Introduction
- Previous studies have not fully capitalized on the life-course approach to chronic disease epidemiology [22].
- Although some studies have collected genetic data on participants and been able to identify polymorphisms that increase the risk of obesity, they have not simultaneously collected the data on environmental exposures needed to carefully examine the interactions of genetic and environmental factors with diet, physical activity, or epigenetic changes—all of which might predict risk of obesity.
- Past studies have not assessed features of the built environment that encourage healthy diet and physical activity among children living in urban areas [25].
Scope of research
- Evaluate influences of prenatal non-persistent chemical exposures on fetal and postnatal growth.
- Evaluate prenatal non-persistent chemical exposures in relation to epigenetic marks and gene expression.
- Identify metabotypes related both to exposures and cardiometabolic outcomes, and assess exposures and metabotypes in relation to oxidative stress and perturbations of adiponectin, leptin, and sex hormones.
- Pool our data with that of other cohorts in the US National Institutes of Health (NIH) Environmental influences on Child Health Outcomes (ECHO) program and answer collaborative research questions on the impact of the preconceptual, prenatal, and postnatal environment on childhood obesity, neurodevelopment, pre/peri/postnatal outcomes, upper and lower airway outcomes, and positive health.
Study population and design
Overview
Eligibility and enrollment
Study cohort
Pregnant women and their children
Characteristica | NYU Langone Hospital-Manhattan | NYU Langone Hospital-Brooklyn | Bellevue Hospital | Total NYU CHES |
---|---|---|---|---|
n = 1076 | n = 673 | n = 444 | n = 2193 | |
Age at enrollment, mean (SD), years | 33.9 (4.5) | 29.3 (5.8) | 30.2 (5.9) | 31.8 (5.6) |
Race/ethnicity, n (%) | ||||
Hispanic | 169 (16%) | 563 (84%) | 339 (77%) | 1071 (49%) |
White, not of Hispanic origin | 652 (61%) | 42 (6%) | 33 (8%) | 727 (33%) |
Black, not of Hispanic origin | 62 (6%) | 33 (5%) | 35 (8%) | 130 (6%) |
Asian | 143 (13%) | 27 (4%) | 23 (5%) | 193 (9%) |
Other | 12 (1%) | 4 (1%) | 4 (1%) | 20 (1%) |
Multiple | 36 (3%) | 2 (< 1%) | 6 (1%) | 44 (2%) |
Marital status, n (%) | ||||
Married/living with a partner | 1024 (95%) | 543 (81%) | 344 (78%) | 1911 (88%) |
Divorced/separated | 10 (1%) | 23 (3%) | 15 (3%) | 48 (2%) |
Single/widowed | 38 (4%) | 104 (16%) | 84 (19%) | 226 (10%) |
Education, n (%) | ||||
High school or less | 33 (3%) | 434 (66%) | 237 (54%) | 704 (32%) |
Some college but no degree | 64 (6%) | 110 (17%) | 82 (19%) | 256 (12%) |
Associate degree | 31 (3%) | 43 (6%) | 32 (7%) | 106 (5%) |
Bachelor’s degree | 380 (36%) | 55 (8%) | 63 (15%) | 498 (23%) |
Post graduate degree | 559 (52%) | 20 (3%) | 23 (5%) | 602 (28%) |
Household income, n (%) | ||||
Less than $30,000 | 24 (2%) | 196 (30%) | 142 (34%) | 362 (17%) |
$30,000–$49,999 | 36 (4%) | 78 (12%) | 64 (15%) | 178 (8%) |
$50,000–$74,999 | 90 (8%) | 31 (5%) | 20 (5%) | 141 (7%) |
$75,000–$99,999 | 93 (9%) | 6 (1%) | 7 (2%) | 106 (5%) |
