Study Questions: What is the association between prenatal and postnatal environmental exposures and blood pressure (BP) in children?

Methods: Patients were studied at six European Centers. Systolic (SBP) and diastolic blood pressure (DBP) were measured in the context of many environmental exposures. The study included 89 prenatal and 128 postnatal exposures, including air pollution, the built environment, meteorology, natural spaces, traffic, noise, chemicals, and lifestyles. Two complex statistical methods were used to adjust for confounders. The first was an exposome-wide association study considering the exposures independently. The second was a deletion-substitution algorithm considering all the exposures simultaneously.

Results: A total of 1,277 children were studied. Decreased SBP was observed with facility density, maternal concentrations of polychlorinated biphenyl 119, and child concentrations of dichlorodiphenyldichloroethylene (DDE), hexachlorobenzene, and mono-benzyl phthalate. Increased SBP was observed with lower outdoor temperature during pregnancy, high fish intake during pregnancy, maternal cotinine concentrations, and child perfluorooctanoate concentrations. Decreases in DBP were observed with outdoor temperature at examination and child DDE concentrations, whereas increases in DBP were observed with maternal bisphenol-A concentrations, high fish intake during pregnancy, and child copper concentrations.

Conclusions: Early-life exposure to several chemicals, as well as built environment and meteorological factors, may affect BP in children.

Perspective: This study demonstrates the complexity of investigating the impact of environmental factors on BP in children. The study made use of a relatively new concept, the “exposome,” which aims to evaluate all the environmental exposures of an individual. The study investigated 89 prenatal and 128 postnatal exposures, ranging from neighborhood factors (location of buslines, walkability) to meteorological factors to multiple chemical exposures. The various exposures were seen to have positive, negative, and neutral impact on BPs in children. Based on the study design, there is risk for both false negatives and false positives in the identification of exposures related to elevated BP. Additional studies with larger patient numbers will be required to understand the significance and clinical implications of these findings.

Clinical Topics: Prevention

Keywords: Air Pollution, Blood Pressure, Copper, Environmental Exposure, Fish Products, Fluorocarbons, Hexachlorobenzene, Life Style, Meteorology, Pediatrics, Pregnancy, Primary Prevention, Temperature