Publications by authors named "Marisa Estarlich"

53 Publications

Pre and postnatal exposure to mercury and respiratory health in preschool children from the Spanish INMA Birth Cohort Study.

Sci Total Environ 2021 Mar 20;782:146654. Epub 2021 Mar 20.

Epidemiology and Environmental Health Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, FISABIO-Public Health, FISABIO-Universitat Jaume I-Universitat de València, Av. Catalunya 21, 46020 Valencia, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029 Madrid, Spain.

Effects of mercury on maturing immune system have been reported, however the association with respiratory and allergy problems during infancy remains unclear. The aim of this study is to evaluate the association between pre and postnatal mercury exposure and respiratory and allergy problems among preschool children and to examine the role of potential modifying factors. Study subjects were children participant in Spanish Childhood and Environment Project (INMA, 2003-2008). We measured total mercury levels in cord blood (n = 1868) and hair at 4 years of age (n = 1347). Respiratory outcomes (wheezing, severe wheezing, chestiness, persistent cough, eczema and otitis) were obtained by questionnaires administered to parents. Associations were investigated by logistic regression adjusted for socio-demographic and lifestyle-related variables in each cohort and subsequent meta-analysis. We tested effect modification by factors related to individual susceptibility, diet and co-exposure with other pollutants. The geometric mean of cord blood and hair total mercury was 8.20 μg/L and 0.97 μg/g, respectively. No statistically significant association between pre or postnatal mercury exposure and respiratory and allergy outcomes was found. Notwithstanding, lower maternal intake of fruits and vegetables increased the risk of some respiratory outcomes due to the prenatal exposure to mercury (p < 0.05). Moreover, an inverse association between prenatal mercury exposure and some respiratory outcomes was observed among children with higher maternal exposure to organocholorine compounds or smoking (p < 0.05). Also, sex and postnatal smoking exposure modulated mercury postnatal effects on persistent cough (p < 0.05). In conclusion, no association between pre and postnatal mercury exposure and respiratory and allergy problems among the whole population at study was found. However, diet and other toxicants could modulate this relation, especially during prenatal period. More research on this topic is warranted due to the limited evidence.
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http://dx.doi.org/10.1016/j.scitotenv.2021.146654DOI Listing
March 2021

Radiofrequency electromagnetic fields from mobile communication: Description of modeled dose in brain regions and the body in European children and adolescents.

Environ Res 2021 02 24;193:110505. Epub 2020 Nov 24.

ISGlobal, Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain. Electronic address:

Background: Little is known about radiofrequency electromagnetic fields (RF) from mobile technology and resulting dose in young people. We describe modeled integrated RF dose in European children and adolescents combining own mobile device use and surrounding sources.

Methods: Using an integrated RF model, we estimated the daily RF dose in the brain (whole-brain, cerebellum, frontal lobe, midbrain, occipital lobe, parietal lobe, temporal lobes) and the whole-body in 8358 children (ages 8-12) and adolescents (ages 14-18) from the Netherlands, Spain, and Switzerland during 2012-2016. The integrated model estimated RF dose from near-field sources (digital enhanced communication technology (DECT) phone, mobile phone, tablet, and laptop) and far-field sources (mobile phone base stations via 3D-radiowave modeling or RF measurements).

Results: Adolescents were more frequent mobile phone users and experienced higher modeled RF doses in the whole-brain (median 330.4 mJ/kg/day) compared to children (median 81.8 mJ/kg/day). Children spent more time using tablets or laptops compared to adolescents, resulting in higher RF doses in the whole-body (median whole-body dose of 81.8 mJ/kg/day) compared to adolescents (41.9 mJ/kg/day). Among brain regions, temporal lobes received the highest RF dose (medians of 274.9 and 1786.5 mJ/kg/day in children and adolescents, respectively) followed by the frontal lobe. In most children and adolescents, calling on 2G networks was the main contributor to RF dose in the whole-brain (medians of 31.1 and 273.7 mJ/kg/day, respectively).

Conclusion: This first large study of RF dose to the brain and body of children and adolescents shows that mobile phone calls on 2G networks are the main determinants of brain dose, especially in temporal and frontal lobes, whereas whole-body doses were mostly determined by tablet and laptop use. The modeling of RF doses provides valuable input to epidemiological research and to potential risk management regarding RF exposure in young people.
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http://dx.doi.org/10.1016/j.envres.2020.110505DOI Listing
February 2021

Residential Surrounding Greenspace and Mental Health in Three Spanish Areas.

Int J Environ Res Public Health 2020 08 5;17(16). Epub 2020 Aug 5.

Barcelona Institute for Global Health (ISGlobal), 08003 Barcelona, Spain.

Exposure to greenspace has been related to improved mental health, but the available evidence is limited and findings are heterogeneous across different areas. We aimed to evaluate the associations between residential exposure to greenspace and specific psychopathological and psychosomatic symptoms related to mental health among mothers from a Spanish birth cohort. Our study was based on data from 1171 women participating in two follow-ups of a population-based cohort in Valencia, Sabadell, and Gipuzkoa (2004-2012). For each participant, residential surrounding greenspace was estimated as the average of the satellite-based Normalized Difference Vegetation Index (NDVI) across different buffers around the residential address at the time of delivery and at the 4-year follow-up. The Symptom Checklist 90 Revised (SCL-90-R) was applied to characterize mental health at the 4-year follow-up. We developed mixed-effects logistic regression models controlled for relevant covariates to evaluate the associations. Higher residential surrounding greenspace was associated with a lower risk of somatization and anxiety symptoms. For General Severity Index (GSI), obsessive-compulsive, interpersonal sensitivity, depression, hostility, phobic anxiety, paranoid ideation, and psychoticism symptoms, we generally observed protective associations, but none attained statistical significance. Findings from this study suggested a potential positive impactof greenspace on mental health.
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http://dx.doi.org/10.3390/ijerph17165670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460179PMC
August 2020

Prenatal air pollution exposure and growth and cardio-metabolic risk in preschoolers.

Environ Int 2020 05 16;138:105619. Epub 2020 Mar 16.

ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.

Objectives: We investigated the association between outdoor air pollutants exposure in the first trimester of pregnancy, and growth and cardio-metabolic risk at four years of age, and evaluated the mediating role of birth weight.

Methods: We included mother-child pairs (N = 1,724) from the Spanish INMA birth cohort established in 2003-2008. First trimester of pregnancy nitrogen dioxide (NO) and fine particles (PM) exposure levels were estimated. Height, weight, waist circumference, blood pressure, and lipids were measured at four years of age. Body mass index (BMI) trajectories from birth to four years were identified.

Results: Increased PM exposure in the first trimester of pregnancy was associated with decreased z-scores of weight (zWeight) and BMI (zBMI) (zWeight change per interquartile range increase in PM exposure = -0.12; 95% CI: -0.23, -0.01; zBMI change = -0.12; 95% CI: -0.23, -0.01). Higher NO and PM exposure was associated to a reduced risk of being in a trajectory with accelerated BMI gain, compared to children with the average trajectory. Birth weight partially mediated the association between PM and zWeight and zBMI. PM and NO were not associated with the other cardio-metabolic risk factors.