$100,000 or more | 778 (74%) | 18 (3%) | 9 (2%) | 805 (38%) |
Don’t know | 34 (3%) | 323 (49%) | 172 (42%) | 529 (25%) |
Employed, n (%) | 916 (86%) | 271 (41%) | 225 (51%) | 1412 (65%) |
Insurance, n (%) | ||||
Public | 139 (13%) | 587 (88%) | 413 (96%) | 1139 (52%) |
Private | 934 (87%) | 83 (12%) | 15 (4%) | 1032 (48%) |
Use of cigarettes and other related productsb during pregnancy, n (%) | ||||
Never | 991 (92%) | 607 (90%) | 385 (87%) | 1983 (91%) |
Used, stopped in pregnancy | 72 (7%) | 57 (9%) | 51 (11%) | 180 (8%) |
Used, continued in pregnancy | 10 (1%) | 9 (1%) | 8 (2%) | 27 (1%) |
Alcohol use during pregnancy, n (%) | ||||
Never | 155 (15%) | 368 (55%) | 211 (48%) | 734 (33%) |
Used, stopped in pregnancy | 700 (65%) | 234 (35%) | 191 (43%) | 1125 (52%) |
Used, continued in pregnancy | 215 (20%) | 66 (10%) | 39 (9%) | 320 (15%) |
Pre-pregnancy body mass index, mean (SD), kg/m2 | 24.7 (5.0) | 27.5 (5.5) | 28.6 (6.5) | 26.3 (5.7) |
Nulliparous, n (%) | 687 (64%) | 227 (34%) | 203 (46%) | 1117 (51%) |
Characteristic | NYU Langone Obstetrics & Gynecology Associates (New York, NY) | Sunset Park Family Health Center at NYU Langone, Women’s Health (Brooklyn, NY) | ||
---|---|---|---|---|
All patients seen in the clinic | NYU CHES participants | All patients seen in the clinic | NYU CHES participants | |
n = 8176 | n = 1076 | n = 2723 | n = 673 | |
Age at first prenatal visit, mean (SD), years | 34.1 (5.1) | 33.9 (4.5) | 29.9 (6.1) | 29.3 (5.8) |
Race/ethnicity, n (%) | ||||
Hispanic | 766 (10%) | 169 (16%) | 1988 (74%) | 563 (84%) |
White, not of Hispanic origin | 5106 (65%) | 652 (61%) | 223 (8%) | 42 (6%) |
Black, not of Hispanic origin | 538 (7%) | 62 (6%) | 147 (5%) | 33 (5%) |
Asian | 972 (13%) | 143 (13%) | 111 (4%) | 27 (4%) |
Other/multiple | 425 (5%) | 48 (4%) | 237 (9%) | 6 (1%) |
Missing | 369 | 2 | 17 | 2 |
Marital status, n (%) | ||||
Married/living with a partner | 5279 (77%) | 1024 (95%) | 1131 (46%) | 543 (81%) |
Divorced/separated | 60 (1%) | 10 (1%) | 30 (1%) | 23 (3%) |
Single | 1451 (21%) | 38 (4%) | 1283 (52%) | 104 (16%) |
Other | 41 (1%) | 0 | 9 (< 1%) | 0 |
Missing | 1345 | 4 | 270 | 3 |
Nulliparous, n (%) | 4939 (62%) | 687 (64%) | 1096 (40%) | 227 (34%) |
Missing | 167 | 0 | 13 | 2 |
Insurance, n (%) | ||||
Public | 1112 (14%) | 139 (13%) | 2366 (87%) | 587 (88%) |
Private | 6960 (86%) | 934 (87%) | 341 (13%) | 83 (12%) |
Missing | 104 | 3 | 16 | 3 |
Pre-pregnancy BMI, mean (SD), kg/m2 | 24.8 (5.2) | 24.7 (5.0) | 28.1 (6.1) | 27.5 (5.5) |
Missing | 3509 | 3 | 1739 | 15 |
Gestational age at delivery, mean (SD), weeksa | 38.8 (2.6) | 39.0 (1.7) | 38.9 (2.0) | 39.0 (1.8) |
Missing | 1930 | 23 | 816 | 12 |
Child sex, male, n (%)b | 3256 (51%) | 534 (53%) | 980 (51%) | 311 (51%) |
Missing | 40 | 27 | 11 | 11 |
Birth weight, mean (SD), gb | 3215 (607) | 3226 (553) | 3052 (811) | 3279 (536) |
Missing | 1859 | 52 | 2534 | 30 |
Characteristic | 2016 New York City birth data | NYU CHES participants with live deliveries |
---|---|---|
n = 88,924 | n = 2000 | |
Mother’s age, years | ||
< 20 | 1754 (2%) | 45 (2%) |
20–24 | 11,977 (14%) | 217 (11%) |
