Sonali Bose, MD, MPH, ATSF, Associate Professor of Medicine, Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, is helping to improve the lives of vulnerable women and babies while pushing the boundaries of indoor air pollution research.
Results from her pilot study, completed in April 2024 and funded by a pilot grant through the NIEHS-funded Center on Health and Environment Across the LifeSpan (HEALS), underscore the urgency of her research. Bose designed an intensive protocol to study a small group of pregnant women with asthma early in their pregnancies. Bose’s team installed air quality monitors in the women’s homes, located in New York City’s asthma hotspots, and measured 1 week of daily repeated lung function, respiratory symptoms, and asthma control in each trimester of pregnancy to evaluate both pollution exposure and respiratory health. The study was published in the American Journal of Respiratory and Critical Care Medicine.
“We only studied a little over 20 participants, but our results were striking,” said Bose, who is also Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai. “We were hoping to identify modifiable environmental factors to which mothers with asthma are exposed.”
Indoor air pollution in the homes of the pregnant women was “extraordinarily high,” at times reaching levels that are hundreds to thousands of times the level of outdoor pollution considered safe by the U.S. Environmental Protection Agency (EPA), Bose said. The EPA does not regulate indoor air pollution, despite Americans spending the majority of their time indoors. After identifiable periods of high indoor exposure that typically originate from activities such as smoking and cooking, lung function abnormalities in participants appeared within 24 hours, and increases in indoor pollutant levels within a trimester were associated with worse respiratory symptoms and poorer asthma control. The results revealed how significant indoor air pollution exposures can be for respiratory health in susceptible pregnant individuals with asthma.
The study also included questionnaires completed by the participants that supported the acceptability of the study’s innovative research methods, which enabled data collection at high time and spatial resolution.
“There is a lack of published data that describes how indoor air pollution impacts pregnant mothers with asthma,” Bose said. “No prior studies have demonstrated simultaneous high-resolution assessments of indoor air pollution and maternal asthma health in pregnancy.”
The pilot cohort focused on pregnant women with a history of active asthma from low-income neighborhoods in northern Manhattan, the Bronx, and Brooklyn. Ninety percent of the women were Black or multiracial and/or of Hispanic ethnicity. Black and Hispanic pregnant women are especially vulnerable patients, because they face both higher risk for asthma and for adverse outcomes in pregnancy such as maternal mortality – “doubly disadvantaged,” Bose said.
Controlling asthma during pregnancy is vital, according to Bose. Pregnancy can worsen asthma and is associated with poor outcomes for both the baby and the mother, including abnormal fetal growth in the baby and preeclampsia in the mother. The risk of pneumonia and asthma in the offspring are also higher in mothers with uncontrolled asthma.
The HEALS pilot grant generated preliminary data that resulted in two published papers and enabled Bose to apply for two large R01 grants through the National Institutes of Health (NIH) and the American Lung Association to continue her critical work.
The grants are an extension of Bose’s longstanding research in asthma that stretches back to her first NIH trainee grant 15 years ago, at Johns Hopkins Hospital. She came to Mount Sinai in 2016.
“I was always interested in identifying the earliest risk factors for lifelong lung disease,” said Bose.
At Mount Sinai, Bose has flourished under the mentorship of Rosalind J. Wright, MD, MPH, Dean for Public Health and Chair of the Department of Public Health at the Icahn School of Medicine at Mount Sinai. Bose credits Wright, who is also Co-Director of the Institute for Exposomic Research at the Icahn School of Medicine at Mount Sinai, with teaching her how to conduct studies in pregnant and ethnically diverse populations, to write grants and manuscripts, and to be an effective mentor. Two of Bose’s junior researchers have published papers from this research that have furthered their careers. Wright also provided infrastructure that allowed Bose to collaborate with environmental data scientists.
“Roz helped me to really refine my skills in research from beginning to end,” Bose said.
Bose’s next steps are to continue her research more robustly in a bigger group of pregnant mothers and to gather data about health outcomes for the babies post-delivery.
“The attention to asthma in pregnancy has been relatively less, but, ironically, it’s one of the most vulnerable periods. You have two patients here, mom and baby. It compels me more to find solutions for this population, because I think the benefit we could give them could be quite longstanding.”