Conclusions: This comprehensive study of many growth and cardio-metabolic risk related outcomes suggests that air pollution exposure during pregnancy may be associated with delays in physical growth in the early years after birth. These findings imply that pregnancy exposure to air pollutants has a lasting effect on growth after birth and require follow-up at later child ages.
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http://dx.doi.org/10.1016/j.envint.2020.105619DOI Listing
May 2020

Risk of child poverty and social exclusion in two Spanish regions: social and family determinants.

Gac Sanit 2021 May-Jun;35(3):216-223. Epub 2020 Jan 21.

Joint Research Unit in Epidemiology, Environment and Health, FISABIO-University of Valencia-Universitat Jaume I, Valencia, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain; Predepartamental Unit of Medicine, Universitat Jaume I, Castellón de la Plana, Spain.

Objective: Describe the risk of poverty and social exclusion in children aged 8-11 years from Gipuzkoa and Valencia (Spain), through AROPE (At Risk Of Poverty or Social Exclusion) indicators, and evaluate their associated factors in the INMA Project (Childhood and Environment).

Method: Families in Gipuzkoa and Valencia (394 and 382, respectively) completed a questionnaire in 2015-2016. Low work intensity (LWI), at risk of poverty (RP) and material deprivation (MD) were estimated. AROPE consisted in meeting any of the previous sub-indicators. Socio-demographic, family and parental characteristics were considered. Frequencies, Venn's diagrams, and chi-square and Fisher tests were used in bivariate analysis and logistic regression in multivariate analysis.

Results: For LWI, RP, MD and AROPE, prevalence of 2.5%, 5.6%, 2.3% and 7.2% were obtained in Gipuzkoa, and 8.1%, 31.5%, 7.8% and 34.7% in Valencia, respectively. In the multivariate analysis, the AROPE was associated in both areas with maternal social class and non-nuclear families. In Gipuzkoa, it was also related to maternal education. In Valencia, other factors were the mother's foreign origin, and paternal education and smoking.

Conclusion: There is higher AROPE prevalence in Valencia. Social class and family type were shared factors, but a differential pattern is observed in other social determinants. It is essential to implement social policies to reduce this axis of inequalities in health, especially in childhood.
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http://dx.doi.org/10.1016/j.gaceta.2019.11.002DOI Listing
January 2020

Exposure to ultrafine particles in children until 18 years of age: A systematic review.

Indoor Air 2020 01 3;30(1):7-23. Epub 2019 Dec 3.

FISABIO-Universitat Jaume I-Universitat de València Joint Research Unit of Epidemiology and Environmental Health, Valencia, Spain.

Airborne ultrafine particles (UFP) have been related to adverse health effects, but exposure in vulnerable population groups such as children is still not well understood. We aim to review the scientific literature regarding personal exposure to UFP in different microenvironments in populations until 18 years of age. The bibliographical search was carried out in July 2019 using the online database PubMed and was completed with references in articles found in the search. We selected the studies that used continuous counters and measured UFP levels in both specific microenvironment (houses, schools, transport, etc) and personal exposure. Finally, 32 studies fulfilled the criteria: of these, 10 analyzed personal exposure and 22 examined UFP levels in the microenvironment (especially in schools or nurseries (18/22)) and five in various microenvironments (including dwellings and means of transport, where exposure levels were higher). The characteristics of the microenvironments with the greatest levels of UFP were being close to heavy traffic or near cooking and cleaning activities. This review revealed the wide differences in exposure assessment methodologies that could lead to a lack of uniform and comparable information about the real UFP exposure in children.
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http://dx.doi.org/10.1111/ina.12620DOI Listing
January 2020

Association of Exposure to Ambient Air Pollution With Thyroid Function During Pregnancy.

JAMA Netw Open 2019 10 2;2(10):e1912902. Epub 2019 Oct 2.

ISGlobal, Barcelona, Spain.

Importance: Air pollutants interact with estrogen nuclear receptors, but their effect on thyroid signaling is less clear. Thyroid function is of particular importance for pregnant women because of the thyroid's role in fetal brain development.

Objective: To determine the short-term association of exposure to air pollution in the first trimester with thyroid function throughout pregnancy.

Design, Setting, And Participants: In this cohort study, 9931 pregnant women from 4 European cohorts (the Amsterdam Born Children and Their Development Study, the Generation R Study, Infancia y Medio Ambiente, and Rhea) and 1 US cohort (Project Viva) with data on air pollution exposure and thyroid function during pregnancy were included. The recruitment period for the Amsterdam Born Children and Their Development Study was January 2003 to March 2004; for Generation R, April 2002 to January 2006; for Infancia y Medio Ambiente, November 2003 to January 2008; for Rhea, February 2007 to February 2008; and for Project Viva, April 1999 to November 2002. Statistical analyses were conducted from January 2018 to April 2019.

Main Outcomes And Measures: Residential air pollution concentrations (ie, nitrogen oxide and particulate matter [PM]) during the first trimester of pregnancy were estimated using land-use regression and satellite-derived aerosol optical depth models. Free thyroxine, thyrotropin, and thyroid peroxidase antibody levels were measured across gestation. Hypothyroxinemia was defined as free thyroxine below the fifth percentile of the cohort distribution with normal thyrotropin levels, following the American Thyroid Association guidelines.

Results: Among 9931 participants, the mean (SD) age was 31.2 (4.8) years, 4853 (48.9%) had more than secondary educational levels, 5616 (56.6%) were nulliparous, 404 (4.2%) had hypothyroxinemia, and 506 (6.7%) tested positive for thyroid peroxidase antibodies. Concentrations of nitrogen dioxide and PM with an aerodynamic diameter of 2.5 μm or less (PM2.5) were lower and had less variation in women in the US cohort than those in European cohorts. No associations of nitrogen oxide with thyroid function were found. Higher exposures to PM2.5 were associated with higher odds of hypothyroxinemia in pregnant women (odds ratio per 5-μg/m3 change, 1.21; 95% CI, 1.00-1.47). Although exposure to PM with an aerodynamic diameter of 10 μm or less was not significantly associated with hypothyroxinemia, the coefficient was similar to that for the association of PM2.5 with hypothyroxinemia (odds ratio per 10-μg/m3 change, 1.18; 95% CI, 0.93-1.48). Absorbances of PM2.5 and PM with aerodynamic diameter from 2.5 to 10 μg and were not associated with hypothyroxinemia. There was substantial heterogeneity among cohorts with respect to thyroid peroxidase antibodies (P for heterogeneity, <.001), showing associations of nitrogen oxide and PM with thyroid autoimmunity only in the women in the Generation R Study.

Conclusions And Relevance: The findings of this study suggest that first-trimester exposures to PM2.5 were associated with mild thyroid dysfunction throughout pregnancy. The association of PM2.5 exposure with thyroid function during pregnancy is of global health importance because air pollution exposure is widespread and hypothyroxinemia may adversely influence the brain development of offspring.
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http://dx.doi.org/10.1001/jamanetworkopen.2019.12902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6806433PMC
October 2019

Prenatal exposure to PM and NO and sex-dependent infant cognitive and motor development.

Environ Res 2019 07 8;174:114-121. Epub 2019 Apr 8.

