1.

After reading the article “Associations of Pre- and Postnatal Air Pollution Exposures with Child Blood
Pressure and Modification by Maternal Nutrition: A Prospective Study in the CANDLE Cohort”,
answer the following question:

a) What is the main result of this study? Do you believe that the criteria of causality of
temporality and biological gradient were respected in this study? Explain. (3pts)

The study comes to the main conclusion that there is an association between prenatal
PM2.5 exposure and childhood hypertension. (1 pt)

The temporality is necessarily respected since the study concerned pediatric patients of the
prenatal stage up to 6 years. Exposure to pollutants therefore occurred before the onset of
hypertension. (1 pt)

The concept of proportionality is also respected since the study states that “on average, a
percentile increase of 14.6 in systolic pressure and 8.7 in diastolic pressure was observed
with every 2 microgram increase in PM2. 5 in the second trimester ”. We can therefore see
that the pressure has a dose-response curve with the amount of PM2.5. (THE EXPLANATION
HERE IS ONLY A SUGGESTION, AS SOON AS THE STUDENT INDICATES THAT YES THE
PROPORTIONALITY IS RESPECTED AND GIVES A BRIEF REASON) (1 pt)

b) What measuring instruments have been used to measure exposure to air pollution? How
could you improve the exposure assessment in a subsequent study? (3 pts)

For the quantity of NO2, regionalized national annual averages were used. (1 pt)

For PM2.5, spatiotemporal models were used. (1 pt)

FOR THE SUGGESTION OF IMPROVEMENT, ONLY ONE IS REQUIRED, BUT SEVERAL ANSWERS
POSSIBLE

1 pt
It might be interesting to take the mother's address not only at the start of the study, but to
see if she has lived elsewhere before this one (or changed addresses)

It would also be good to use spatiotemporal models for the quantity of NO2, more suitable
than the model, which was used.

Exposure should be measured inside buildings in order to have better accuracy.

Individual exposure should be improved by using measuring instruments at the individual

level
c) What type of study is used in this scientific article? How could the type of study be improved
in subsequent research? (2pts)

This is a cohort study (or longitudinal study or prospective study)

For a future study, it would be good to conduct the same type of study with a different
cohort in a different location.

d) How can we explain the results of this study from the point of view of a mechanism of
action? (1 pt)

MULTIPLE ANSWERS POSSIBLE, BUT ONLY ONE NECESSARY

The pollutants could cause inflammation in the placenta and systematically in the fetus,
oxidative stress or endocrine disruption.

e) In a subsequent study, how could the measurement of blood pressure be improved? (1 pt)

A future study should take the blood pressure measurement several times, on various occasions,

f) According to the scientific article, what is the most important duration of exposure to study
the link between air pollution and cardiometabolic health in infancy? Explain. (2pts)

The prenatal period is the most important, especially the second trimester of pregnancy. (2pts)