Wuhan Healthy Baby cohort
With social and economic development and the changes of environment, the incidence of various childhood diseases increases over years. Environmental factors play an unneglectable role in the onset and progress of childhood diseases. Environmental pollutants such as environmental endocrine disruptors may increase children's metabolic diseases (obesity, high blood pressure, etc.), neurological developmental disorders (autism, attention deficit hyperactivity disorder, etc.), respiratory allergic diseases (wheeze, asthma, etc.). The adverse impacts of exposure to environmental factors in utero may proceed to influence offspring growth in childhood. Embryonic and neonatal period are critical periods in which fetal growth, organs and systems development are maximally sensitive to environmental influences due to the immature metabolism system, nervous system and respiratory system. Besides, maternal malnutrition, obesity, smoking, infection, endocrine disorders and psychological trauma may also pose a threat on the fetus and infants and thus increase the risk of various childhood diseases.
Clarifying the causes and mechanisms of diseases is the primary condition of disease prevention. Birth cohort is the best platform to study the causes of diseases which related to pregnant women and children, including pregnancy complication, adverse pregnancy outcomes, adverse physical development, neurodevelopment, etc. The conclusions of long-term cohort study are highly reliable, with important theoretical and practical significance. We established a birth cohort of more than 20,000 pairs of mothers and infants, explored the role and mechanism of adverse environmental exposure in the occurrence and development of diseases in early life, verified important etiological hypotheses, and provided theoretical basis for improving the health condition of the next generation and providing scientific basis for the treatment of environmental pollutants. Biological samples such as blood, urine, placenta tissue, cord, breast milk were collected in different time period to explore the relationship between environment factors, gene, epigenetic factors and fetal growth and long-term health effects. Detailed information on birth outcomes, pregnancy complications, clinical laboratory examinations, demographic characteristics, socio-economic status, and life-style factors, physical and neurodevelopment of children was collected through either in-person interviews or medical records to build a massive database.
Here are some selected major research achievements:
1. Impact of the 2017 ACC/AHA Guideline for High Blood Pressure on Evaluating Gestational Hypertension Associated Risks for Newborns and Mothers
In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) released a new hypertension guideline for non-pregnant adults, using lower blood pressure values to identify hypertension. However, the impact of this new guideline on the diagnosis of gestational hypertension and the associated maternal and neonatal risk are unknown. Recently, we published a study on Circulation Research and observed that adopting the 2017 ACC/AHA hypertension guideline would result in a five-fold increase in the prevalence of gestational hypertension; gestational hypertension, especially stage 2 hypertension, was associated with increased risk of adverse birth outcomes for newborns and altered indicators of liver, renal, and coagulation functions during pregnancy for mothers, while the elevated blood pressure category defined by the 2017 ACC/AHA hypertension guideline (SBP = 120-129 mmHg and DBP < 80 mmHg) was not. Therefore, we concluded that adopting the 2017 ACC/AHA hypertension guideline to define gestational hypertension in prenatal care practice could improve the detection of high blood pressure during pregnancy and the efforts to reduce gestational hypertension related adverse maternal and neonatal outcomes in the perinatal period.
2. Cadmium Body Burden and Gestational Diabetes Mellitus
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance that is first recognized during pregnancy. The prevalence of GDM has been steadily increasing in many countries, including China. GDM may lead to serious adverse maternal outcomes such as high cesarean section rate and preeclampsia and to detrimental infant outcomes such as macrosomia, infant respiratory distress syndrome, and neonatal hypoglycemia. There is increasing evidence indicating that GDM might be caused by environmental chemical exposures, which has earned less attention than the traditional risk factors. We published a study on Environmental Health Perspectives and observed marginal associations between Cd body burden and the risk of GDM in the overall study population. Among women with male fetuses, the relative risk for those in the top versus bottom tertile of urinary Cd was 1.86 (95% CI: 1.14, 2.93). The association between higher urinary Cd and risk of GDM appeared to be limited to women with normal prepregnancy BMI, although differences between women with high versus normal BMI were not significant. Our findings suggest that Cd body burden may be a potential risk factor for GDM and that the association may be modified by fetal sex.
