Research in Action
Diseases of poverty persist in low- and middle-income countries (LMIC). Women die needlessly during childbirth. Women and children suffer from cardiovascular and respiratory ailments due to their disproportionate exposure to household air pollution; also, from Neglected Tropical Diseases such as Toxoplasmosis and diarrheal illnesses due to lack of access to clean water, good nutrition, safe housing and affordable health care. The global becomes local, as CGH-affiliated faculty pursue research on conditions that impact the health of women and children not only in LMIC but also in neighborhoods within University of Chicago Medicine's catchment area on the city of Chicago's south and west sides.
Eradication of Toxoplasmosis
There is no definitive cure for toxoplasmosis or Toxoplasma infections; nor, for many of the diseases that seem to associate with this infection. Dr. Rima McLeod has long recognized the great need for such a definitive cure. Her life's work has pioneered the way. Dr. McLeod’s contributions to our basic understanding and treatment of human toxoplasmosis over her career at UChicago are seminal and include developing a rigorous understanding of human toxoplasmosis and how to best use available medicines to treat this disease rationally. Dr. McLeod has proved that careful, systematic, diagnosis with effective treatment for active infection is life-saving. Before her studies, favorable outcomes were not expected. Because of them, treated children now walk, talk, see, hear, and grow up able to go to university and have families of their own, rather than facing a life of severe disabilities or not surviving at all. Dr. McLeod has developed global partnerships with the poorest communities in Panama, Colombia, Morocco and across the US to implement and disseminate point-of-care diagnosis for toxoplasmosis.
Preeclampsia: A Major Cause of Maternal and Neonatal Morbidity
Dr. Sarosh Rana's laboratory in the Section of Maternal-Fetal Medicine at University of Chicago Medicine (UCM) has the long-term goal of contributing to the reduction, if not elimination, of the terrible outcomes associated with pre-eclampsia, a pregnancy complication involving high blood pressure and damage to other organ systems. Dr. Rana's research extends to the communities served by UCM and those of the Hôpital Albert Schweitzer in Haiti, which has the world’s highest rates of preeclampsia-related maternal and fetal/neonatal mortality. Her early studies had revealed that the current diagnostic criteria for preeclampsia very poorly predicted adverse outcomes in Haiti and that angiogenic factors are closely related to adverse outcomes associated with preeclampsia, regardless of gestational age. Dr. Rana and her team are testing the idea that novel angiogenic biomarkers will prove to be superior in predicting adverse outcomes, leading to dramatic reductions in maternal and fetal mortality related to preeclampsia.
Impact of Household Air Pollution on Maternal and Child Health
Around the world, 93% of children under age 15 breathe toxic air every day that puts their health and development at risk. Of 7 million deaths per year attributable to air pollution, over 60% are due to exposure to household air pollution (HAP) from burning biomass fuels or kerosene for household energy needs. Such fuels burn inefficiently, producing toxic pollutants like fine particulate matter (PM2.5) and black carbon (BC). Mothers and children suffer the highest exposures, resulting in respiratory, cardiovascular, and neurologic injury. Risks to children begin in-utero. Pregnant women inhale polluted air, with ill effects on their developing fetuses and newborns, including growth restriction, preterm birth, and low birth weight. High exposures likely induce oxidative stress and systemic inflammation. There is evidence of mediating factors: maternal stress level, mother/child nutritional status, and home environment. Recently, Dr. Sola Olopade led a randomized controlled trial (RCT) in Nigeria to evaluate the effects of replacing traditional cookstoves with clean-burning ethanol stoves. The researchers randomized 324 pregnant women into groups based on fuel use: clean versus polluting. Study results revealed, for polluting-fuel users: 1) increased preterm delivery, miscarriage, and reduced gestational age at delivery, 2) biomarkers of placental oxygen deprivation, 3) excessive placental vascularization, and 4) increased systemic inflammation. Further, polluting-fuel users reported more psychosocial stress and less energy during pregnancy.
Pilot study underway: NIEHS has funded Dr. Olopade and CGH faculty affiliate Dr. Brisa Aschebrook-Kilfoy through the Chicago Center for Health and Environment (CACHET, a CGH partner) for a pilot study across Chicago Southside neighborhoods to investigate the impact of exposure to environmental pollutants in air (including HAP), water and soil on the health of mothers and developing children. This study's initial assessments of HAP (PM2.5) have revealed levels in some Chicago Southside neighborhoods that are higher than those observed in the Nigerian RCT.
Planned follow-up study: Mounting evidence suggests that HAP can also impair infant and child neurocognitive development. Particulate matter deposits in brain tissue have been demonstrated; also, HAP is a medium of exposure to heavy metals. Dr. Olopade and his Nigerian colleagues have continued to follow the cohort of children whose mothers participated in the RCT, monitoring their HAP exposures and other health-related variables. The planned study will test the hypothesis that high pre- and postnatal HAP exposure negatively impacts neurocognitive development in children. It will assess neurocognitive development from infancy to age 8 years as associated with: (1) prenatal and early childhood HAP exposures; (2) maternal psychosocial stress level, maternal and child nutritional status, and child’s home environment. Results will illuminate how HAP exposures and maternal stress affect child neurocognitive development and have impact on development of policies and programs to reduce HAP through use of clean-fuel cookstoves.