Biodonostia Health Institute Research, San Sebastián, Basque Country, 20014, Spain; Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, 28029, Spain; School of Psychology, University of the Basque Country(UPV/EHU), San Sebastián, 20080, Spain; Sub-directorate for Public Health of Gipuzkoa, BasqueGovernment, San Sebastián, 20013, Spain.

Background: Prenatal exposure to air pollutants including particulate matter (<2.5 μm of diameter,PM)and nitrogen dioxide (NO) has been identified as a potential risk factor for neuropsychological developmental and mental health disorders.

Objective: This study aimed to analyze the associations between prenatal PM and NO exposure and cognitive functions in children at 4-6 years of age, including sex differences, and the modification effect of the duration predominant breastfeeding these associations.

Design: This study was conducted as part of the INMA project, a population-based birth cohort study in Spain (n = 1119). Each of the pregnant mothers was assigned a prenatal exposure to PM and NO for their whole pregnancy based on their place of residence. At the 4-6 year-old follow-up, infants' neuropsychological development was assessed using McCarthy scales: Verbal, Perceptive-Manipulative, Numeric, General Cognitive, Memory and Motor (gross and fine). Between 6 and 14 months of age, information concerning breastfeeding was gathered with a questionnaire. Regression analyses were performed to estimate the associations between exposure and outcomes, accounting for potential confounders. The analyses were stratified by child sex and breastfeeding duration.

Results: The majority of coefficients for the different cognitive domains were negative either for PM and NO, though none was statistically significant. After stratifying by sex, the associations become even more negative for boys, with some of the associations becoming statistically significant (memory both for PM and NO), and global cognition and verbal for NO. Duration of predominant breastfeeding was not found to have a modifying effect.

Conclusions: These findings suggest a sex-dependent effects on neuropsychological development at 4-6 years of age, with a greater vulnerability in boys, specifically in domains related to memory, verbal and general cognition. No modifying effect was observed for duration of predominant breastfeeding.
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http://dx.doi.org/10.1016/j.envres.2019.04.001DOI Listing
July 2019

Personal exposure to radio-frequency electromagnetic fields in Europe: Is there a generation gap?

Environ Int 2018 12 11;121(Pt 1):216-226. Epub 2018 Sep 11.

Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.

Background: Exposure to radiofrequency electromagnetic fields (RF-EMF) from mobile communication technologies is changing rapidly. To characterize sources and associated variability, we studied the differences and correlations in exposure patterns between children aged 8 to 18 and their parents, over the course of the day, by age, by activity pattern, and for different metrics of exposure.

Methods: Using portable RF-EMF measurement devices, we collected simultaneous real-time personal measurements of RF-EMF over 24 to 72 h in 294 parent-child pairs from Denmark, the Netherlands, Slovenia, Switzerland, and Spain. The devices measured the power flux density (mW/m) in 16 different frequency bands every 4 s, and activity diary Apps kept by the participants were used to collect time-activity information in real-time. We analyzed their exposures by activity, for the different source constituents of exposure: downlink (radiation emitted from mobile phone base stations), uplink (transmission from phone to base station), broadcast, DECT (digital enhanced cordless telecommunications) and Wi-Fi. We looked at the correlations between parents and children overall, during day (06:00-22.00) and night (22:00-06:00) and while spending time at home.

Results: The mean of time-weighted average personal exposures was 0.16 mW/m for children and 0.15 mW/m for parents, on average predominantly originating from downlink sources (47% for children and 45% for parents), followed by uplink (18% and 27% respectively) and broadcast (25% and 19%). On average, exposure for downlink and uplink were highest during the day, and for Wi-Fi and DECT during the evening. Exposure during activities where most of the time is spent (home, school and work) was relatively low whereas exposure during travel and outside activities was higher. Exposure to uplink increased with age among young people, while DECT decreased slightly. Exposure to downlink, broadcast, and Wi-Fi showed no obvious trend with age. We found that exposure to total RF-EMF is correlated among children and their parents (R = 0.45), especially while at home (0.62) and during the night (0.60). Correlations were higher for environmental sources such as downlink (0.57) and broadcast (0.62) than for usage-related exposures such as uplink (0.29).

Conclusion: The generation gap between children and their parents is mostly evident in uplink exposure, due to more and longer uplink and cordless phone calls among parents, and their tendency to spend slightly more time in activities with higher environmental RF-EMF exposure, such as travel. Despite these differences in personal behavior, exposure to RF-EMF is moderately correlated between children and their parents, especially exposures resulting from environmental RF-EMF sources.
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http://dx.doi.org/10.1016/j.envint.2018.09.002DOI Listing
December 2018

Influence of paid maternity leave on return to work after childbirth.

Med Lav 2018 08 28;109(4):243-252. Epub 2018 Aug 28.

Mutua ASEPEYO.

Background: Paid maternity leave (ML) has been associated with better health outcomes in mothers and newborns. However, its protective role in mothers' employment after childbirth remains unclear.

Objective: To assess the association between paid ML and being employed 1-year after childbirth.

Methods: As part of the INfancia y Medio Ambiente (INMA) cohort study, 507 Spanish women employed at 12th week of pregnancy, were asked about their employment status and job characteristics at 32nd week of pregnancy. One year after childbirth, they were re-interviewed about their employment status and if they had taken paid ML. Incidence of maternal employment 1-year after childbirth was estimated. Crude and adjusted associations with paid ML were assessed by logistic regression, and characterized by odds ratios (ORs) with associated 95% CIs.

Results: Information was obtained from 398 women. Of those, 290 (72.9%) were employed 1-year after childbirth. Incidence of maternal employment was lower for those who: i) didn't take paid ML, ii) were younger than 27 years; iii) had temporary contract, iv) had part-time jobs, v) reported less-favoured familiar social class, and vi) left the job before 32 weeks of pregnancy. Being employed 1-year after childbirth was more common in those who took paid ML (OR 2.7, 95%CI 1.6-4.5), also after adjusting for staying at work until advanced stages of pregnancy (OR 1.8, 95%CI 1.0-3.1).

Conclusions: Taking paid ML seems to be associated with higher maternal employment rates 1-year after childbirth. Therefore, our findings suggest that protection of maternity might positively influence women's labour market participation after childbirth.
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http://dx.doi.org/10.23749/mdl.v109i4.7226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7682161PMC
August 2018

[Effect of employment and domestic load on fetal development and length of gestation in a birth cohort study].

Rev Esp Salud Publica 2018 Aug 17;92. Epub 2018 Aug 17.

Centros de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP). Madrid. España.

Objective: Published studies are not conclusive on the impact of certain occupational exposures in pregnancy, stressing the need to consider the double role, professional and family, of women. The objective of this study is to evaluate the effect of employment and domestic load on the duration of pregnancy and fetal development.

Methods: Using Univariate and Multivariate regression models, we studied the association of preterm deliveries (PPT) (<37 weeks), full term newborns with low weight (BPT) (<2500g) and small for their gestational age (PEG) (<10th percentile) in weight, length and head circumference according to work situation (employment/non-employment) and domestic load (low/ medium/ high) in 2506 women. The analyses were carried out using SPSS and R.