25–29 | 22,442 (25%) | 425 (21%) |
30–34 | 28,737 (32%) | 732 (37%) |
35–39 | 18,850 (21%) | 454 (23%) |
40+ | 5164 (6%) | 127 (6%) |
Race/ethnicity, n (%) | ||
Hispanic | 23,614 (27%) | 965 (48%) |
Asian/Pacific Islander | 16,586 (18%) | 180 (9%) |
Non-Hispanic White | 33,737 (38%) | 677 (34%) |
Non-Hispanic Black | 13,843 (16%) | 114 (6%) |
Other | 1096 (1%) | 59 (3%) |
Missing | 48 | 5 |
Marital status, n (%) | ||
Married | 59,466 (67%) | 1757 (88%) |
Not married | 29,458 (33%) | 242 (12%) |
Missing | 0 | 1 |
Education, n (%) | ||
High school or less | 31,321 (35%) | 635 (32%) |
Some college, associate degree | 18,914 (21%) | 327 (16%) |
Bachelor’s degree | 20,864 (24%) | 457 (23%) |
Post graduate degree | 17,646 (20%) | 564 (29%) |
Missing | 179 | 17 |
Nulliparous, n (%) | 38,772 (44%) | 1002 (50%) |
Missing | 1 | 3 |
Pre-pregnancy BMI category, n (%) | ||
Underweight | 4920 (5%) | 41 (2%) |
Normal | 48,515 (55%) | 947 (48%) |
Overweight | 21,091 (24%) | 571 (29%) |
Obese | 14,191 (16%) | 422 (21%) |
Missing | 207 | 19 |
Multiple births, n (%) | 3250 (4%) | 37 (2%) |
Delivery method, n (%) | ||
Vaginal | 59,366 (67%) | 1264 (67%) |
Cesarean section | 29,558 (33%) | 615 (33%) |
Missing | 0 | 121 |
Gestational age category, n (%) | ||
17–31 weeks | 1222 (1%) | 14 (1%) |
32–33 weeks | 912 (1%) | 18 (1%) |
34–36 weeks | 5686 (7%) | 124 (6%) |
37–47 weeks | 81,104 (91%) | 1797 (92%) |
Missing | 0 | 47 |
Preterm births (< 37 weeks), n (%) | 7820 (9%) | 156 (8%) |
Missing | 0 | 47 |
Child sex, male, n (%)a | 45,423 (51%) | 1031 (52%) |
Missing | 0 | 56 |
Birth weight category, n (%)a | ||
< 1000 | 521 (1%) | 6 (< 1%) |
1000–1499 | 649 (1%) | 9 (< 1%) |
1500–1999 | 1328 (1%) | 34 (2%) |
2000–2499 | 4613 (5%) | 101 (5%) |
2500–2999 | 17,852 (20%) | 389 (20%) |
3000–3499 | 35,977 (40%) | 777 (40%) |
3500–3999 | 22,295 (25%) | 490 (26%) |
4000–4499 | 5027 (6%) | 105 (5%) |
4500–4999 | 605 (1%) | 17 (1%) |
5000+ | 57 (< 1%) | 1 (< 1%) |
Missing | 0 | 108 |
Low birth weight (< 2500 g), n (%)a | 7111 (8%) | 150 (8%) |
Missing | 0 | 108 |
Characteristica | NYU Langone Hospital—Manhattan | NYU Langone Hospital—Brooklyn | Bellevue Hospital | Total |
---|---|---|---|---|
n = 1076 | n = 673 | n = 444 | n = 2193 | |
Pregnancy outcome, n (%) | ||||
Live delivery | 1006 (95%) | 611 (93%) | 383 (90%) | 2000 (94%) |
Stillbirth | 9 (1%) | 7 (1%) | 4 (1%) | 20 (1%) |
Miscarriage | 28 (3%) | 33 (5%) | 27 (6%) | 88 (4%) |
Elective termination | 11 (1%) | 5 (1%) | 12 (3%) | 28 (1%) |
Multiple births (all twins), n (%)b | 24 (2%) | 9 (1%) | 4 (1%) | 37 (2%) |
Gestational age at delivery, mean (SD), weeksb | 39.0 (1.7) | 39.0 (1.8) | 39.0 (2.0) | 39.0 (1.8) |
Preterm births (< 37 weeks), n (%)b | 79 (8%) | 40 (7%) | 37 (10%) | 156 (8%) |
Delivery method, n (%)b | ||||
Vaginal | 591 (63%) | 394 (68%) | 279 (78%) | 1264 (67%) |
Cesarean section | 352 (37%) | 186 (32%) | 77 (22%) | 615 (33%) |
Child sex, n (%), malec | 534 (53%) | 311 (51%) | 186 (50%) | 1031 (52%) |
Birth weight, mean (SD), gc | 3226 (553) | 3279 (536) | 3284 (571) | 3284 (568) |
Low birth weight (< 2500 g), n (%)c | 86 (9%) | 36 (6%) | 28 (8%) | 150 (8%) |