3. Critical Windows for Associations between Manganese Exposure during Pregnancy and Size at Birth
Prenatal overexposure to manganese (Mn), an essential micronutrient, is related to impaired fetal growth and development. Fetuses appear to be highly sensitive to Mn during short periods of gestation. We published a study on Environmental Health Perspectives and observed significant associations of elevated urinary Mn concentrations during pregnancy, especially in the second and third trimesters, with reductions in birth weight, birth length, and ponderal index, based on repeated measurements of urinary Mn concentrations in the first, second, and third trimesters. Moreover, newborns with restricted size at birth had relatively higher exposure levels of Mn in the second and third trimesters, especially during the late third trimesters. Our findings suggest that high levels of Mn exposure during late pregnancy may be a risk factor for restricted size at birth, and may also be one of the risk factors for childhood and adulthood diseases that have been associated with restricted fetal growth.
4. A Case–Control Study of Prenatal Thallium Exposure and Low Birth Weight in China
Tallium (Tl) is a highly toxic heavy metal widely present in the environment. China is the largest producer and consumer of Tl in the world, and, as a result, there is increased concern about the widespread presence of this metal in the environment. We published a study on Environmental Health Perspectives and suggest that prenatal exposure to the current levels of Tl encountered today in China may potentially increase the risk of delivering LBW infants. Higher maternal urinary Tl levels were significantly associated with increased risk of LBW [crude odds ratio (OR) = 1.52; 95% CI: 1.00, 2.30 for the highest vs. lowest tertile], and the association was similarly elevated after adjustment for potential confounders (adjusted OR = 1.90; 95% CI: 1.01, 3.58 for the highest vs. lowest tertile). Stratifed analyses showed slightly higher risk estimates for LBW associated with higher Tl levels for mothers < 28 years old and for mothers with lower household income. Additional research is needed to confirm the association between prenatal exposure to Tl and LBW and develop strategies for reducing LBW related to developmental exposure to environmental pollutants, including Tl.
Selected publications:
1. Jie Hu#, Yuanyuan Li#, Bin Zhang#, Tongzhang Zheng, Jun Li, Yang Peng, Aifen Zhou, Stephen L Buka, Simin Liu, Yiming Zhang, Kunchong Shi, Wei Xia, Kathryn Rexrode, Shunqing Xu*. Impact of the 2017 ACC/AHA Guideline for High Blood Pressure on Evaluating Gestational Hypertension Associated Risks for Newborns and Mothers: A Retrospective Birth Cohort Study. Circulation Research, 2019; doi: 10.1161/CIRCRESAHA.
2. Jiufeng Li#, Wenyu Liu#, Wei Xia, Hongzhi Zhao, Yanqiu Zhou, Yuanyuan Li, Chuansha Wu, Hongxiu Liu, Bin Zhang, Yingshuang Zhu, Jie Hu, Xianliang Wang, Dan Ye, Shunqing Xu*, Zongwei Cai*. Variations, Determinants, and Coexposure Patterns of Personal Care Product Chemicals among Chinese Pregnant Women: A Longitudinal Study. Environmental Science & Technology. 2019; doi: 10.1021/acs.est.9b01562.
3. Jiufeng Li#, Wei Xia#, Chuansha Wu, Hongzhi Zhao, Yanqiu Zhou, Juntong Wei, Fenfen Ji, Hemi Luan, Shunqing Xu, Zongwei Cai*. Variations of phthalate exposure and metabolism over three trimesters. Environmental Pollution. 2019; 251:137-145.
4. Lulu Song, Bin Zhang, Bingqing Liu, Mingyang Wu, Lina Zhang, Lulin Wang, Shunqing Xu, Zhongqiang Cao*, Youjie Wang*. Effects of maternal exposure to ambient air pollution on newborn telomere length. Environment International. 2019; 128:254-260.
5. Jiaqiang Liao, Bin Zhang, Wei Xia, Zhongqiang Cao, Yiming Zhang, Shengwen Liang, Ke Hu, Shunqing Xu, Yuanyuan Li*. Residential exposure to green space and early childhood neurodevelopment. Environment International. 2019; 128:70-76.
6. Wenyu Liu#, Yanqiu Zhou#, Jiufeng Li, Xiaojie Sun, Hongxiu Liu, Yangqian Jiang, Yang Peng, Hongzhi Zhao, Wei Xia, Yuanyuan Li, Zongwei Cai*, Shunqing Xu*. Parabens exposure in early pregnancy and gestational diabetes mellitus. Environment International. 2019; 126:468-475.
7. Yangqian Jiang#, Hongzhi Zhao#, Wei Xia, Yuanyuan Li, Hongxiu Liu, Ke Hao, Jia Chen, Xiaojie Sun, Wenyu Liu, Jiufeng Li, Yang Peng, Chen Hu, Chunhui Li, Bin Zhang, Shi Lu, Zongwei Cai*, Shunqing Xu*. Prenatal exposure to benzophenones, parabens and triclosan and neurocognitive development at 2 years. Environment International. 2019; 126:413-421.