Results: Women with medium domestic load have lower risk of PPT (OR=0.41, 95%CI:0.21-0.81), PEG in weight (OR=0.47, 95%CI:0.32-0.69), length (OR=0.57, 95%CI:0.39-0.83) and head circumference (OR=0.58, 95% CI:0.40-0.83) and with high load PEG in weight (OR=0.72,95%CI:0.54-0.98) and head circumference (OR = 0.73, 95% CI:0.54-0.99). When analyzing employment situation and domestic load, women with medium domestic load have less risk of PPT (OR=0.29, 95%CI:0.14-0.58) than the absence of load or high domestic load.

Conclusions: The results show a protective effect of the medium and high domestic load, reducing the probability of preterm birth and small for gestational age babies.
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August 2018

Air Pollution Exposure During Pregnancy and Symptoms of Attention Deficit and Hyperactivity Disorder in Children in Europe.

Epidemiology 2018 09;29(5):618-626

Danish Cancer Society Research Center, Strandboulevarden, Denmark.

Background: Exposure to air pollution during pregnancy may increase attention-deficit/hyperactivity disorder (ADHD) symptoms in children, but findings have been inconsistent. We aimed to study this association in a collaborative study of eight European population-based birth/child cohorts, including 29,127 mother-child pairs.

Methods: Air pollution concentrations (nitrogen dioxide [NO2] and particulate matter [PM]) were estimated at the birth address by land-use regression models based on monitoring campaigns performed between 2008 and 2011. We extrapolated concentrations back in time to exact pregnancy periods. Teachers or parents assessed ADHD symptoms at 3-10 years of age. We classified children as having ADHD symptoms within the borderline/clinical range and within the clinical range using validated cutoffs. We combined all adjusted area-specific effect estimates using random-effects meta-analysis and multiple imputations and applied inverse probability-weighting methods to correct for loss to follow-up.

Results: We classified a total of 2,801 children as having ADHD symptoms within the borderline/clinical range, and 1,590 within the clinical range. Exposure to air pollution during pregnancy was not associated with a higher odds of ADHD symptoms within the borderline/clinical range (e.g., adjusted odds ratio [OR] for ADHD symptoms of 0.95, 95% confidence interval [CI] = 0.89, 1.01 per 10 µg/m increase in NO2 and 0.98, 95% CI = 0.80, 1.19 per 5 µg/m increase in PM2.5). We observed similar associations for ADHD within the clinical range.

Conclusions: There was no evidence for an increase in risk of ADHD symptoms with increasing prenatal air pollution levels in children aged 3-10 years. See video abstract at, http://links.lww.com/EDE/B379.
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http://dx.doi.org/10.1097/EDE.0000000000000874DOI Listing
September 2018

Spatial and temporal variability of personal environmental exposure to radio frequency electromagnetic fields in children in Europe.

Environ Int 2018 08 10;117:204-214. Epub 2018 May 10.

ISGlobal, Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands. Electronic address:

Background: Exposure to radiofrequency electromagnetic fields (RF-EMF) has rapidly increased and little is known about exposure levels in children. This study describes personal RF-EMF environmental exposure levels from handheld devices and fixed site transmitters in European children, the determinants of this, and the day-to-day and year-to-year repeatability of these exposure levels.

Methods: Personal environmental RF-EMF exposure (μW/m, power flux density) was measured in 529 children (ages 8-18 years) in Denmark, the Netherlands, Slovenia, Switzerland, and Spain using personal portable exposure meters for a period of up to three days between 2014 and 2016, and repeated in a subsample of 28 children one year later. The meters captured 16 frequency bands every 4 s and incorporated a GPS. Activity diaries and questionnaires were used to collect children's location, use of handheld devices, and presence of indoor RF-EMF sources. Six general frequency bands were defined: total, digital enhanced cordless telecommunications (DECT), television and radio antennas (broadcast), mobile phones (uplink), mobile phone base stations (downlink), and Wireless Fidelity (WiFi). We used adjusted mixed effects models with region random effects to estimate associations of handheld device use habits and indoor RF-EMF sources with personal RF-EMF exposure. Day-to-day and year-to-year repeatability of personal RF-EMF exposure were calculated through intraclass correlations (ICC).

Results: Median total personal RF-EMF exposure was 75.5 μW/m. Downlink was the largest contributor to total exposure (median: 27.2 μW/m) followed by broadcast (9.9 μW/m). Exposure from uplink (4.7 μW/m) was lower. WiFi and DECT contributed very little to exposure levels. Exposure was higher during day (94.2 μW/m) than night (23.0 μW/m), and slightly higher during weekends than weekdays, although varying across regions. Median exposures were highest while children were outside (157.0 μW/m) or traveling (171.3 μW/m), and much lower at home (33.0 μW/m) or in school (35.1 μW/m). Children living in urban environments had higher exposure than children in rural environments. Older children and users of mobile phones had higher uplink exposure but not total exposure, compared to younger children and those that did not use mobile phones. Day-to-day repeatability was moderate to high for most of the general frequency bands (ICCs between 0.43 and 0.85), as well as for total, broadcast, and downlink for the year-to-year repeatability (ICCs between 0.49 and 0.80) in a small subsample.

Conclusion: The largest contributors to total personal environmental RF-EMF exposure were downlink and broadcast, and these exposures showed high repeatability. Urbanicity was the most important determinant of total exposure and mobile phone use was the most important determinant of uplink exposure. It is important to continue evaluating RF-EMF exposure in children as device use habits, exposure levels, and main contributing sources may change.
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http://dx.doi.org/10.1016/j.envint.2018.04.026DOI Listing
August 2018

Urban upbringing and childhood respiratory and allergic conditions: A multi-country holistic study.

Environ Res 2018 02;161:276-283

ISGlobal, Barcelona Institute for Global Health - Campus MAR, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.

Objective: We integratively assessed the effect of different indoor and outdoor environmental exposures early in life on respiratory and allergic health conditions among children from (sub-) urban areas.

Methods: This study included children participating in four ongoing European birth cohorts located in three different geographical regions: INMA (Spain), LISAplus (Germany), GINIplus (Germany) and BAMSE (Sweden). Wheezing, bronchitis, asthma and allergic rhinitis throughout childhood were assessed using parental-completed questionnaires. We designed "environmental scores" corresponding to different indoor, green- and grey-related exposures (main analysis, a-priori-approach). Cohort-specific associations between these environmental scores and the respiratory health outcomes were assessed using random-effects meta-analyses. In addition, a factor analysis was performed based on the same exposure information used to develop the environmental scores (confirmatory analysis, data-driven-approach).

Results: A higher early exposure to the indoor environmental score increased the risk for wheezing and bronchitis within the first year of life (combined adjusted odds ratio: 1.20 [95% confidence interval: 1.13-1.27] and 1.28 [1.18-1.39], respectively). In contrast, there was an inverse association with allergic rhinitis between 6 and 8 years (0.85 [0.79-0.92]). There were no statistically significant associations for the outdoor related environmental scores in relation to any of the health outcomes tested. The factor analysis conducted confirmed these trends.

Conclusion: Although a higher exposure to indoor related exposure through occupants was associated with an increased risk for wheezing and bronchitis within the 1st year, it might serve as a preventive mechanism against later childhood allergic respiratory outcomes in urbanized environments through enhanced shared contact with microbial agents.
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http://dx.doi.org/10.1016/j.envres.2017.11.013DOI Listing
February 2018

Lifelong Residential Exposure to Green Space and Attention: A Population-based Prospective Study.

