Investigating Determinants of Perinatal Lead Exposure, Associations with Preterm Birth, and Reporting Back Research Results

Lead (Pb) is a naturally occurring metal in the environment, however; biomonitoring and epidemiologic studies have demonstrated that there is no safe level of Pb in humans. Despite this fact, the Centers for Disease Control and Prevention (CDC) identifies documented levels of Pb exposure in most humans, with different levels of Pb exposure across different demographic groups and geographic regions. Psychosocial stressors may also associate with many of the demographic characteristics commonly associated with Pb exposure. For example, data from the continuous National Health and Nutrition Examination Survey (NHANES; 1999–2016) demonstrates differing Pb levels among individuals living in different types of housing. The CDC also identifies pregnant women as a population at higher risk for Pb exposure, as bioaccumulated Pb released from bone during pregnancy can cause an acute increase in blood Pb concentration. Further, Pb exposure during pregnancy has been associated with an increased risk for adverse birth outcomes, including preterm birth, the leading cause of infant morbidity and mortality worldwide. However, research has yet to elucidate determinants of increased Pb exposure among pregnant women. To address this knowledge gap, my study will leverage the Atlanta Maternal Child Cohort, an ongoing, prospective birth cohort of pregnant women in Atlanta, Georgia. In seeking to understand risk factors for adverse maternal health outcomes, I will take advantage of the rich extant survey data and biologic measurements of Pb. In Aim 1, I will test the hypothesis that levels of maternal Pb are different across strata of covariates. In Aim 2, I will examine associations between exposure to Pb and preterm birth and assess whether this relationship is stronger among those who report experiencing greater frequency of psychosocial stress. In Aim 3, I will return contextualized Pb exposure data back to participants through reporting back of research results (RBRR), a powerful tool in the advancement of optimal health and exposure risk mitigation. Participants will not only learn about the impact of Pb exposure on adverse maternal health outcomes, including preterm birth, but will receive this information through focus groups designed in partnership with the community and facilitated by scientific researchers. Together, these aims will fill a critical knowledge gap in understanding the burden of Pb exposure and identifying risk factors for overexposed populations. The proposed project represents an innovative and accessible approach to research in perinatal health: exploring risk identification and intervention through community-academic partnerships.