JMIR Publications

ABSTRACT

Background:

Negative early-life exposures, particularly during the golden first 1000 days, may compromise organ development and cause life-long negative consequences.

Objective:

This paper provides a comprehensive overview of a cohort study, underpinned by an exposome and deep-phenotyping framework, aiming to identify potential consequences of exposures, including environmental pollutants during pregnancy and infancy, on child health and development. Our main research questions are: 1. What are the most common environmental pollutants in Nepalese women and children? 2. Is there a social gradient in exposure to these pollutants? 3. To what extent are these exposures associated with nutritional status, growth, neurodevelopment, and clinical outcomes?

Methods:

We will leverage an ongoing pregnancy cohort of 800 mother–infant pairs in Bhaktapur, Nepal, nested within a randomized controlled trial (ClinicalTrials.gov: NCT03071666) that evaluated daily vitamin B12 supplementation from approximately 15 weeks of gestation until 6 months postpartum. The main outcomes of the original trial were linear growth and neurodevelopment at 12 months. In the current follow-up, children will be evaluated at school age to obtain more robust estimates of neurodevelopment and long-term health outcomes. The outcomes include neurodevelopment, vaccine responses, thyroid function, growth and body composition, markers of metabolic disease, and lung function. The study exposures include biochemical analyses of different environmental pollutants, inflammation, micronutrient status, and mental health.

Results:

Associations will be examined using cross-sectional, case–control, and cohort designs, and advanced statistical approaches will be applied to account for confounding and complex exposure patterns.

Conclusions:

The current study uses a well-characterized mother-child cohort in a South Asian setting, with repeated biological samples from blood, breast milk, and urine, and a wide array of high-quality longitudinal data on health, growth, and neurodevelopment. Using these data, our aim is to provide a deeper understanding of the interplay among environmental pollutants, nutrition, inflammation, and health outcomes to inform guidelines and interventions that protect vulnerable women and children in marginalized settings.