Three contaminated sites in southern Italy. The Neonatal Environment and Health Outcomes cohort: protocol for a longitudinal birth cohort study

Introduction: Exposure to environmental contaminants during pregnancy is one of the determinants of child's future health outcomes. The effects of environmental pollution on pregnant women living in heavily polluted areas is of special interest and, in this context, the Neonatal Environment and Health Outcomes (NEHO) cohort will focus on the investigation of: i) toxicants transferred from the environment to the mother and from the mother to the developing fetus; ii) the influence of toxicants on pregnancy outcomes, fetal development, and health status during infancy. Because the human placenta is positioned at the interface between the maternal/external environment and the embryo, it can be considered a highly informative matrix regarding many key pregnancy events that can shape infant's future health. Methods and analysis: The NEHO cohort will enrolls an estimated total of 800 pregnant women in three selected National Priority Contaminated Sites in southern Italy. Epidemiological data collection, concerning maternal health status, lifestyle, and pregnancy are obtained through questionnaires provided to the mother starting from the last two months of pregnancy. At delivery, maternal blood, umbilical cord blood, and placenta tissue are collected to assess contaminant levels and to clarify how toxicants interact with the placental domain. Furthermore, placental transcriptome is studied in order to explore the interferences of toxicants on the role of the placenta in maternal/fetal interplay. Regular follow-up is planned at 6, 12, and 24 months. Ethics and dissemination: The study has been approved by all the Ethics Committees of the three NPCSs involved: the Ethics Committee of the University Hospitals of Messina (September 18, 2017, n. 9/2017); the Ethics Committee "Catania 2" (July 11, 2017, n. 38/2017/CECT2); the Ethics Committee of the Region of Calabria (July 20, 2017, n. 173). Findings will be disseminated in the scientific community and on a regional basis for appropriate policy actions.