Kim BM, Ha M, Park HS, Lee BE, Kim YJ, Hong YC, Kim Y, Chang N, Roh YM, Kim BN, Oh SY, Ha EH, MOCEH Study Group. (2009). The Mothers and Children's Environmental Health (MOCEH) study. Eur J Epidemiol. 24(9):573-83.

Studies of cohorts of pregnant women that look at health outcomes in their infants are of considerable potential value and have been undertaken in several countries, including the US, England, the Netherlands, and Norway.  These types of studies allow investigators to look at a wide spectrum of environmental risk factors and their effects on multiple outcomes in order to determine how pre-and post-natal environmental exposures affect growth, development, and health from early fetal life until young adulthood. In Korea in 2006, the Mothers and Children’s Environmental Health (MOCEH) program, a multi-centre prospective cohort study, began as an initiative of the National Environmental Health Action Plan, which outlines strategies for eliminating environmental health hazards and reducing their adverse effects on pregnant women and their children.

The present study aims to introduce the planning processes, study design, protocols, current status, and future directions of the MOCEH study.

(i) Study area and collaboration.  The MOCEH network consists of 9 centres: a coordinating centre, a biorepository, an environmental exposure assessment centre, a nutrition assessment centre, a neurobehavioural assessment centre, and 4 community-based local centres.

(ii) Study design.  The MOCEH study is a prospective hospital- and community-based cohort study.

(iii) Core hypotheses.  Specific questions this study plans to address include: (1) the role of bio-aerosols in the etiology of adverse birth outcomes and health problems in children; (2) the role of heavy metals in the etiology of adverse neurobeahvioural outcomes; (3) the role of endocrine-disrupting chemicals in abnormal fetal growth and neurobehavioural outcomes; (4) the interactions between environmental factors and susceptibility genes in the development of disease.

(iv) Study protocol.  Prenatal examinations, including ultrasound, are conducted during the first and third trimesters.  Information on demographic and environmental exposures, including the use of mobile phones and other sources of exposure to electromagnetic fields (EMF), is obtained through a comprehensive questionnaire. Questions about environmental exposure are asked at 20 or fewer weeks of gestation, 2, 6, 12, 24, and 36 months, and then again at 5 years.  Nutritional status is ascertained and blood and urine samples are collected.  Information about the labor and delivery, as well as cord blood, placental tissue, neonatal urine, and samples of colustrum are also collected at birth.  Data is collected from children at 6, 12, and 24 months of age and then again at age 5.  The MOCEH plans to recruit more than 1,500 women during the early period of pregnancy between 2006 and 2010.

As of February 2009, 1,229 mothers and fathers have joined the study.

Interpretation and Limitations
The standardized protocol used in this study will make it very useful for future research.  The information and biological samples collected from cohort subjects are very comprehensive.  The follow-up of infants will provide a unique opportunity to study the long-term effects of perinatal exposures.  This study will also allow interactions between potentially harmful exposures to be investigated.  This study faces methodological challenges associated with sophisticated data analysis and difficulties recruiting sufficient numbers of participants.

The results of this study have the potential to provide new information about how the gestational environment affects the development of diseases during adulthood.  This information could be used to establish a national policy for improving the health of pregnant women and their children.



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