Environ Health Perspect 2017 09 18;125(9):097016. Epub 2017 Sep 18.

ISGlobal, CREAL (Centre for Research in Environmental Epidemiology) , Barcelona, Spain.

Background: Natural environments, including green spaces, may have beneficial impacts on brain development. However, longitudinal evidence of an association between long-term exposure to green spaces and cognitive development (including attention) in children is limited.

Objectives: We evaluated the association between lifelong residential exposure to green space and attention during preschool and early primary school years.

Methods: This longitudinal study was based on data from two well-established population-based birth cohorts in Spain. We assessed lifelong exposure to residential surrounding greenness and tree cover as the average of satellite-based normalized difference vegetation index and vegetation continuous fields, respectively, surrounding the child's residential addresses at birth, 4-5 y, and 7 y. Attention was characterized using two computer-based tests: Conners' Kiddie Continuous Performance Test (K-CPT) at 4-5 y (n=888) and Attentional Network Task (ANT) at 7 y (n=987). We used adjusted mixed effects models with cohort random effects to estimate associations between exposure to greenness and attention at ages 4-5 and 7 y.

Results: Higher lifelong residential surrounding greenness was associated with fewer K-CPT omission errors and lower K-CPT hit reaction time-standard error (HRT-SE) at 4-5 y and lower ANT HRT-SE at 7 y, consistent with better attention. This exposure was not associated with K-CPT commission errors or with ANT omission or commission errors. Associations with residential surrounding tree cover also were close to the null, or were negative (for ANT HRT-SE) but not statistically significant.

Conclusion: Exposure to residential surrounding greenness was associated with better scores on tests of attention at 4-5 y and 7 y of age in our longitudinal cohort. https://doi.org/10.1289/EHP694.
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http://dx.doi.org/10.1289/EHP694DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915181PMC
September 2017

[Exposure to nitrogen dioxide and respiratory health at 2 years in the INMA-Valencia cohort].

Gac Sanit 2018 Nov - Dec;32(6):507-512. Epub 2017 Jul 26.

Departament d'Infermeria, Universitat de València, Valencia, España; Unidad Mixta de Investigación en Epidemiología y Salud Ambiental, FISABIO-Universitat Jaume I-Universitat de València, Valencia, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España. Electronic address:

Objective: To analyze the association between exposure to nitrogen dioxide (NO) during pregnancy and the postnatal period up to the age of 2 years old and the incidence of respiratory problems in children from the INMA-Valencia cohort.

Methods: The study population included 624 children from the INMA-Valencia cohort. Individual exposure to NO was estimated in different environments outside the home during pregnancy and up to the age of 2 using empirical measurement and data from geo-statistical methods. Respiratory symptoms were obtained from a questionnaire applied at the age of two. The association between NO exposure and respiratory symptoms was performed using multivariate logistic regression.

Results: The cumulative incidence was 16.3% for persistent cough, 34.9% for wheezing and 27.6% for lower respiratory tract infections. No association was found between respiratory symptoms and exposure to NO in any of the children. However an association between NO exposure and persistent cough was found at two years of life in the children with a parental history of allergy.

Conclusion: NO exposure would lead to persistent cough in children with a parental history of allergies.
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http://dx.doi.org/10.1016/j.gaceta.2017.05.012DOI Listing
June 2019

Prenatal and postnatal exposure to NO and child attentional function at 4-5years of age.

Environ Int 2017 09 6;106:170-177. Epub 2017 Jul 6.

ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia 08003, Spain; Pompeu Fabra University, Barcelona, Catalonia 08003, Spain; Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid 28029, Spain; Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam 3015CN, The Netherlands. Electronic address:

Background: Prenatal and postnatal exposure to air pollution has been linked to cognitive impairment in children, but very few studies have assessed its association with attentional function.

Objectives: To evaluate the association between prenatal and postnatal exposure to nitrogen dioxide (NO) and attentional function in children at 4-5years of age.

Methods: We used data from four regions of the Spanish INMA-Environment and Childhood-Project, a population-based birth cohort. Using land-use regression models (LUR), we estimated prenatal and postnatal NO levels in all of these regions at the participants' residential addresses. We assessed attentional function using the Kiddie-Conners Continuous Performance Test (K-CPT). We combined the region-specific adjusted effect estimates using random-effects meta-analysis.

Results: We included 1298 children with complete data. Prenatal exposure to NO was associated with an impaired standard error of the hit reaction time (HRT(SE)) (increase of 1.12ms [95% CI; 0.22 a 2.02] per 10μg/m increase in prenatal NO) and increased omission errors (6% [95% CI; 1.01 to 1.11] per 10μg/m increase in prenatal NO). Postnatal exposure to NO resulted in a similar but borderline significant increase of omission errors (5% [95% CI; =0.99 to 1.11] per 10μg/m increase in postnatal NO). These associations did not vary markedly between regions, and were mainly observed in girls. Commission errors and lower detectability were associated with prenatal and postnatal exposure to NO only in some regions.

Conclusions: This study indicates that higher exposure to ambient NO, mainly during pregnancy and to a lesser extent postnatally, is associated with impaired attentional function in children at 4-5years of age.
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http://dx.doi.org/10.1016/j.envint.2017.05.021DOI Listing
September 2017

Urban green and grey space in relation to respiratory health in children.

Eur Respir J 2017 06 22;49(6). Epub 2017 Jun 22.

Campus MAR, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.

We assessed the effect of three different indices of urban built environment on allergic and respiratory conditions.This study involved 2472 children participating in the ongoing INMA birth cohort located in two bio-geographic regions (Euro-Siberian and Mediterranean) in Spain. Residential surrounding built environment was characterised as 1) residential surrounding greenness based on satellite-derived normalised difference vegetation index (NDVI), 2) residential proximity to green spaces and 3) residential surrounding greyness based on urban land use patterns. Information on wheezing, bronchitis, asthma and allergic rhinitis up to age 4 years was obtained from parent-completed questionnaires. Logistic regression and generalised estimating equation modelling were performed.Among children from the Euro-Siberian region, higher residential surrounding greenness and higher proximity to green spaces were negatively associated with wheezing. In the Mediterranean region, higher residential proximity to green spaces was associated with a reduced risk for bronchitis. A higher amount of residential surrounding greyness was found to increase the risk for bronchitis in this region.Associations between indices of urban residential greenness and greyness with respiratory diseases differ by region. The pathways underlying these associations require further exploration.
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http://dx.doi.org/10.1183/13993003.02112-2015DOI Listing
June 2017

Comparison of urinary iodine levels in women of childbearing age during and after pregnancy.

Eur J Nutr 2018 Aug 29;57(5):1807-1816. Epub 2017 Apr 29.

Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.

Purpose: Median urinary iodine concentration (UIC) is used to describe the iodine status of a population. However, the link between UIC and iodine intake may vary during pregnancy. The aim of this study was to compare UIC during and after pregnancy, adjusting for factors that affect iodine intake.

Methods: Two repeated measures of UIC and data on maternal iodine intake estimated through questionnaires were collected during pregnancy and 1-4 years after pregnancy in a subsample of women (n = 598) from a mother and child cohort study in Spain. Random-effects interval regression was used to assess the changes in UIC according to pregnancy status.

