The INMA—INfancia y Medio Ambiente—(Environment and Childhood) project: More than 10 years contributing to environmental and neuropsychological research

doi:10.1016/j.ijheh.2017.02.008

International Journal of Hygiene and Environmental Health

Volume 220, Issue 4, June 2017, Pages 647-658

https://doi.org/10.1016/j.ijheh.2017.02.008 Get rights and content

Abstract

Background

In 2003 the INMA—INfancia y Medio Ambiente (Environment and Childhood) project, a Spanish national network of birth cohorts including more than 3500 participants, was set up with the aim to assess the health impacts of pre- and postnatal environmental exposures on children. The project has published more than 60 papers on maternal and environmental factors related to neuropsychological development in children, one of the main research interests within the project. With the present review, we evaluate the evidence provided by the INMA project on this topic and discuss how the data can contribute to cover the challenges that children’s environmental health research will face in the coming years.

Results

The INMA project has contributed to provide increasing evidence of the association between prenatal exposure to persistent organic pollutants (POPs) and child neuropsychological development, but it has also shown, using innovative methodologies, that postnatal exposure to these compounds does not play a role in this association. The project has also contributed to show the detrimental influence of certain air pollutants on child neuropsychological development, as well as how a balanced maternal fish intake can protect from the potential adverse effects of prenatal exposure to mercury. Also, the project has contributed to the understanding of impacts of nutritional factors including supplement intake and vitamin D levels during pregnancy and the role of breastfeeding on the neuropsychological benefits.

Conclusions

INMA findings underscore the importance of continued research on the delineation of the sensitive windows of exposure both during pregnancy and postnatally and on the combined effects of environmental exposures, denoted the exposome. In terms of health policy, INMA findings have important implications for the development of public health policies to advance the health and development of children.

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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ReviewThe INMA—INfancia y Medio Ambiente—(Environment and Childhood) project: More than 10 years contributing to environmental and neuropsychological research

Abstract

Background

Results

Conclusions

Introduction

Section snippets

Tools to assess neuropsychological development in INMA

Discussion

Conclusions

Funding

Acknowledgments

Int. J. Hyg. Environ. Health

Environ. Res.

J. Nutr.

Sci. Total Environ.

Neurotoxicology

Environ. Res.

Environ. Int.

Neurotoxicology

Int. J. Hyg. Environ. Health

Clin. Psychol. Rev.

Lancet Neurol.

J. Am. Acad. Child Adolesc. Psychiatry

Environ. Int.

Environ. Int.

Neurotoxicology

Environ. Int.

Environ. Res.

Prenatal head growth and child neuropsychological development at age 14 months

Am. J. Obstet. Gynecol.

TSH concentration within the normal range is associated with cognitive function and ADHD symptoms in healthy preschoolers

Clin. Endocrinol. (Oxf.)

Escalas Bayley De Desarrollo Infantil [Bayley Scales of Infant Development]

Does exposure to environmental radiofrequency electromagnetic fields cause cognitive and behavioral effects in 10-year-old boys?

Bioelectromagnetics

Maternal pre-pregnancy overweight and obesity, and child neuropsychological development: two Southern European birth cohort studies

Int. J. Epidemiol.

The global burden of disease due to outdoor air pollution

J. Toxicol. Environ. Health A

Review of pesticide urinary biomarker measurements from selected US EPA children’s observational exposure studies

Int. J. Environ. Res. Public Health

Association between child cortisol levels in saliva and neuropsychological development during the second year of life

Stress Health

Prenatal exposure to organochlorine compounds and neuropsychological development up to two years of life

Maternal intelligence-mental health and child neuropsychological development at age 14 months

Gac. Sanit.

Newborn TSH concentration and its association with cognitive development in healthy boys

Eur. J. Endocrinol.

Association of traffic-related air pollution with cognitive development in children

J. Epidemiol. Community Health

Polybrominated diphenyl ethers (PBDEs) in breast milk and neuropsychological development in infants

Environ. Health Perspect.

The strengths and difficulties questionnaire: a research note

J. Child Psychol. Psychiatry

Only one chance: how environmental pollution impairs brain Development–and how to protect the brains of the next generation

Environmental Ethics and Science Policy Series

The Griffiths Mental Development Scales

Cognitive function and overweight in preschool children

Am. J. Epidemiol.

Breastfeeding, long-chain polyunsaturated Fatty acids in colostrum, and infant mental development

Pediatrics

Cohort profile: the INMA–INfancia y medio Ambiente–(Environment and Childhood) project

Int. J. Epidemiol.

Prenatal exposure to residential air pollution and infant mental development: modulation by antioxidants and detoxification factors

Environ. Health Perspect.

Air pollution during pregnancy and childhood cognitive and psychomotor development: six European birth cohorts

Epidemiology

Air pollution exposure during pregnancy and childhood autistic traits in four european population-Based cohort studies: the ESCAPE project

Environ. Health Perspect.

Review
The INMA—INfancia y Medio Ambiente—(Environment and Childhood) project: More than 10 years contributing to environmental and neuropsychological research