Data collection in the prenatal phase
During pregnancy gestational age, weeks | Any time during pregnancy | At birth | |||
---|---|---|---|---|---|
< 18 | 18–25 | > 25 | |||
Questionnaires, n (%) | 2000 (100%) | 1726 (86%) | 2000 (100%) | 1080 (54%) | |
Diet History Questionnaire II, n (%) | 1406 (70%) | 1406 (70%) | |||
Maternal urine, n (%) | 1777 (89%) | 1318 (66%) | 1627 (81%) | 1938 (97%) | |
Maternal saliva, n (%) | 1603 (80%) | 1074 (54%) | 1458 (73%) | 1868 (93%) | |
Maternal whole blood, n (%) | 1146 (57%) | 479 (24%) | 850 (43%) | 1514 (76%) | |
Maternal PAXgene RNA tube, n (%) | 1174 (59%) | 850 (43%) | 1441 (72%) | ||
Maternal plasma, n (%) | 477 (24%) | 477 (24%) | |||
Maternal serum, n (%) | 1155 (58%) | 492 (25%) | 858 (43%) | 1521 (76%) | |
Maternal vaginal swab, n (%) | 1088 (54%) | 860 (43%) | 1173 (59%) | 1491 (75%) | |
Placental core, n (%) | 1509 (75%) | ||||
Umbilical cord, n (%) | 1491 (75%) | ||||
Cord blood (PAXgene RNA tube), n (%) | 1392 (70%) | ||||
Cord blood (Whole), n (%) | 1059 (53%) | ||||
Cord serum, n (%) | 886 (44%) | ||||
Cold plasma, n (%) | 417 (21%) | ||||
Neonatal meconium, n (%) | 396 (20%) |
Questionnaires and medical chart abstraction
< 18 weeks | 18–25 weeks | > 25 weeks | Birth | 4–7 months | 8–11 months | 12–17 months | 18–23 months | 24–35 months | |
---|---|---|---|---|---|---|---|---|---|
Maternal/family characteristics | |||||||||
Family sociodemographic factors | Q, EHR | EHR | Q | Q | Q | Q | Q | ||
Gestational hypertension, preeclampsia and gestational diabetes | Q, EHR | Q, EHR | EHR | Q | Q | ||||
Current pregnancy information, including morning sickness and vitamin/medication use | Q | Q | Q | ||||||
Maternal stress, depression, or anxiety | Q | Q | Q | Q | Q | Q | |||
Adverse events during pregnancy | EHR | EHR | EHR | Q | |||||
Reproductive history | Q, EHR | EHR | EHR | ||||||
General health and health history | Q, EHR | Q, EHR | Q, EHR | Q | Q | ||||
Sleep | Q | Q | Q | ||||||
Physical activity | Q | Q | Q | Q | |||||
Maternal substance use | Q | Q | Q | Q | Q | Q | Q | Q | |
Housing characteristics | Q | Q | Q | Q | |||||
Home environment | Q | ||||||||
Pets and pests | Q | Q | Q | Q | Q | Q | Q | ||
Maternal social support, exposure to domestic violence | Q | Q | Q | ||||||
Diet | Q | ||||||||
Labor and delivery of previous birth, and previous pregnancies | Q, EHR | Q, EHR | |||||||
Maternity leave/employment | Q | Q | Q | Q | |||||
Childcare | Q | Q | Q | Q | |||||
Food insecurity | Q | Q | |||||||
Parenting and family cohesion | Q | ||||||||
Child characteristics | |||||||||
Diet and feeding | Q | Q | Q | Q | |||||
General health, medications, and hospitalizations | Q, EHR | Q, EHR | Q, EHR | Q, EHR | Q, EHR | ||||
Early development | Q | Q | Q | Q | Q | ||||
Language development | Q | ||||||||
Emotional and behavioral development | Q | Q | |||||||
Floor time and devices that hold the baby | Q | Q | Q | ||||||
Media exposure | Q | Q | Q | Q | Q | ||||
Sleep | Q | Q | Q | Q | |||||
Clinical measures | |||||||||
Fetal sonographic measurements | Measured | Measured | Measured | ||||||
