An investigation of the group of basic and clinical oncology of the ibs.GRANADA shows that pollution affects the weight of the newborn and lung and cognitive development
The A15-BASIC AND CLINICAL ONCOLOGY group is part of the Spanish research group that has followed the growth of 3.700 minors (and their mothers) over the last 20 years. The origin of the INMA (Childhood and Environment) project is in the follow-up studies started in 1997 in Ribera d'Ebre and Menorca, and in 2000 in Granada.
These three investigations with volunteers were the basis for launching a much more ambitious program in 2003 with the incorporation of another four studies in Asturias, Guipuzkoa, Valencia and Sabadell (Barcelona).
The Granada participants, no longer so young, have turned 18 and some are studying at our university (UGR). They were invited to participate when their mothers gave birth at the San Cecilio University Hospital between 2000 and 2002, and the study is still ongoing. The many results published to date are making it possible to know the impact of environmental pollution on the development and growth of the participating volunteers.
News from El Pais
When Belén Hinarejos went to have her first pregnancy ultrasound, the one at 2005 weeks' gestation, in 12, a nurse at the San Félix Primary Care Center in Sabadell suggested that she be part of an investigation. This is how the scientific monitoring of the development of her son, Roger, began. Then it was a fetus of only a few grams, but today it is about to turn 15 years old and the tests continue. Both are part of the more than 3.700 mothers and 3.700 children monitored in seven areas of the country within the INMA project coordinated by the Barcelona Institute for Global Health (ISGlobal). An investigation with volunteers that has lasted for 20 years, the largest of its kind in Spain, with results that show the impact of pollution on size at birth, the development of lung or cognitive function.
"I'm in science, I work as a laboratory technician and research has always attracted me, I thought I had nothing to lose," says Hinarejos, who without receiving anything in return accepted that they start taking blood samples and having to fill in endless questionnaires about their health, their diet, their lifestyle… Several of the questions focused on their place of residence: an apartment on a street in Sabadell with a lot of car traffic and high levels of air pollution. At the same time, pregnancy ultrasounds also began to take measurements of the child she was carrying, such as the size of the head, the femur or the weight. Roger was born on May 10, 2006, almost a month early. Despite being a premature baby, he weighed about three kilos.
Maite Lemus used to work in a bank, but left to go to teaching. “I was fed up,” she says. He also fled the pollution of Valencia and moved to a quiet house on the outskirts of the city, with a terrace overlooking the Mediterranean Sea and the Sierra Calderona. "I was looking for quality of life," emphasizes the Valencian, who was recruited for the study at the end of 2004, when she went to the La Fe hospital for the first pregnancy ultrasound. His daughter Arantxa was born on June 10, 2005. "Any research that can help health must be supported," says Lemus, who says that more than 15 years later she herself had just had blood taken and had a cytology done.
One of the first results from volunteer data was that, on average, babies whose mothers lived in areas with more polluted air weighed less and were smaller at birth. A relationship with pollution that was even clearer with pregnant women who spent more time at home. There are several scientific papers published in this regard within the project, such as the one that appeared in 2011 in the journal Environmental Health Perspectives, with information from 2.505 mothers and 2.505 babies, including Roger and Arantxa. The researchers estimated the exposure to nitrogen dioxide and benzene of pregnant women and compared the measurements of the little ones at birth. "We discovered that the children of the mothers in the most polluted areas weighed an average of 70 or 80 grams less than those in the same city in less polluted areas," explains Jordi Sunyer, one of the authors of the scientific work and the first director of the project. INMA. "This was not due to social differences, because most people in the most polluted areas had better education and more opportunities for a better life," he says.
In the birth in which Roger was born in Sabadell, one of the nurses who collected samples from the umbilical cord was Silvia Fochs, who later ended up taking care of his follow-up, along with that of many other boys and girls. "We are like their aunts, we have seen them born," he comments with emotion. Periodically, usually every two years, they contact the mothers and children to arrange a new visit in which to carry out more tests and more questionnaires. In addition, during this time they have been collecting biological samples of all kinds that are stored in freezers at 80 degrees below zero. They are preserved in this way so that researchers can have this material available as scientific work progresses and because perhaps in the future they will serve to extract important information that is currently unknown. "There is still pregnancy urine from 16 years ago to continue investigating," says Fochs.
The origin of the INMA project lies in the studies begun in 1997 in Ribera d'Ebre and Menorca, as well as another started in 2000 in Granada. These three studies with volunteers were the basis for launching a much more ambitious program between 2001 and 2002 with the incorporation of four other follow-up studies (also called cohort studies) in Asturias, Guipuzkoa, Valencia and Sabadell (Barcelona). These seven coordinated areas to harmonize their scientific work represent a mine of information for researchers.