8. Qi Liu#, Shuna Jin#, Xiaojie Sun, Xia Sheng, Zhenxing Mao, Yangqian Jiang, Hongxiu Liu, Chen Hu, Wei Xia, Yuanyuan Li, Shunqing Xu*. Maternal Blood Pressure, Cord Glucocorticoids, and Child Neurodevelopment at 2 Years of Age: A Birth Cohort Study. American Journal of Hypertension. 2019; 32(5):524-530.
9. Lina Zhang, Lulu Song, Bingqing Liu, Mingyang Wu, Lulin Wang, Bin Zhang, Chao Xiong, Wei Xia, Yuanyuan Li, Zhongqiang Cao, Youjie Wang*, Shunqing Xu*. Prenatal cadmium exposure is associated with shorter leukocyte telomere length in Chinese newborns. BMC Medicine. 2019; 17(1):27.
10. Hongxiu Liu#, Jiufeng Li#, Wei Xia, Bin Zhang, Yang Peng, Yuanyuan Li, Yanqiu Zhou, Jing Fang, Hong zhi Zhao, Yangqian Jiang, Wenyu Liu, Xiaojie Sun, Chen Hu, Zongwei Cai*, Shunqing Xu*. Blood pressure changes during pregnancy in relation to urinary paraben, triclosan and benzophenone concentrations: A repeated measures study. Environment International. 2019; 122:185-192.
11. Chuansha Wu#, Wei Xia#, Yuanyuan Li, Jiufeng Li, Bin Zhang, Tongzhang Zheng, Aifen Zhou, Hongzhi Zhao, Wenqian Huo, Jie Hu, Minmin Jiang, Chen Hu, Jiaqiang Liao, Xi Chen, Bing Xu, Shi Lu, Zongwei Cai*, Shunqing Xu*. Repeated Measurements of Paraben Exposure during Pregnancy in Relation to Fetal and Early Childhood Growth. Environmental Science & Technology. 2019; 53(1):422-433.
12. Jie Hu#, Chuansha Wu#, Tongzhang Zheng, Bin Zhang, Wei Xia, Yang Peng, Wenyu Liu, Minmin Jiang, Simin Liu, Stephen L. Buka, Aifen Zhou, Yiming Zhang, Yangqian Jiang, Chen Hu, Xiaomei Chen, Qiang Zeng, Xi Chen, Bing Xu, Xichi Zhang, Ashley Truong, Kunchong Shi, Zhengmin Qian, Yuanyuan Li, Shunqing Xu*. Critical Windows for Associations between Manganese Exposure during Pregnancy and Size at Birth: A Longitudinal Cohort Study in Wuhan, China. Environmental Health Perspectives. 2018; 126(12):127006.
13. Yanqiu Zhou#, Hongxiu Liu#, Jiufeng Li, Shunqing Xu, Yuanyuan Li, Hongzhi Zhao, Hangbiao Jin, Wenyu Liu, Arthur C.K. Chung, Yanjun Hong, Xiaojie Sun, Yangqian Jiang, Wenxin Zhang, Jing Fang, Wei Xia*, Zongwei Cai*. Profiles, variability, and predictors of urinary benzotriazoles and benzothiazoles in pregnant women from Wuhan, China. Environment International. 2018; 121(Pt 2):1279-1288.
14. Jie Hu#, Yang Peng#, Tongzhang Zheng, Bin Zhang, Wenyu Liu, Chuansha Wu, Minmin Jiang, Joseph M Braun, Simin Liu, Stephen L Buka, Aifen Zhou, John Pierce Wise Sr, Yiming Zhang, Yangqian Jiang, Chen Hu, Xiaomei Chen, Zheng Huang, Dan Zheng, ShunqingXu*. Effects of trimester-specific exposure to vanadium on ultrasound measures of fetal growth and birth size: a longitudinal prospective prenatal cohort study. The Lancet Planet Health. 2018; 2(10):e427-e437.
15. Xiaojie Sun#, Jiufeng Li#, Shuna Jin, Yuanyuan Li, Wenyu Liu, Hongzhi Zhao, Yanqiu Zhou, Yangqian Jiang, Hongxiu Liu, WeiXia, Zongwei Cai, Shunqing Xu*, Xiantao Shen*. Associations between repeated measures of maternal urinary phthalate metabolites during pregnancy and cord blood glucocorticoids. Environment International. 2018; 121(Pt 1):471-479.
