專題討論10:兒童環境醫學
Children’s Environmental Medicine

程 序 表

S10-1
Child environmental health- based on birth cohort studies
陳美惠
台大醫院雲林分院小兒科

  Children’s environmental health is increasingly recognized as a global public health issue of great importance. Over the decades, epidemiologic research demonstrated the adverse health outcomes of the human fetus, child and adult from parental or childhood exposures to environmental toxicants that disrupted time-specific growth and developmental processes. In addition to the diverse vulnerability in each developmental step, the complicated interactions between environmental exposure and genetic susceptibility also lead to different health outcomes. The current problems in Taiwan we have identified to perform researches including: the prevalence of asthma is still increasing up to more than 10%; preterm delivery has been increasing up to 9% in 2003; neurodevelopmental disorders are highly prevalent and affected 8% of the examined children under the age of four years; and the prevalence of childhood obesity has doubled. Therefore, we started to conduct Taiwan Birth Panel Study (TBPS) to investigate prenatal and postnatal factors on infant and early childhood health. Through this prospective birth cohort, the main health outcomes focused on child growth and development, atopic diseases, and neurocognitive and language development. We investigated the main prenatal and postnatal factors including infection, allergens and other pollutants such as environmental tobacco smoke, heavy metals, non-persistent pesticides (perfluorinated compounds) and endocrine disrupting chemicals under the consideration of interaction of the environment and genes. We found genetic modification effects of prenatal exposure to environmental tobacco smoke on infant growth, atopic dermatitis and early childhood neurobehavioral development. Prenatal exposures to heavy metals including lead, manganese, and mercury were also associated with neurobehavioral development in the early childhood. Perfluorinated compounds levels in cord blood were noted to be associated with infant growth, atopic dermatitis and neurodevelopment. These studies bridge knowledge gaps and answer unsolved issues in the low-level, prenatal or postnatal, and multiple exposures, genetic effect modification, and the initiation and progression of “environmentally-related childhood diseases.” In addition, we play an active role in education, research, and services in the field of “pediatric environmental health” via integrating multi-disciplines.