Air pollution exposures in early life and brain development in children (ABC): protocol for a pregnancy cohort study

Abstract

Introduction: Air pollution is linked with poor neurodevelopment in high-income countries. Comparable data are scant for low-income countries, where exposures are higher. Longitudinal pregnancy cohort studies are optimal for individual exposure assessment during critical windows of brain development and examination of neurodevelopment. This study aims to determine the association between prenatal ambient air pollutant exposure and neurodevelopment in children aged 12, 24 and 36 months through a collaborative, capacity-enriching research partnership.

Methods and analysis: This observational cohort study is based in Nairobi, Kenya. Eligibility criteria are singleton pregnancy, no severe pregnancy complications and maternal age 18 to 40 years. At entry, mothers (n=400) are administered surveys to characterise air pollution exposures reflecting household features and occupational activities and provide blood (for lead analysis) and urine specimens (for polycyclic aromatic hydrocarbon (PAH) metabolites). Mothers attend up to two additional antenatal study visits, with urine collection, and infants are followed through age 36 months for annual neurodevelopment and caregiving behaviour assessment, and child urine and blood collection. Primary outcomes are child motor skills, language and cognition at 12, 24 and 36 months, and executive function at 36 months. The primary exposure is urinary PAH metabolite concentrations. Additional exposure assessment in a subset of the cohort includes residential indoor and outdoor air monitoring for fine particulate matter (PM2.5), carbon monoxide (CO), ultrafine particles (UFP) and black carbon (BC).

Ethics and dissemination: This study was approved by the Kenyatta National Hospital - University of Nairobi Ethics and Research Committee, and the University of Washington Human Subjects Division. Results are shared at annual workshops.

Keywords: Child Health; Infant; Low and Middle Income Countries; Neurodevelopment.

Figure 1. Overview of study environmental exposures, risk/protective factors (grey) and outcomes (white) data collection. BC, black carbon; CO, carbon monoxide; EF, executive function; OH-PAH, hydroxy-polycyclic aromatic hydrocarbon, particulate matter <2.5 μm diameter; UFP, ultra-fine particulate matter.