16. Hongzhi Zhao, Jiufeng Li, Yanqiu Zhou, Lin Zhu, Yuanyuan Zheng, Wei Xia, Yuanyuan Li, Li Xiang, Wei Chen, Shunqing Xu*, Zongwei Cai*. Investigation on Metabolism of Di(2-Ethylhexyl) Phthalate in Different Trimesters of Pregnant Women. Environmental Science & Technology. 2018; 52(21):12851-12858.
17. Yang Peng#, Jie Hu#, Yuanyuan Li, Bin Zhang, Wenyu Liu, Han Li, Hongling Zhang, Chen Hu, Xiaomei Chen, Wei Xia, Shi Lu*, Shunqing Xu*. Exposure to chromium during pregnancy and longitudinally assessed fetal growth: Findings from a prospective cohort. Environment International. 2018; 121(Pt 1):375-382.
18. Chuansha Wu#, Jiufeng Li#, Wei Xia, Yuanyuan Li, Bin Zhang, Aifen Zhou, Jie Hu, Chunhui Li, Hongzhi Zhao, Minmin Jiang, Chen Hu, Jiaqiang Liao, Wenqian Huo, Xi Chen, Bing Xu, Shi Lu, Zongwei Cai*, Shunqing Xu*. The association of repeated measurements of prenatal exposure to triclosan with fetal and early-childhood growth. Environment International. 2018; 120:54-62.
19. Minmin Jiang, Yuanyuan Li, Bin Zhang, Aifen Zhou, Yingshuang Zhu, Jiufeng Li, Hongzhi Zhao, Li Chen, Jie Hu, Chuansha Wu, Yang Peng, Jiaqiang Liao, Zhiguo Xia, Zongwei Cai, Xi Chen, Bing Xu, Wei Xia*, Shunqing Xu*. Urinary Concentrations of Phthalate Metabolites Associated with Changes in Clinical Hemostatic and Hematologic Parameters in Pregnant Women. Environment International. 2018; 120:34-42.
20. Jiaqiang Liao, Huifang Yu, Wei Xia, Bing Zhang, Bin Lu, Zhongqiang Cao, Shengwen Liang, Ke Hu, Shunqing Xu, Yuanyuan Li*. Exposure to ambient fine particulate matter during pregnancy and gestational weight gain. Environment International. 2018; 119:407-412.
21. Yanjian Wan#, Wenqian Huo#, Shunqing Xu, Tongzhang Zheng, Bin Zhang, Yuanyuan Li, Aifen Zhou, Yiming Zhang, Jie Hu, Yingshuang Zhu, Zhong Chen, Shi Lu, Chuansha Wu, Minmin Jiang, Yangqian Jiang, Hongxiu Liu, Xueyu Yang, Wei Xia*. Relationship between maternal exposure to bisphenol S and pregnancy duration. Environmental Pollution. 2018; 238:717-724.
22. Hongxiu Liu, Shi Lu, Bin Zhang, Wei Xia, Wenyu Liu, Yang Peng, Hongling Zhang, Kangbing Wu, Shunqing Xu, Yuanyuan Li*. Maternal arsenic exposure and birth outcomes: A birth cohort study in Wuhan, China. Environmental Pollution. 2018; 236:817-823.
23. Wenyu Liu, Bin Zhang, Zheng Huang, Xinyun Pan, Xiaomei Chen, Chen Hu, Hongxiu Liu, Yangqian Jiang, Xiaojie Sun, Yang Peng, Wei Xia, Shunqing Xu, Yuanyuan Li*. Cadmium Body Burden and Gestational Diabetes Mellitus: A Prospective Study. Environmental Health Perspectives. 2018; 126(2):027006.
24. Yangqian Jiang, Wei Xia, Bin Zhang, Xinyun Pan, Wenyu Liu, Shuna Jin, Wenqian Huo, Hongxiu Liu, Yang Peng, Xiaojie Sun, Hongling Zhang, Aifen Zhou, Shunqing Xu, Yuanyuan Li*. Predictors of thallium exposure and its relation with preterm birth. Environmental Pollution. 2018; 233:971-976.
25. Wenqian Huo, Wei Xia, Chuansha Wu, Yingshuang Zhu, Bin Zhang, Yanjian Wan, Aifen Zhou, Zhenming Qian, Zhong Chen, Yangqian Jiang, Hongxiu Liu, Jie Hu, Bing Xu, Shunqing Xu, Yuanyuan Li*. Urinary level of triclosan in a population of Chinese pregnant women and its association with birth outcomes. Environmental Pollution. 2018; 233:872-879.
