The Pregnancy Environment and Lifestyle Study (PETALS): a population-based longitudinal multi-racial birth cohort

Abstract

BackgroundIncreasing recognition has been received regarding the proven and suggested links between multi-level environmental exposures on a broad scale (e.g., chemical, clinical, behavioral, physical and social) and health deficits originated from the critical window of development. However, such prospective human data are limited. In 2016, the National Institutes of Health funded 35 centers comprising 84 extant cohorts for the Environmental Influences on Child Health Outcomes (ECHO) pediatric cohorts program. The Pregnancy Environment and Lifestyle Study (PETALS) is one of the cohorts at the participating centers of Kaiser Permanente Northern California (KPNC).MethodsPETALS was originally funded by the National Institute of Environmental Health Sciences to establish a longitudinal birth cohort of 3,350 mother-infant pairs and conduct a nested case–control study of 300 women with gestational diabetes (GDM) and 600 matched controls to investigate the associations between phenol exposures in first and second trimesters and GDM risk and the related outcome of infant macrosomia. This paper describes the prospective cohort design of PETALS, current research activities, and cohort profile of enrolled women who delivered as of February 2016. Women are enrolled from the KPNC membership. Fasting blood draw, urine collection, anthropometric measurements, and questionnaires on health history and lifestyle are completed at baseline and follow-up clinic visits with targeted windows of 10–13 and 16–19 weeks of gestation, respectively. Further, women’s clinical and health assessments before and after the index pregnancy in addition to their children’s birth outcomes and health information can be abstracted from electronic health records, allowing future follow-up. Study data could also be linked and extended to a myriad of additional observational data including environmental and area-level databases and census data.DiscussionIn this racially- and ethnically-diverse pregnancy cohort, the generated biospecimen and data repository will establish a comprehensive framework which may provide unique opportunities to address a multitude of research questions on the intrauterine environment and adverse pregnancy and birth outcomes in a representative multi-racial/ethnic population with generalizable findings.

Central Obesity Increases the Risk of Gestational Diabetes Partially Through Increasing Insulin Resistance

“…The study design and scope have been described in detail elsewhere (19). The source population was identified from the Kaiser Permanente Northern California, an integrated health care delivery system serving 4 million members, representing approximately 30% of the northern California population and is racially/ethnically and socio- economically diverse and representative of the population in the served geographic area (20, 21).…”

“…The study population was from the Pregnancy Environment and Lifestyle Study (PETALS), a longitudinal cohort of multi-racial/ethnic pregnant women, within which a nested case-control study of GDM etiology is underway. The study design and scope have been described in detail elsewhere ( 19 ). The source population was identified from the Kaiser Permanente Northern California, an integrated health care delivery system serving 4 million members, representing approximately 30% of the northern California population and is racially/ethnically and socio- economically diverse and representative of the population in the served geographic area ( 20 , 21 ).…”

Liver Enzymes in Early to Mid-pregnancy, Insulin Resistance, and Gestational Diabetes Risk: A Longitudinal Analysis

“…The study participants were from the Pregnancy Environment and Lifestyle Study (PETALS), a longitudinal prospective multi-racial/ethnic cohort of pregnant women. The study design and scope have been described in detail elsewhere ( 14 ). Briefly, after weekly search of the electronic health records, pregnant women aged 18–45 years, of all races/ethnicities, carrying a singleton, and without recognized pre-existing diseases (i.e., diabetes, cancer, hepatitis C, or liver cirrhosis) were recruited before gestational week 11 at five participating medical centers of Kaiser Permanente Northern California.…”

Poor diet quality in pregnancy is associated with increased risk of excess fetal growth: a prospective multi-racial/ethnic cohort study

“…The study design and scope have been described in detail elsewhere. 23 The source population was identified from the Kaiser Permanente Northern California (KPNC) membership, an integrated health care delivery system serving 4.2 million members, including about 30% of the underlining population, and is racially/ethnically and socio-economically diverse and representative of the population in the served geographic area. 24,25 Briefly, after weekly search of the electronic health records (EHR), pregnant women aged 18-45 years of all races/ethnicities, carrying singleton infants and without recognized pre-existing diseases (i.e.…”