Brachial artery distensibility, blood pressure | M:Measured | M:Measured C:Measured | |||||||
Weight and height | M:Q, EHR P:Q | M:EHR | M:EHR | M:Q, EHR C:Q, EHR | C:Q | C:Q | C:Q | M:Measured C:Measured | M:Measured C:Measured |
Anogenital distance | Measured | Measured | Measured | ||||||
Fat, lean mass (DXA scan) | C:Measured | C:Measured | |||||||
Biological measures | |||||||||
Bisphenols, phthalate metabolites, dialkylphosphate metabolites, polycyclic aromatic hydrocarbon metabolites | M:Urine | M:Urine | M:Urine | C:Urine | C:Urine | ||||
Biomarkers of oxidant stress | M:Urine | M:Urine | M:Urine | C:Urine | C:Urine | ||||
Metabolomics | M:Urine | M:Urine | M:Urine | C:Urine | C:Urine | ||||
Adiponectin and leptin | Cord serum | ||||||||
Thyroid function and Thyroid peroxidase antibody | M:Serum | ||||||||
Biomarkers of inflammation and endothelial dysfunction | M:Serum | M:Serum | M:Serum | Cord serum | |||||
Sex steroids | M:Serum | ||||||||
Methylomics (genome-wide) | Cord PAXgene | ||||||||
Transcriptomics (genome-wide) | Cord PAXgene |
Specimen analyses
Data collection in the postnatal phase
Data management and statistical power
Data preparation
Privacy protection
Statistical power
Proportion exposed (%) | NYU CHES cohort (n = 2000) |
---|---|
50 | 0.125 |
20 | 0.157 |
10 | 0.209 |
5 | 0.287 |
1 | 0.630 |
Strengths and limitations
Characteristica | Participants consented to postnatal phase | Participants not consented to postnatal phase |
---|---|---|
n = 1597a | n = 403 | |
Age at enrollment, mean (SD), years | 32.0 (5.5) | 31.2 (5.7) |
Race/ethnicity, n (%) | ||
Hispanic | 769 (49%) | 196 (49%) |
White, not of Hispanic origin | 546 (34%) | 131 (32%) |
Black, not of Hispanic origin | 84 (5%) | 30 (7%) |
Asian | 145 (9%) | 35 (9%) |
Other | 14 (1%) | 3 (1%) |
Multiple | 35 (2%) | 7 (2%) |
Marital status, n (%) | ||
Married/living with a partner | 1410 (88%) | 347 (86%) |
Divorced/separated | 38 (3%) | 6 (2%) |
Single/widowed | 149 (9%) | 49 (12%) |
Education, n (%) | ||
High school or less | 491 (31%) | 144 (36%) |
Some college but no degree | 187 (12%) | 42 (11%) |
Associate degree | 76 (5%) | 22 (6%) |
Bachelor’s degree | 360 (22%) | 97 (24%) |
Post graduate degree | 472 (30%) | 92 (23%) |
Household income, n (%) | ||
Less than $30,000 | 258 (17%) | 62 (16%) |
$30,000–$49,999 | 128 (8%) | 40 (11%) |
$50,000–$74,999 | 104 (7%) | 28 (7%) |
$75,000–$99,999 | 70 (4%) | 23 (6%) |
$100,000 or more | 630 (40%) | 129 (34%) |
Don’t know | 368 (24%) | 101 (26%) |
Employed, n (%) | 1046 (66%) | 260 (65%) |
Insurance, n (%) | ||
Public | 798 (50%) | 221 (55%) |
Private | 786 (50%) | 175 (45%) |
Use of cigarettes and other related products during pregnancy, n (%) | ||
Never | 1450 (91%) | 362 (90%) |
Used, stopped in pregnancy | 127 (8%) | 35 (9%) |
Used, continued in pregnancy | 18 (1%) | 5 (1%) |
Alcohol use during pregnancy, n (%) | ||
Never | 518 (32%) | 144 (36%) |
Used, stopped in pregnancy | 809 (51%) | 215 (54%) |
Used, continued in pregnancy | 268 (17%) | 40 (10%) |
Pre-pregnancy body mass index, mean (SD), kg/m2 | 26.4 (5.9) | 25.8 (5.1) |
Nulliparous, n (%) | 779 (49%) | 223 (56%) |