26. Jie Hu#, Wei Xia#, Xinyun Pan, Tongzhang Zheng, Bin Zhang, Aifen Zhou, Stephen L Buka, Bryan A Bassig, Wenyu Liu, Chuansha Wu, Yang Peng, Jun Li, Chuncao Zhang, Hongxiu Liu, Minmin Jiang, Youjie Wang, Jianduan Zhang, Zheng Huang, Dan Zheng, Kunchong Shi, Zhengmin Qian, Yuanyuan Li*, Shunqing Xu*. Association of adverse birth outcomes with prenatal exposure to vanadium: a population-based cohort study. The Lancet Planetary Health. 2017; 1(6): e230–e241.
27. Sha Huang, Wei Xia, Yuanyuan Li, Bin Zhang, Aifen Zhou, Tongzhang Zheng, Zhengmin Qian, Zheng Huang, Shi Lu, Zhong Chen, Youjie Wang, Xinyun Pan, Wenqian Huo, Shuna Jin, Yangqian Jiang, Shunqing Xu*. Association between maternal urinary chromium and premature rupture of membranes in the Healthy Baby Cohort study in China. Environmental Pollution. 2017; 230: 53-60.
28. Yitao Pan#, Yingshuang Zhu#, Tongzhang Zheng, Qianqian Cui, Stephen L. Buka, Bin Zhang, Yong Guo, Wei Xia, Leo W. Y. Yeung, Yuanyuan Li, Aifen Zhou, Lin Qiu, Hongxiu Liu, Minmin Jiang, Chuansha Wu, Shunqing Xu*, Jiayin Dai*. Novel chlorinated polyfluorinated ether sulfonates and legacy per-/polyfluoroalkyl substances: placental transfer and relationship with serum albumin and glomerular filtration rate. Environmental Science & Technology. 2016; 51(1): 634-644.
29. Wei Xia#, Xiaofu Du#, Bin Zhang, Yuanyuan Li, Bryan A. Bassig, Aifen Zhou, Youjie Wang, Chao Xiong, Zhengkuan Li, Yuanxiang Yao, Jie Hu, Yanqiu Zhou, Qi Wang, Juan Liu, Weiyan Xue, Yue Ma, Xinyun Pan, Yang Peng, Tongzhang Zheng, Shunqing Xu*. A Case–Control Study of Prenatal Thallium Exposure and Low Birth Weight in China. Environmental Health Perspectives. 2016; 124(1):164-9.
30. Jie Yang#, Wenqian Huo#, Bin Zhang, Tongzhang Zheng, Yuanyuan Li, Xinyun Pan, Wenyu Liu, Huailong Chang, Minmin Jiang, Aifen Zhou, Zhengmin Qian, Yanjian Wan, Wei Xia*, Shunqing Xu*. Maternal urinary cadmium concentrations in relation to preterm birth in the Healthy Baby Cohort Study in China. Environment International. 2016; 94:300-306.
31. Yingshuang Zhu#, Yanjian Wan#, Yuanyuan Li, Bin Zhang, Aifen Zhou, Zongwei Cai, Zhengmin Qian, Chuncao Zhang, Wenqian Huo, Kai Huang, Jie Hu, Lu Cheng, Huailong Chang, Zheng Huang, Bing Xu, Wei Xia*, Shunqing Xu*. Free and total urinary phthalate metabolite concentrations among pregnant women from the Healthy Baby Cohort (HBC), China. Environment International. 2016; 88:67-73.
32. Minmin Jiang, Yuanyuan Li, Bin Zhang, Aifen Zhou, Tongzhang Zheng, Zhengmin Qian, Xiaofu Du, Yanqiu Zhou, Xinyun Pan, Jie Hu, Chuansha Wu, Yang Peng, Wenyu Liu, Chuncao Zhang, Wei Xia*, Shunqing Xu*. A nested case–control study of prenatal vanadium exposure and low birthweight. Human Reproduction. 2016; 31(9), 2135-2141.
33. Wenqian Huo#, Wei Xia#, Yanjian Wan, Bin Zhang, Aifen Zhou, Yiming Zhang, Kai Huang, Yingshuang Zhu, Chuansha Wu, Yang Peng, Minmin Jiang, Jie Hua, Huailong Chang, Bing Xu, Yuanyuan Li*, Shunqing Xu*. Maternal urinary bisphenol A levels and infant low birth weight: A nested case-control study of the Health Baby Cohort in China. Environment International. 2015; 85:96-103.
