Accepted for/Published in: JMIR Research Protocols
Date Submitted: Feb 15, 2025
Date Accepted: Sep 18, 2025
Air Pollution impact on Pregnancy and Early childhood Development (APiPED) in India: Cohort Protocol
ABSTRACT
Background:
Impact of Air Pollution (AP) on early childhood development in low polluting settings is well known. However, evidence from high-pollution settings, such as the Delhi National Capital Region (NCR), India, is yet to be comprehensively studied.
Objective:
This proposed study aims to investigate the developmental and intergenerational impacts of AP in India, generating insights to inform remedial measures at various levels.
Methods:
This longitudinal intergenerational cohort study in rural and urban Delhi NCR will assess AP exposure, confounders, pregnancy outcomes, and early childhood development. For mothers, it will evaluate pregnancy complications, gestational diabetes, preeclampsia, delivery type, parity, gravidity, and weight gain. For newborns, it will examine gestational age, birth weight, length, head circumference, and congenital malformations. Early childhood development will be assessed for cognition, language, motor skills, and growth velocities. Personal monitors will measure indoor and outdoor AP exposure during each pregnancy trimester and every six months for two years in newborns. Developmental milestones will be evaluated using the Indian-adapted DASII. Biomarkers reflecting inflammatory and cardiovascular impacts of AP will also be analyzed.
Results:
As of January 2025, 10% of estimated participants (2500) have been recruited, with baseline data collection completed, and 10% undergoing exposure assessment and sample collection.
Conclusions:
Exposure assessment variables (particulate matter, PM2.5 and PM10) will be evaluated both continuously and categorically, using quartile-based analysis, to comprehensively examine the relationship between air pollution exposure and health outcomes during pregnancy and early childhood. A personal exposure model will be developed by integrating the subjects' time activity profiles with both outdoor and indoor measurements to reconstruct their 24-hour exposure levels. This will facilitate context-specific strategies on personal protection measures against air pollution exposure for pregnant women and infant.
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