Toxic exposures in early life, growth, and development: An exposome study in Nepal.

Project objectives are to identify current exposures to environmental pollutants during pregnancy and infancy and in an exposome framework, to investigate the consequences of such exposures for child health and development. We use collected material and information from 800 mother-child pairs who are participants in an ongoing cohort study in the Bhaktapur district of the Kathmandu Valley in Nepal. The project is a collaboration between 3 Norwegian institutions (the University of Bergen, the University Hospital of North Norway, and the Innlandet Hospital Trust) and 3 Nepalese Institutions (Tribhuvan University, Siddhi Memorial Foundation, and LEADERS Nepal) where we are also working to establish a sustainable infrastructure for the continued investigation of issues related to environmental pollutants and health in the future. By incorporating the new infrastructure into the clinical practice at Siddhi Memorial Hospital, further data collection becomes easier, population-based, and sustainable. Here, expertise is developed and exchanged between Nepal and Norway. Since the start of the project, we have started to identify several environmental pollutants to which mother and child are exposed by analyzing elements, heavy metals, and PFAS in the mother's blood during pregnancy and in breast milk. We have also investigated the mother's thyroid function during pregnancy and created reference values for normal function. We have engaged two PhD students who separately examine the children's development and health, focusing on different exposures and outcomes.

Exposure to environmental pollutants is a global health threat that respects no borders. The impact of these exposures may be detrimental to human health affecting growth, immunity, neurodevelopment, and cardiovascular health. Simultaneous exposure to multiple pollutants is higher in marginalized populations with limited means to monitor, regulate, and deal with the potential health consequences. Generating population-based estimates on the exposures and effects of such exposure is resource-intensive and requires interdisciplinary collaborations. Moreover, inferring causality between exposures to environmental pollutants and health outcomes requires an exposome approach. In an ongoing pregnancy cohort in Nepal where we have collected biological samples from women and their babies over five time points from early pregnancy until 12 months postpartum, we have also collected data on health, growth, maternal distress, and neurodevelopment. In this proposed project, using collected biological material we will analyze several environmental pollutants, nutrients, and other biomarkers reflecting inflammation and altered metabolic pathways and follow the children to an age when adequate measures of cognitive development such as executive functioning and general abilities ("IQ") can be performed. In this effort, we will include local non-governmental organizations to assist with data collection, facilitate communication to the community, government, and international organizations, and safeguard the continuation of the work beyond the project period. The proposed project is the first step in a planned long-term effort to monitor potential harmful environmental exposures and address future research questions related to the exposome and human health outcomes. In other words, our ambition is to fill present research gaps and form a foundation that can address future knowledge gaps.