A rapidly growing body of research shows that exposure to common environmental chemicals can disrupt endocrine and metabolic function, and negatively impact pregnancy outcomes and child development. Studies also demonstrate that certain pregnancy conditions (e.g., preeclampsia) and outcomes (e.g., preterm birth) are associated with adverse health later in the life of the mother. However, research is lacking on the relationships between exposures in pregnancy and later health of the mother, and how pregnancy outcomes impact those associations. Puerto Rico suffers from elevated rates of numerous morbidities compared to the mainland U.S., including preterm birth and Type II diabetes. Puerto Rico also has a history of extensive contamination with increased human exposure to a range of pollutants. We established the PROTECT cohort in the northern coast of Puerto Rico to study the impacts of exposure to an array of environmental chemicals during gestation and adverse pregnancy outcomes. We have developed an incredibly rich dataset on exposures, biomarkers of intermediate effects, questionnaires, and health record information. PROTECT is also a participating cohort within the newly established US-wide ECHO study, following the development of children born into PROTECT. We propose building upon this vast dataset and continued recruitment in PROTECT, along with the repeated participant contact during the ECHO follow-up visits, to investigate status and longitudinal trajectories of maternal metabolic health and endocrine function for up to five years following pregnancy among 1000 women in Puerto Rico. We have exposure biomarker data from repeated samples collected in pregnancy on urinary phthalate metabolites, phenols/parabens, and PAH metabolites, as well as 17 metals measured in both urine and blood. In this study, with new data and sample collection on PROTECT mothers at 6 months, 1 year, 2 years, and 5 years following delivery, we aim to: 1) Determine whether maternal exposures during pregnancy are associated with measures and trajectories of metabolic health (i.e., body size, body composition, physical strength, clinical diagnoses, blood pressure, and blood glucose, insulin, lipids, HbA1c) in short- and long-term follow-up assessments after delivery; 2) Investigate the relationships between maternal exposures during pregnancy and longitudinal measures of endocrine function (e.g., estradiol, testosterone, SHBG, FSH and AMH) in the follow-up assessments after delivery; and 3) Explore effect modification of the associations between pregnancy exposures and later women’s health from the first two aims by pregnancy complications (gestational diabetes, preeclampsia, preterm birth), and/or by social determinants (socioeconomic status, social support, depression, stress, life experiences, and others) and other physical determinants of health (body size, physical activity, breast feeding, polycystic ovarian syndrome, menstrual patterns, and others). The expected outcomes of this study are to provide new and much needed information on the impacts of pregnancy exposures, pregnancy outcomes, and social factors on women’s health.

This study is designed to investigate the status and longitudinal trajectories of maternal metabolic health and endocrine function for up to five years following pregnancy among women participating in the Puerto Rico PROTECT cohort study. Little is known about the health status of women after the postpartum period and until mid-life, despite emerging evidence that this life stage may be influential with respect to long-term metabolic health outcomes. This study will fill this knowledge gap among a population at high risk for both adverse metabolic health and exposure to environmental chemicals.