Results: Median UIC was similar during (133 μg/L) and after pregnancy (139 μg/L). After adjusting for iodised salt, iodine supplement consumption, and socio-demographic related variables, UIC was 24.0% (95% CI 11.3, 38.2) higher after than during pregnancy. This difference was maintained in a subsample of women with exhaustive information on diet (n = 291): 26.2%, 95% CI 10.3, 44.4.

Conclusions: In an iodine sufficient area for the general population, iodine excretion was lower during than after pregnancy when factors affecting iodine intake were controlled for. Current recommendations of median UIC during pregnancy are based on the equivalence between iodine intake and UIC estimated from studies in non-pregnant populations, which might lead to overestimation of iodine deficiency during gestation. Further studies should evaluate the equivalence between iodine intake and its urinary excretion during pregnancy.
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http://dx.doi.org/10.1007/s00394-017-1465-4DOI Listing
August 2018

Maternal cell phone use during pregnancy and child behavioral problems in five birth cohorts.

Environ Int 2017 07 7;104:122-131. Epub 2017 Apr 7.

ISGlobal Center for Research in Environmental Epidemiology, Doctor Aiguader 88, 08003 Barcelona, Spain; Pompeu Fabra University, Carrer Ramon Trias Fargas, 25-27, 08005 Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5, Madrid, Spain.

Introduction: Previous studies have reported associations between prenatal cell phone use and child behavioral problems, but findings have been inconsistent and based on retrospective assessment of cell phone use. This study aimed to assess this association in a multi-national analysis, using data from three cohorts with prospective data on prenatal cell phone use, together with previously published data from two cohorts with retrospectively collected cell phone use data.

Methods: We used individual participant data from 83,884 mother-child pairs in the five cohorts from Denmark (1996-2002), Korea (2006-2011), the Netherlands (2003-2004), Norway (2004-2008), and Spain (2003-2008). We categorized cell phone use into none, low, medium, and high, based on frequency of calls during pregnancy reported by the mothers. Child behavioral problems (reported by mothers using the Strengths and Difficulties Questionnaire or Child Behavior Checklist) were classified in the borderline/clinical and clinical ranges using validated cut-offs in children aged 5-7years. Cohort specific risk estimates were meta-analyzed.

Results: Overall, 38.8% of mothers, mostly from the Danish cohort, reported no cell phone use during pregnancy and these mothers were less likely to have a child with overall behavioral, hyperactivity/inattention or emotional problems. Evidence for a trend of increasing risk of child behavioral problems through the maternal cell phone use categories was observed for hyperactivity/inattention problems (OR for problems in the clinical range: 1.11, 95%CI 1.01, 1.22; 1.28, 95%CI 1.12, 1.48, among children of medium and high users, respectively). This association was fairly consistent across cohorts and between cohorts with retrospectively and prospectively collected cell phone use data.

Conclusions: Maternal cell phone use during pregnancy may be associated with an increased risk for behavioral problems, particularly hyperactivity/inattention problems, in the offspring. The interpretation of these results is unclear as uncontrolled confounding may influence both maternal cell phone use and child behavioral problems.
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http://dx.doi.org/10.1016/j.envint.2017.03.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506372PMC
July 2017

The Influence of Meteorological Factors and Atmospheric Pollutants on the Risk of Preterm Birth.

Am J Epidemiol 2017 02;185(4):247-258

Department of Adult Nursing, Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.

Atmospheric pollutants and meteorological conditions are suspected to be causes of preterm birth. We aimed to characterize their possible association with the risk of preterm birth (defined as birth occurring before 37 completed gestational weeks). We pooled individual data from 13 birth cohorts in 11 European countries (71,493 births from the period 1994-2011, European Study of Cohorts for Air Pollution Effects (ESCAPE)). City-specific meteorological data from routine monitors were averaged over time windows spanning from 1 week to the whole pregnancy. Atmospheric pollution measurements (nitrogen oxides and particulate matter) were combined with data from permanent monitors and land-use data into seasonally adjusted land-use regression models. Preterm birth risks associated with air pollution and meteorological factors were estimated using adjusted discrete-time Cox models. The frequency of preterm birth was 5.0%. Preterm birth risk tended to increase with first-trimester average atmospheric pressure (odds ratio per 5-mbar increase = 1.06, 95% confidence interval: 1.01, 1.11), which could not be distinguished from altitude. There was also some evidence of an increase in preterm birth risk with first-trimester average temperature in the -5°C to 15°C range, with a plateau afterwards (spline coding, P = 0.08). No evidence of adverse association with atmospheric pollutants was observed. Our study lends support for an increase in preterm birth risk with atmospheric pressure.
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http://dx.doi.org/10.1093/aje/kww141DOI Listing
February 2017

Infants' indoor and outdoor residential exposure to benzene and respiratory health in a Spanish cohort.

Environ Pollut 2017 Mar 4;222:486-494. Epub 2017 Jan 4.

Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I, Universitat de València, Avenida de Catalunya 21, 46020, Valencia, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.

Benzene exposure represents a potential risk for children's health. Apart from being a known carcinogen for humans (group 1 according to IARC), there is scientific evidence suggesting a relationship between benzene exposure and respiratory problems in children. But results are still inconclusive and inconsistent. This study aims to assess the determinants of exposure to indoor and outdoor residential benzene levels and its relationship with respiratory health in infants. Participants were 1-year-old infants (N = 352) from the INMA cohort from Valencia (Spain). Residential benzene exposure levels were measured inside and outside dwellings by means of passive samplers in a 15-day campaign. Persistent cough, low respiratory tract infections and wheezing during the first year of life, and covariates (dwelling traits, lifestyle factors and sociodemographic data) were obtained from parental questionnaires. Multiple Tobit regression and logistic regression models were performed to assess factors associated to residential exposure levels and health associations, respectively. Indoor levels were higher than outdoor ones (1.46 and 0.77 μg/m, respectively; p < 0.01). A considerable percentage of dwellings, 42% and 21% indoors and outdoors respectively, surpassed the WHO guideline of 1.7 μg/m derived from a lifetime risk of leukemia above 1/100 000. Monitoring season, maternal country of birth and parental tobacco consumption were associated with residential benzene exposure (indoor and outdoors). Additionally, indoor levels were associated with mother's age and type of heating, and outdoor levels were linked with zone of residence and distance from industrial areas. After adjustment for confounding factors, no significant associations were found between residential benzene exposure levels and respiratory health in infants. Hence, our study did not support the hypothesis for the benzene exposure effect on respiratory health in children. Even so, it highlights a public health concern related to the personal exposure levels, since a considerable number of children surpassed the abovementioned WHO guideline for benzene exposure.
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http://dx.doi.org/10.1016/j.envpol.2016.11.065DOI Listing
March 2017

Heritability and Genome-Wide Association Analyses of Sleep Duration in Children: The EAGLE Consortium.

Sleep 2016 Oct 1;39(10):1859-1869. Epub 2016 Oct 1.

Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.

Study Objectives: Low or excessive sleep duration has been associated with multiple outcomes, but the biology behind these associations remains elusive. Specifically, genetic studies in children are scarce. In this study, we aimed to: (1) estimate the proportion of genetic variance of sleep duration in children attributed to common single nucleotide polymorphisms (SNPs), (2) identify novel SNPs associated with sleep duration in children, and (3) investigate the genetic overlap of sleep duration in children and related metabolic and psychiatric traits.