In Europe there are even larger studies of this type: if here the babies are already adolescents, in Finland there are still active investigations with people born in the sixties and eighties, and in the UK there are those who follow now to the children of the first children.
If here the babies are already teenagers, in Finland there is still active research with people born in the sixties and eighties, and in the United Kingdom there are now those who follow the children of the first children
At four years of age, one of the tests performed on Roger was a spirometry. This consists of blowing into a device (spirometer) that measures the amount of air that one can retain and the velocity of pulmonary flow. Although this type of test is usually carried out at older ages, the trials with 1.175 children from Sabadell and Gipuzkoa worked and again gave interesting results. The investigation published this time in Thorax in 2015. found a relationship between prenatal exposure to traffic-induced air pollution and impaired lung function in preschool children. "We saw that there was a certain delay in how these lungs matured, linked to atmospheric pollution," stresses researcher Jordi Sunyer.
During their childhood, there have been multiple tests carried out on children and the systems used to collect the samples. Children have sometimes been asked to carry backpacks with pollution collectors. And there have even been occasions when nurses have gone to the families' own homes to vacuum the dust from the mattresses or to place a meter on the windows with which to analyze the air. "I think I began to be aware of what was happening when I was seven years old, I knew it was to do an experiment with people my age," says Arantxa. "I've had all kinds of tests, but I've always liked it a lot, I feel important and I have fun," he says.
"I think I began to be aware of what was happening when I was seven years old, I knew it was to do an experiment with people my age," says Arantxa. "I've had all kinds of tests, but I've always liked it a lot, I feel important and I have fun"
Last year, Roger had to wear a watch for a while to measure his heart rate and a belt that monitored his physical activity and hours of sleep. He also had to carry a sensor to measure pollution in his class at school. "It's true that some tests are a bit heavy, but it's for a good cause," says the man from Sabadell. "This is very interesting for the future, as pollution has serious consequences for health and the environment."
As detailed by Llúcia González, psychopedagogue at the CIBER (Center for Biomedical Research on the Net) of Epidemiology and Public Health, who monitors Arantxa and other children in Valencia, the questionnaires are key to obtain information not only on what they eat or their habits, but also their mental development. Computer games are also used to study their brain from the age of four. They are more objective to measure your cognitive abilities. In one of the exercises used, objects appear on the screen for seven minutes - a boat, a ball, a horse - and the little ones must always press the space bar on the keyboard, except when an X appears. It is used to measure your attention span.
From the data obtained with this same computer game -in Asturias, Guipuzkoa, Sabadell and Valencia-, the researchers determined in a study published in 2017 Environmental International that greater exposure to nitrogen dioxide pollution, mainly during pregnancy and, to a lesser extent, after childbirth, is also associated with poor attentional function in children aged 4 to 5 years. “With pollution, we have found a great relationship with attentional function, memory, mental development and motor skills; which is also very consistent with the results of other studies”, emphasizes Mònica Guxens, ISGlobal researcher who participated in this scientific work and current director of the INMA project. "On the other hand, we have not found a relationship with ADHD (attention deficit hyperactivity disorder), features of autism, depression, anxiety and aggressiveness, although other US cohort studies have."
“With pollution, we have found a great relationship with attentional function, memory, mental development and motor skills; which is also very consistent with the results of other studies”, emphasizes Mònica Guxens, director of the INMA project
"We still have many questions to answer," says Guxens, who explains that research now seeks to better understand the relationship between pollution and childhood obesity or precursors of possible cardiovascular pathologies in the future. However, in these 20 years of the project it has already been shown that air pollution, apart from causing illnesses in children (such as asthma or other respiratory problems), can also affect the functionalities of children, even if they are healthy. To what extent does it condition in life to have a lower cognitive development or respiratory function? “It is not clear, but the ideal is for the brain to grow fully, nobody wants to have less development”, answers the director of INMA.
"It is not the same as someone having an IQ of 85 and lowering 5 points to another with 135 who lowers it to 130," says researcher Jordi Sunyer, who stresses that individually each case is different and depends on the predetermined potentialities for each child. "We are not certain that these functional impacts are very decisive for the development, well-being or health of a person, but what we do know is that at a collective level this has great socioeconomic importance," he stresses. "These differences are very noticeable at the scale of an entire neighborhood or an entire population exposed to high levels of pollution."