International Journal of Hygiene and Environmental Health
ReviewThe INMA—INfancia y Medio Ambiente—(Environment and Childhood) project: More than 10 years contributing to environmental and neuropsychological research
Introduction
In 2003 the INMA—Infancia y MedioAmbiente (Environmental and Childhood) project, a Spanish national network of birth cohorts aimed at assess the health impacts of pre- and postnatal environmental exposures on children, was set up (Ramón et al., 2017). The first cohorts started in 1997 in the locations of Ribera d’Ebre (n = 102) and Menorca (n = 482), in 2001 another birth cohort was set up Granada (n = 668, including only boys). Based on the experience from these three cohorts, a new common research protocol was developed and four new cohorts were designed to evaluate the impact of environmental exposures and diet on children’s health: Valencia (n = 787), Sabadell (n = 622), Asturias (n = 485) and Gipuzkoa (n = 612) (Ribas-Fito et al., 2006a, Guxens et al., 2012a). Overall, the project includes more than 3500 participant mother-child pairs.
Since 2001, the number of original papers published by the project has exponentially increased and so far more than 300 articles are contributing to the knowledge of the association between pre- and postnatal environmental exposures and child health. One of the main research interests within the INMA project has been the study of the neuropsychological development of children and, along the years, different tools, listed in Table 1, have been used in order to evaluate cognitive and psychomotor functions as well as behavioral outcomes.
Overall, the INMA project has published more than 60 papers on maternal and environmental factors related to neuropsychological development in children. Beyond the work conducted by other research teams, that contributes to the evidence of the associations between environmental factors and neuropsychological development in children, and beyond the mechanisms that explain these associations, which have been discussed in other articles (Grandjean and Landrigan, 2014), with the present review we aim to evaluate the evidence provided by the INMA project up to January 2016 on which maternal and environmental determinants during pre- and postnatal life are associated with child’s neuropsychological development and to discuss how INMA data is contributing to cover the challenges that child health environmental research will face in the coming years.
Section snippets
Tools to assess neuropsychological development in INMA
General cognition was evaluated with the Bayley Scales of Infant Development 1st edition (BSID-I) (Bayley, 1977) and the Griffiths Scales of Infant Development (GSID) (Griffiths, 1996) – first two years of life – and the McCarthy Scales of Children’s Abilities (MCSA) (McCarthy, 1972) – 4–5 years of life. BSID yields two indices, the Mental Development Index (MDI) and the Psychomotor Developmental Index (PDI), whereas the GSID is divided into five subscales (locomotor, personal-social, hearing
Discussion
The current review provides an overview of the main determinants of child’s neuropsychological development studied within the INMA project and the main findings obtained, related with prenatal and postnatal exposures to maternal, environmental and dietary determinants and co-morbidities.
In terms of the environmental pollutants, INMA has provided substantial evidence for the inclusion of DDT in the current list of known developmental neurotoxicants (Grandjean and Landrigan, 2014). In addition,
Conclusions
The updated findings presented in this Review confirm and add evidence of the role of a range of maternal and environmental exposures on early childhood neuropsychological development. The findings underscore the importance of continued research on the delineation of the sensitive windows of exposure during pregnancy and postnatally and on the combined effects of toxicant exposures, denoted the exposome, since environmental exposure to multiple pollutants are the norm rather than the exception.
Funding
This study was supported Instituto de Salud Carlos III (Red INMA G03/176, CB06/02/0041, 97/0588, 00/0021-2, PI04/1436, PI06/1756, PI08/1151, PS09/01958, PI12/01890, PI14/00677, MS13/00054, CP13/00054 including FIS-FEDER funds 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314, 09/02311, 09/02647, 11/0178, 11/02591, 11/02038, 13/1944, 13/2032, 13/02429, 14/0891, 14/1687, and 16/1288) and Miguel Servet-FEDER MS15/00025, Spanish Ministry of Health - CIBERESP (FIS-97/1102,
Acknowledgments
The authors are indebted to all participants, without whom this work would not have been possible. We are grateful to all the personnel that have made INMA Project a reality.
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