Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH) Cohort Study: influences of complex environmental exposures on maternal and child health in Suriname

Abstract

PurposeThe Caribbean Consortium for Research in Environmental and Occupational Health prospective environmental epidemiologic cohort study addresses the impact of chemical and non-chemical environmental exposures on mother/child dyads in Suriname. The study determines associations between levels of environmental elements and toxicants in pregnant women, and birth outcomes and neurodevelopment in their children.ParticipantsPregnant women (N=1143) were enrolled from December 2016 to July 2019 from three regions of Suriname: Paramaribo (N=738), Nickerie (N=204) and the tropical rainforest interior (N=201). Infants (N=992) were enrolled at birth. Follow-up will take place until children are 48 months old.Findings to dateBiospecimens and questionnaire data on physiological and psychosocial health in pregnant women have been analysed. 39.1% had hair mercury (Hg) levels exceeding values considered safe by international standards. Median hair Hg concentrations in women from Paramaribo (N=522) were 0.64 µg/g hair (IQRs 0.36–1.09; range 0.00–7.12), from Nickerie (N=176) 0.73 µg/g (IQR 0.45–1.05; range 0.00–5.79) and the interior (N=178) 3.48 µg/g (IQR 1.92–7.39; range 0.38–18.20). 96.1% of women ate fish, respective consumption of the three most consumed carnivorous species, Hoplias aimara, Serrasalmus rhombeus and Cichla ocellaris, known to have high Hg levels, was 44.4%, 19.3% and 26.3%, respectively, and was greater among the interior subcohort. 89% frequently consumed the vegetable tannia, samples of which showed presence of worldwide banned pesticides. 24.9% of pregnant women had Edinburgh Depression Scale scores indicative of probable depression.Future plansFish consumption advisories are in development, especially relevant to interior women for whom fish consumption is likely to be the primary source of Hg exposure. Effects of potentially beneficial neuroprotective factors in fish that may counter neurotoxic effects of Hg are being examined. A pesticide literacy assessment in pregnant women is in progress. Neurodevelopmental assessments and telomere length measurements of the children to evaluate long-term effects of prenatal exposures to toxicant mixtures are ongoing.

The Cumulative Risk of Prenatal Exposures to Chemical and Non-Chemical Stressors on Birth Outcomes in Suriname

“…Approximately 55% of our participants had no education, primary education or lower secondary/vocational education, and about 65% had monthly household incomes of lower than SRD 3000 (equivalent to USD 143). The sample of this study is a statistically acceptable representation of the total CCREOH cohort [ 23 ].…”

“…Pregnant women were recruited during the first or second trimester of pregnancy in three regions of Suriname: Paramaribo, Nickerie and the Amazonian Interior. The types and levels of exposures are expected to be different among these regions, with respect to both non-essential and essential elements, which may be explained by their diets and metal-based pesticides [ 23 ].…”

“…Women were eligible if they were 16 years or older, spoke Dutch, Saramaccan, or Trio, had a singleton gestation, were planning to give birth at one of the study sites and provided written informed consent/assent. Pregnant women were recruited at four hospitals, prenatal clinics and midwife facilities of the Regional Health Department, and at multiple health care clinics of the Medical Mission Primary Health Care Suriname (MMPHCS) in the Interior [ 20 , 23 ].…”

Association of Mercury Exposure and Maternal Sociodemographics on Birth Outcomes of Indigenous and Tribal Women in Suriname

“…The study population is composed of a sub-cohort of pregnant women living in the capital, Paramaribo, and in the remote tropical rainforest interior of Suriname as part of the CCREOH prospective environmental epidemiologic cohort study, which addresses the impact of chemical and non-chemical environmental exposures in mother/child dyads. The full study details are described elsewhere [ 17 ]. Briefly, 1200 women aged 16–45 years were recruited from December 2016 through July 2019.…”

“…Pregnant women living in the remote interior of Suriname are known to experience relatively high exposures to mercury (Hg) [ 16 , 17 ] and have a significantly higher rate of ABO, especially PTB and LBW [ 15 ]. Mercury has been listed by the World Health Organization (WHO) as one of the most toxic agents for public health concerns.…”