Methods: We performed a population-based molecular genetic study, using data form the EArly Genetics and Life course Epidemiology (EAGLE) Consortium. 10,554 children of European ancestry were included in the discovery, and 1,250 children in the replication phase.

Results: We found evidence of significant but modest SNP heritability of sleep duration in children (SNP 0.14, 95% CI [0.05, 0.23]) using the LD score regression method. A novel region at chromosome 11q13.4 (top SNP: rs74506765, P = 2.27e-08) was associated with sleep duration in children, but this was not replicated in independent studies. Nominally significant genetic overlap was only found ( = 0.23, P = 0.05) between sleep duration in children and type 2 diabetes in adults, supporting the hypothesis of a common pathogenic mechanism.

Conclusions: The significant SNP heritability of sleep duration in children and the suggestive genetic overlap with type 2 diabetes support the search for genetic mechanisms linking sleep duration in children to multiple outcomes in health and disease.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020368PMC
http://dx.doi.org/10.5665/sleep.6170DOI Listing
October 2016

The association between passive and active tobacco smoke exposure and child weight status among Spanish children.

Obesity (Silver Spring) 2016 08 1;24(8):1767-77. Epub 2016 Jul 1.

ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.

Objective: To assess the impact of passive and active tobacco smoke exposure, both pre- and postnatally, on child body mass index (BMI) and overweight.

Methods: Pregnant women were enrolled into the Spanish INMA prospective birth cohort during 1997 to 2008. Tobacco smoke exposure was assessed by questionnaire and corroborated by pre- and postnatal cotinine measurements. Children were followed up until 4 years in newer subcohorts (N = 1866) and until 14 years in one older subcohort (N = 427). Child age- and sex-specific BMI Z-scores were calculated, and generalized estimating equations were used to model their relationship with repeated measures of tobacco smoke exposure.

Results: Associations between prenatal passive exposure to tobacco smoke (adjusted β = 0.15, 95% CI: 0.05-0.25) and active maternal smoking (adjusted β = 0.20, 95% CI: 0.08-0.33) and child zBMI up to 4 years were observed. Stronger associations were observed in the older subcohort between both prenatal and child passive smoke exposure and zBMI up to 14 years.

Conclusions: Evidence for an effect of both passive and maternal active smoking on child postnatal growth has been provided. Although residual confounding cannot be completely ruled out, associations were robust to adjustment for a range of lifestyle factors.
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http://dx.doi.org/10.1002/oby.21558DOI Listing
August 2016

Characterisation of exposure to non-ionising electromagnetic fields in the Spanish INMA birth cohort: study protocol.

BMC Public Health 2016 Feb 18;16:167. Epub 2016 Feb 18.

BIODONOSTIA Health Research Institute, Paseo Dr. Beguiristain, San Sebastian, 20014, Spain.

Background: Analysis of the association between exposure to electromagnetic fields of non-ionising radiation (EMF-NIR) and health in children and adolescents is hindered by the limited availability of data, mainly due to the difficulties on the exposure assessment. This study protocol describes the methodologies used for characterising exposure of children to EMF-NIR in the INMA (INfancia y Medio Ambiente- Environment and Childhood) Project, a prospective cohort study.

Methods/design: Indirect (proximity to emission sources, questionnaires on sources use and geospatial propagation models) and direct methods (spot and fixed longer-term measurements and personal measurements) were conducted in order to assess exposure levels of study participants aged between 7 and 18 years old. The methodology used varies depending on the frequency of the EMF-NIR and the environment (homes, schools and parks). Questionnaires assessed the use of sources contributing both to Extremely Low Frequency (ELF) and Radiofrequency (RF) exposure levels. Geospatial propagation models (NISMap) are implemented and validated for environmental outdoor sources of RFs using spot measurements. Spot and fixed longer-term ELF and RF measurements were done in the environments where children spend most of the time. Moreover, personal measurements were taken in order to assess individual exposure to RF. The exposure data are used to explore their relationships with proximity and/or use of EMF-NIR sources.

Discussion: Characterisation of the EMF-NIR exposure by this combination of methods is intended to overcome problems encountered in other research. The assessment of exposure of INMA cohort children and adolescents living in different regions of Spain to the full frequency range of EMF-NIR extends the characterisation of environmental exposures in this cohort. Together with other data obtained in the project, on socioeconomic and family characteristics and development of the children and adolescents, this will enable to evaluate the complex interaction between health outcomes in children and adolescents and the various environmental factors that surround them.
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http://dx.doi.org/10.1186/s12889-016-2825-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4758161PMC
February 2016

Exposure to ambient air pollution during pregnancy and preterm birth: A Spanish multicenter birth cohort study.

Environ Res 2016 May 4;147:50-8. Epub 2016 Feb 4.

Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Avenida de Catalunya 21, 46020 Valencia, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.

Background And Objective: Preterm birth is a major determinant of infant mortality and morbidity. Air pollution has been suggested as a risk factor for preterm delivery; however, the scientific evidence on this impact remains inconsistent. We assessed the association between residential exposure to air pollution during pregnancy and preterm birth (gestational age at delivery <37 weeks) in Spain.

Methods: This study was based on 2409 pregnant women participating in the INMA birth cohorts in Asturias, Gipuzkoa, Sabadell and Valencia. Ambient levels of nitrogen dioxide (NO2) and benzene were estimated for each woman's residence for each trimester and for the whole pregnancy, using temporally adjusted land-use regression models. The association between air pollution exposure and preterm birth was assessed for each cohort separately by means of logistic regression models controlling for potential confounders, under single- and two-pollutant models, for all the women in the study and for those spending more than 15h/day at home. Combined estimates of the association across cohorts were obtained through meta-analysis.

Results: Throughout the whole sample, suggestive but no statistically significant associations were found between exposure and preterm birth. For pregnant women spending more time at home significant associations were found for both pollutants, under single- and two-pollutant models. Under the last ones, NO2 exposure during the second trimester and the whole pregnancy was associated with a higher risk of preterm delivery (OR=1.58, (95%CI: 1.04-2.42) per 10μg/m(3) increase). Benzene exposure during the third trimester was also associated with preterm birth in that subsample (OR=1.45, (95%CI: 1.00-2.09) per 1μg/m(3) increase).

Conclusion: We found suggestive associations between NO2 and benzene exposure during pregnancy and preterm birth. Estimates of the association were higher among women who spent more time at home, probably reflecting a better exposure assessment in this group.
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http://dx.doi.org/10.1016/j.envres.2016.01.037DOI Listing
May 2016

Health effects of the 2012 Valencia (Spain) wildfires on children in a cohort study.

Environ Geochem Health 2016 Jun 29;38(3):703-12. Epub 2015 Jul 29.

Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, FISABIO - Public Health, Avda Catalunya, 21, 46020, Valencia, Spain.

