rico (“PROTECT”, P42ES017198)
that has recently initiated infant/child follow-up (“CRECE”, P50ES026049). ECHO-PRO will provide data and
biospecimens for 570 mother-child pairs already participating in the PROTECT/CRECE cohort, as well as
recruit an additional 1100 pregnant women, yielding 990 more children, for a total of 1560 mother-child pairs
(88% retention by completion of study) with data and biospecimens to be integrated into the ECHO
Consortium.
To accomplish this, we will use our established, proven PROTECT/CRECE infrastructure and our experience
in recruitment, follow up, sample and data collection, management and analysis, to (a) recruit pregnant
women, (b) collect and analyze biological samples during pregnancy, at birth and at annual child visits through
age 5, and (c) collect detailed demographic, health, and exposure information collected through
questionnaires, evaluations and medical record abstraction during pregnancy, at birth and at annual child visits
through age 5.
In addition, the multidisciplinary ECHO-PRO team will study (using novel statistical methods for analysis
of mixtures) the impact of multiple environmental exposures and exposure mixtures; specifically the
relationship between exposure (maternal, in utero and/or during early childhood) to common mixtures
of environmental contaminants (air pollution, metals, polycyclic aromatic hydrocarbons, phthalates,
phenols, parabens), as well as their mechanistic mediators and modifying factors, on the four ECHO
outcome domains: (1) adverse birth outcomes, including preterm birth, reduced fetal growth, and birth
defects, (2) obesity, including maternal gestational glycemia and measures of child adiposity and
cardiometabolic health, (3) neurodevelopment, including measures of child personal-social, adaptive, motor,
communication and cognitive abilities and (4) respiratory health, including measures of child cardiorespiratory
patterning, lung volume, and respiratory symptoms. Finally, ECHO-PRO will integrate and compare data
obtained through our cohort with the overall ECHO data to better understand the environmental influences on
child health outcomes in Puerto Rico and the U.S. mainland.