Prenatal Exposures and Child Health Outcomes: A Statewide Study

Project Summary: Evidence from epidemiologic studies demonstrates the negative effects of both chronic and acute stress duringgestation. These effects may occur perinatally or later in the child's life. The COVID-19 global pandemic has ledto unprecedented mass disruption of social and financial security as well as changes in medical care delivery.These conditions are causing elevated levels of distress even for portions of the population that may havepreviously been protected from psychosocial stress. Of particular concern for pregnant women and their children,there may be direct biological effects related to infection with SARS-CoV-2 as well as substantial indirectpsychosocial effects during critical periods of development with long-lasting impact on children relevant to theEnvironmental Child Health Outcomes (ECHO) program. This proposal addresses how psychosocial stressrelated to the COVID pandemic may impact perinatal and neurodevelopmental outcomes. Furthermore, evidencesuggests that psychosocial stress is associated with both the gastrointestinal and vaginal microbiomes.Therefore, we will determine if maternal microbiomes or infant microbiomes mediate the impact of psychosocialstress on perinatal and neurodevelopmental outcomes. In aim 1, we address the maternal microbes and theirrole in mediating perinatal outcomes caused by maternal psychosocial stress during pregnancy. In aim 2, wefocus on maternal psychosocial stress and its impact on neurodevelopment as mediated by the changes to theinfant microbiota. We will examine these objectives in the context of our ongoing work, and as an extension ofthe parent grant (UG3/UH3OD023285, Paneth), where our organizing principle is that for many environmentalexposures the most sensitive period of risk for child health is pregnancy and the perinatal period. The parentgrant explores three primary exposures: toxic, nutritional, and inflammatory in a stratified random sample of statebirths recruited in the first trimester of pregnancy. Of the planned 1,100 new enrollments of cohort dyads intoECHO, more than 700 pregnant women have been consented, and, with a 75% follow up rate, more than 400children have already been seen in infancy. Over 300 women are expected to be enrolled during the projectperiod. While this research will leverage the local ECHO cohort, the project is designed to engage ECHO teamscience through two distinct but complementary ECHO-wide projects: (1) incorporation of data from two cohorts(O'Conner & Deoni) to address the aims proposed above and (2) provision of data and biospecimens to separateCOVID supplement (Transande) which addresses SARS-CoV-2 seropositivity/COVID illness as well aspsychosocial stress (assessed via questionnaire and cortisol measured in hair) as they relate to shortenedgestation and other perinatal outcomes. Our efforts will not only inform the specific hypotheses being tested butwill also inform "touch-free" methods for sample collection and patient interaction. The work proposed hereincomplements the parent grant by addressing an exposure (maternal psychosocial stress during a time ofpandemic), not included in the parent grant, and at least two of ECHO's outcomes (PPP and neurodevelopment).