1. Effects of air pollution in early life on infant and maternal health
Partnership for Enhanced Engagement in Research /PEER Study (Cycle 2)
Study outline
Nikmah Salamia Idris/Wahyuni Indawati
Child Health Department Faculty of Medicine University of Indonesia

2. Background information
PEER application call (March 2014), maternal/child health themes
Motivation:
Increasing evidence points at adverse effects throughout life of air pollution.
Jakarta is one of the most polluted cities in the world. Need more evidence on the effects of heavy air pollutant exposure
Limited evidence on neonatal lung function, infection and long-term effect on child health
Approved in August 2014

3. Occurrence relations studied
Primary outcomes
Maternal lung function
Hypertension disorder in pregnancy
Infant lung function
Infection episodes in early Infancy
Early life air pollutant exposure (including smoking)
Secondary outcomes
Prematurity/gestational age
chorioamnionitis
Maternal retinal vasculature*
Birth size
Birth asphyxia
Neonatal cardiovascular health (blood pressure, cardiac function/structures, aIMT)
Confounders
Maternal age
SES
Maternal nutritional status
etc.

4. Scheme of the nesting BRAVO study (n =708)
Sites involved
Budi Kemuliaan
Senen/Kenari
Jatinegara primary care centre

5. Study flow

6. Air pollutant measurements
PM 2.5, Black Carbon, NOX
Methods
Questionnaires for habits, work activities, travel history
Site sampling (static) measurements and mobile campaign (land regression methods)
Personal badge to measure NOx
Air pollutant measurements methods

7. Air pollutant measurements
PM 2.5, NOx
NOx
Black Carbon
Particulate Matter 2,5
(PM 2.5) is an aerodynamic diameter of less than 2.5 micro-meter
Subject criteria
Pregnant Women Trimester I-Baby age 6 Months. In Budi Kemuliaan Hospital; Senen primary care; Jatinegara Primary Care and Cempaka Putih primary care; (a prospective cohort)

8. Methods
Questionnaires for habits, work activities, travel history
Site sampling (static) measurements and mobile campaign (land regression methods)
Personal badge to measure NO

9. Site sampling (static) measurements
Site selection: traffic, urban background, regional background, green, water, industrial, reference
We use google earth and GIS to select the study area
In site selection we have some criteria so we may reduce the bias when the measure is starting.
Device used in this measurement will be put in around the subject’s house
The device will be put inside a box
The device will be connected to the electricity during 2 weeks
We will put devices which will measure the air around the subject’s house, it will be there 2 weeks and it will be taken in the next week to lab.

10. Study Area

11. Mobile campaign (land regression methods)
This measurement use mobile devices which will be carried to the whole study area
This mobile devices will be carried by our team. They will drive electric motorcycles and take the devices together with them. The devices will measure the air around the area which driver have been through.

12. Personal badge to measure NO
Devices used in this measurement will be put in subject’s clothes
This devices will be put in subject’s clothes then it will measure the air around the subject
This devices will be put in inside the bag so the subject could carry it together with them for 96 hours

13. Tobacco exposure measurements
Second-hand smoking (in pregnancy and after birth)
Questionnaire (modified from current BRAVO questionnaire)
Analysis in BRAVO subjects: increased second-hand smoking exposure in pregnancy is associated with an approximately 300 grams decrease in birth weight
Passive nicotine sampler
Method : Questionnaire
questionnaires

16. Outcome measurements Primary outcomes
Neonatal lung function: portable lung function device
Infection rate: ICD 10 standardised physician diagnosis
Hypertension disorder in pregnancy
Maternal lung function
Secondary outcomes: birth size, preterm birth, asphyxia, maternal and neonatal mortality
Exploratory outcomes: chorioamnionitis (histologic criteria), maternal retinal vasculature, neonatal cardiovascular health (cardiac status, abdominal intima media thickness)

17. Lung function device

18. Vascular ultrasound
Intima media thickness, distensibility, elastic modulus

19. Key personnel Name Institution Role Nikmah S Idris
Paediatrician (cardiology) - University of Indonesia PI
Cuno S.P.M Uiterwaal
A/Prof in Clinical Epidemiology UMC Utrecht
Co-PI/Tutor
Diederick E. Grobbee
Professor in Epidemiology/Global Health - UMC Utrecht
Sudigdo Sastroasmoro
Prof in Paediatrics - University of Indonesia
Bert Brunekreef
Prof in Environmental Science - UMC Utrecht
Co-PI
Gerard Hoek
A/Prof in Environmental Science - UMC Utrecht
Kerstin Klipstein-Goburg
A/Prof in Epidemiology - UMC Utrecht
USG-funded partner
Wahyuni Indawati
Paediatrician (respirology) - University of Indonesia
Ari Prayitno
Paediatrician (ID) - University of Indonesia
Nina Dwi Putri
Michael Cheung
A/Prof in Paediatric Cardiology - University of Melbourne
David Burgner
Prof in Paediatric ID - University of Melbourne

20. Time line

21. Thank You