In July 2012, two simultaneous wildfires burnt a big area in Valencia (Spain), where a birth cohort study (INMA) is being developed. The heavy smoke covered the whole INMA study area for several days. We aimed at evaluating the 2012 Valencia wildfire effects on the health of children enrolled in the INMA-Valencia cohort. Two weeks after the extinction of the wildfires, a phone survey was conducted and finally 460 individuals were enrolled. We considered a wildfire period (12-day interval when they were active) and a control period (12-day interval just before wildfires). Parents were asked about respiratory symptoms experienced during both periods, and during wildfires only about the preventive measures adopted and the perception of exposure, along with individual data collected through the different follow-up surveys of the cohort. Conditional logistic regression models were applied, and we included interaction terms for asthma/rhinitis and level of perception of exposure; 82.4 % perceived smoke smell outdoors, 40 % indoors and more than 90 % of the families observed the presence of ash. An adjusted odds ratio of 3.11 [95 % confidence interval 1.62-5.97] for itchy/watery eyes and 3.02 [1.41-6.44] for sore throat was obtained. Significant interaction terms for rhinitis and asthma in itchy/watery eyes and sneezing, and only asthma for sore throat were obtained. Exposure to wildfire smoke was associated with increased respiratory symptoms in this child population, particularly affecting susceptible individuals with asthma or rhinitis.
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http://dx.doi.org/10.1007/s10653-015-9753-5DOI Listing
June 2016

Prenatal Exposure to NO2 and Ultrasound Measures of Fetal Growth in the Spanish INMA Cohort.

Environ Health Perspect 2016 Feb 26;124(2):235-42. Epub 2015 Jun 26.

Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain.

Background: Air pollution exposure during pregnancy has been associated with impaired fetal growth. However, few studies have measured fetal biometry longitudinally, remaining unclear as to whether there are windows of special vulnerability.

Objective: The aim was to investigate the impact of nitrogen dioxide (NO2) exposure on fetal and neonatal biometry in the Spanish INMA study.

Methods: Biparietal diameter (BPD), femur length (FL), abdominal circumference (AC), and estimated fetal weight (EFW) were evaluated for up to 2,478 fetuses in each trimester of pregnancy. Size at 12, 20, and 34 weeks of gestation and growth between these points, as well as anthropometry at birth, were assessed by SD scores derived using cohort-specific growth curves. Temporally adjusted land-use regression was used to estimate exposure to NO2 at home addresses for up to 2,415 fetuses. Associations were investigated by linear regression in each cohort and subsequent meta-analysis.

Results: A 10-μg/m(3) increase in average exposure to NO2 during weeks 0-12 was associated with reduced growth at weeks 0-12 in AC (-2.1%; 95% CI: -3.7, -0.6) and EFW (-1.6%; 95% CI: -3.0, -0.3). The same exposure was inversely associated with reduced growth at weeks 20-34 in BPD (-2.6%; 95% CI: -3.9, -1.2), AC (-1.8%; 95% CI: -3.3, -0.2), and EFW (-2.1%; 95% CI: -3.7, -0.2). A less consistent pattern of association was observed for FL. The negative association of this exposure with BPD and EFW was significantly stronger in smoking versus nonsmoking mothers.

Conclusions: Maternal exposure to NO2 in early pregnancy was associated with reduced fetal growth based on ultrasound measures of growth during pregnancy and measures of size at birth.
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http://dx.doi.org/10.1289/ehp.1409423DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4749079PMC
February 2016

Air Pollution Exposure during Pregnancy and Childhood Autistic Traits in Four European Population-Based Cohort Studies: The ESCAPE Project.

Environ Health Perspect 2016 Jan 12;124(1):133-40. Epub 2015 Jun 12.

Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.

Background: Prenatal exposure to air pollutants has been suggested as a possible etiologic factor for the occurrence of autism spectrum disorder.

Objectives: We aimed to assess whether prenatal air pollution exposure is associated with childhood autistic traits in the general population.

Methods: Ours was a collaborative study of four European population-based birth/child cohorts-CATSS (Sweden), Generation R (the Netherlands), GASPII (Italy), and INMA (Spain). Nitrogen oxides (NO2, NOx) and particulate matter (PM) with diameters of ≤ 2.5 μm (PM2.5), ≤ 10 μm (PM10), and between 2.5 and 10 μm (PM(coarse)), and PM2.5 absorbance were estimated for birth addresses by land-use regression models based on monitoring campaigns performed between 2008 and 2011. Levels were extrapolated back in time to exact pregnancy periods. We quantitatively assessed autistic traits when the child was between 4 and 10 years of age. Children were classified with autistic traits within the borderline/clinical range and within the clinical range using validated cut-offs. Adjusted cohort-specific effect estimates were combined using random-effects meta-analysis.

Results: A total of 8,079 children were included. Prenatal air pollution exposure was not associated with autistic traits within the borderline/clinical range (odds ratio = 0.94; 95% CI: 0.81, 1.10 per each 10-μg/m3 increase in NO2 pregnancy levels). Similar results were observed in the different cohorts, for the other pollutants, and in assessments of children with autistic traits within the clinical range or children with autistic traits as a quantitative score.

Conclusions: Prenatal exposure to NO2 and PM was not associated with autistic traits in children from 4 to 10 years of age in four European population-based birth/child cohort studies.

Citation: Guxens M, Ghassabian A, Gong T, Garcia-Esteban R, Porta D, Giorgis-Allemand L, Almqvist C, Aranbarri A, Beelen R, Badaloni C, Cesaroni G, de Nazelle A, Estarlich M, Forastiere F, Forns J, Gehring U, Ibarluzea J, Jaddoe VW, Korek M, Lichtenstein P, Nieuwenhuijsen MJ, Rebagliato M, Slama R, Tiemeier H, Verhulst FC, Volk HE, Pershagen G, Brunekreef B, Sunyer J. 2016. Air pollution exposure during pregnancy and childhood autistic traits in four European population-based cohort studies: the ESCAPE Project. Environ Health Perspect 124:133-140; http://dx.doi.org/10.1289/ehp.1408483.
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http://dx.doi.org/10.1289/ehp.1408483DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4710593PMC
January 2016

Short-term relationship between hip fracture and weather conditions in two Spanish health areas with different climates.

J Environ Public Health 2015 10;2015:395262. Epub 2015 Feb 10.

Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain ; University of Valencia, 46010 Valencia, Spain ; Center for Research on Public Health (CSISP), 46020 Valencia, Spain.

Objective: To evaluate differences in the short-term relationship between weather conditions and the incidence of hip fracture in people aged 65 and over among two regions of Spain.

Methods: Hip fracture incidence was calculated for the years 2000-2008 for residents of Health Area 14 in Valencian Community (Mediterranean climate) and the "Mancha Centro" Health Area in Castilla-La Mancha (inland climate), Spain. The relationship between hip fracture incidence and weather was analyzed with a case-crossover design and explored in subgroups defined by sex, age, and fracture type.

Results: In the inland area, a positive and significant tendency for hip fracture incidence was observed (annual increase: 1.5%) whereas in the Mediterranean area a seasonal increase of 9% was noted in autumn and winter with respect to spring. Weather conditions, especially wind, were significantly associated with hip fracture incidence: days with more frequent windy periods and/or a greater wind velocity were associated with an increase in hip fracture incidence of 51% in the Mediterranean area and 44% in the inland area.

Conclusions: Hip fracture incidence exhibits seasonal changes that differ between the Mediterranean and inland areas. The short-term relationship with climate, although similar in both areas, may partly explain these seasonal changes.
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http://dx.doi.org/10.1155/2015/395262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338400PMC
May 2016