Three contaminated sites in southern Italy. The Neonatal Environment and Health Outcomes cohort: protocol for a longitudinal birth cohort study

Abstract

Introduction: Exposure to environmental contaminants during pregnancy is one of the determinants of child's future health outcomes. The effect of environmental pollution on pregnant women living in heavily polluted areas is of special interest and, in this context, the Neonatal Environment and Health Outcomes (NEHO) cohort will focus on the investigation of (1) toxicants transferred from the environment to the mother and from the mother to the developing fetus and (2) the influence of toxicants on pregnancy outcomes, fetal development and health status during infancy. Because the human placenta is positioned at the interface between the maternal/external environment and the embryo, it can be considered a highly informative matrix regarding many key pregnancy events that can shape infant's future health.

Methods and analysis: The NEHO cohort will enrol an estimated total of 800 pregnant women in three selected National Priority Contaminated Sites in southern Italy. Epidemiological data, concerning maternal health status, lifestyle and pregnancy, are obtained through questionnaires provided to the mother starting from the last 2 months of pregnancy. At delivery, maternal blood, umbilical cord blood and placenta tissue are collected to assess contaminant levels and to clarify how toxicants interact with the placental domain. Furthermore, placental transcriptome is studied in order to explore the interferences of toxicants on the role of the placenta in maternal/fetal interplay. Regular follow-up is planned at 6, 12 and 24 months.

Ethics and dissemination: The study has been approved by all the Ethics Committees of the three National Priority Contaminated Sites involved: the Ethics Committee of the University Hospitals of Messina (18 September 2017, n. 9/2017); the Ethics Committee 'Catania 2' (11 July 2017, n. 38/2017/CECT2); the Ethics Committee of the Region of Calabria (20 July 2017, n. 173). Findings will be disseminated in the scientific community and on a regional basis for appropriate policy actions.

Keywords: birth cohort study; developmental origins of health and disease; fetal exposure; maternal exposure; polluted areas.

Figure 1

The three selected National Priority Contaminated Sites involved in the study in the south Mediterranean area of Italy. Created through QGIS Development Team, 2009. QGIS Geographic Information System. Open Source Geospatial Foundation. URL http://qgis.org; shapefile from https://www.arcgis.com/home/item.html?id=2ca75003ef9d477fb22db19832c9554f. Last accessed 29 March 2019.

Figure 2

The selected communities and the distribution of the maternal units (H) where the pregnant women are recruited. The National Priority Contaminated Sites are in red, the surrounding areas are in green. Created through QGIS Development Team, 2009. QGIS Geographic Information System. Open Source Geospatial Foundation. URL http://qgis.org; shapefile from https://www.arcgis.com/home/item.html?id=61145ee86375431f9c54762de4ccd9e7.

Figure 3

Schematic overview of the project’s time course.