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Epidemiology
Cohort profile
Cohort profile: the Environmental Reproductive and Glucose Outcomes (ERGO) Study (Boston, Massachusetts, USA) — a prospective pregnancy cohort study of the impacts of environmental exposures on parental cardiometabolic health
  1. Emma V Preston1,
  2. Marlee R Quinn1,
  3. Paige L Williams2,3,
  4. Thomas F McElrath3,4,
  5. David E Cantonwine4,
  6. Ellen W Seely5,
  7. Blair J Wylie6,7,
  8. Michele R Hacker3,6,
  9. Karen O'Brien6,
  10. Florence M Brown8,
  11. Camille E Powe9,10,11,
  12. Andrea Bellavia1,
  13. Zifan Wang1,
  14. Kathryn S Tomsho1,
  15. Russ Hauser1,3,11,
  16. Tamarra James-Todd1,3
  17. the Environmental Reproductive and Glucose Outcomes (ERGO) Study
  1. 1 Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  2. 2 Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  3. 3 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  4. 4 Division of Maternal Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  6. 6 Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  7. 7 Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
  8. 8 Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
  9. 9 Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  10. 10 Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  11. 11 Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Emma V Preston; epreston{at}hsph.harvard.edu

Abstract

Purpose Pregnancy and the postpartum period are increasingly recognised as sensitive windows for cardiometabolic disease risk. Growing evidence suggests environmental exposures, including endocrine-disrupting chemicals (EDCs), are associated with an increased risk of pregnancy complications that are associated with long-term cardiometabolic risk. However, the impact of perinatal EDC exposure on subsequent cardiometabolic risk post-pregnancy is less understood. The Environmental Reproductive and Glucose Outcomes (ERGO) Study was established to investigate the associations of environmental exposures during the perinatal period with post-pregnancy parental cardiometabolic health.

Participants Pregnant individuals aged ≥18 years without pre-existing diabetes were recruited at <15 weeks of gestation from Boston, Massachusetts area hospitals. Participants completed ≤4 prenatal study visits (median: 12, 19, 26, 36 weeks of gestation) and 1 postpartum visit (median: 9 weeks), during which we collected biospecimens, health histories, demographic and behavioural data, and vitals and anthropometric measurements. Participants completed a postpartum fasting 2-hour 75 g oral glucose tolerance test. Clinical data were abstracted from electronic medical records. Ongoing (as of 2024) extended post-pregnancy follow-up visits occur annually following similar data collection protocols.

Findings to date We enrolled 653 unique pregnancies and retained 633 through delivery. Participants had a mean age of 33 years, 10% (n=61) developed gestational diabetes and 8% (n=50) developed pre-eclampsia. Participant pregnancy and postpartum urinary phthalate metabolite concentrations and postpartum glycaemic biomarkers were quantified. To date, studies within ERGO found higher exposure to phthalates and phthalate mixtures, and separately, higher exposure to radioactive ambient particulate matter, were associated with adverse gestational glycaemic outcomes. Additionally, certain personal care products used in pregnancy, notably hair oils, were associated with higher urinary phthalate metabolite concentrations, earlier gestational age at delivery and lower birth weight.

Future plans Future work will leverage the longitudinal data collected on pregnancy and cardiometabolic outcomes, environmental exposures, questionnaires, banked biospecimens and paediatric data within the ERGO Study.

  • OBSTETRICS
  • Postpartum Period
  • DIABETES & ENDOCRINOLOGY
  • Cardiac Epidemiology
  • Chronic Disease
  • Diabetes in pregnancy

Data availability statement

Data are available upon reasonable request. Data will be made available to interested collaborators pending submission and approval of a data interest form, analysis plan and necessary IRB and institutional approvals.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2023-079782

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    Data availability statement

    Data are available upon reasonable request. Data will be made available to interested collaborators pending submission and approval of a data interest form, analysis plan and necessary IRB and institutional approvals.

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    Footnotes

    • X @emvirg

    • Collaborators The Environmental Reproductive and Glucose Outcomes (ERGO) Study.

    • Contributors EVP participated in data management and analysis, abstraction of medical records and study design of ongoing ERGO efforts, and led the writing and editing of the manuscript. MRQ participated in data collection, sample processing, data management and analysis, abstraction of medical records, study implementation, and the preparation, review and editing of the current manuscript. PLW participated in study design, data management and analysis, interpretation of results, and review and editing of the current manuscript. TFM participated in study design and implementation, resources for recruitment, sample collection and processing, and review and editing of the current manuscript. DEC participated in study design and implementation, supervision of recruitment, sample collection and processing, data management, and review and editing of current manuscript. EWS participated in the study design and implementation, data collection methodologies, review and editing of the current manuscript. BJW participated in interpretation of study results, review and editing of the current manuscript. MRH participated in study design and implementation, recruitment, data and sample collection, data management, interpretation of study results, and review and editing of the current manuscript. KO'B participated in study implementation, interpretation of study results, and review and editing of the current manuscript. FMB participated in study design, data collection methodologies, review and editing of the current manuscript. CEP contributed SPRING Study resources, including access to and harmonisation of data and samples with ERGO, data management, and review and editing of the current manuscript. AB participated in study design, data management and analysis, interpretation of results, and review and editing of the current manuscript. ZW participated in data management and analysis, and review and editing of the current manuscript. KST participated in study design and implementation for expanded ongoing ERGO efforts, data analysis, and review and editing of the current manuscript. RH participated in study design and implementation, data management and interpretation of results, and review and editing of the current manuscript. TJ-T led the design of the research questions and ERGO Study; she oversaw human subjects and IRB approval, data collection and study implementation, including recruitment and retention efforts, as well as data management, analysis, interpretation of study results, review and editing of the current manuscript and serves as guarantor of this work.

    • Funding The ERGO Study was supported by funding from the National Institutes of Health (NIH) (R01ES026166, P30ES000002, R01ES033185) and the March of Dimes (MOD research grant #6-FY19-367). ERGO data collection was also supported by NIH grant numbers 1UL1TR002541-01 and 1UL1TR001102. SPRING was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (K23DK113218), the Robert Wood Johnson Foundation’s Harold Amos Medical Faculty Development Program (N/A) and the Massachusetts General Hospital Claflin Distinguished Scholar Award (N/A). SPRING data collection was also supported by Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD094150), as well as UL1TR001102, UL1TR000170 to the Harvard Clinical and Translational Science Center from the National Center for Advancing Translational Science.

    • Competing interests CEP is an associate editor of Diabetes Care, receives payments from Wolters Klumer for UpToDate chapters on diabetes in pregnancy, and has received payments for consulting and speaking from Mediflix. All other authors declare no additional actual or perceived competing interests.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.