Defense of doctoral thesis by Virginia Fuentes


Doctoral Thesis entitled “Effects on infant’s respiratory health of pre and postnatal tobacco smoke exposure and other environmental pollutants” has been recenly defended by Virginia Fuentes Leonarte at the Department of Gynecology, Public Health and Science History of the Miguel Hernández University of Elche. Dr. Fuentes is specialized in Family Medicine and is a contributor to the INMA project through Environment and Health Area of FISABIO-Salud Pública. The work was directed by professors Ferran Ballester of the University of Valencia and FISABIO-Salud Pública and Marisa Rebagliato, of the Jaume I University of Castellón. The tesis has obtained a Summa Cum Laude. The main body of this work has involved six papers -three sistematic reviews and three original papers-, all of them published in international journals. All the original papers have been performed in the frame of the INMA project, two of them being multicentric studies conducted with cohorts from Asturias, Gipuzkoa, Sabadell and Valencia.

The Tribunal was constituted by widely recognized doctors within Public Health and Infants Health. The Tribunal’s president has been Dr. Ildefonso Hernández Aguado, cathedratic of the Public Helath Department, Science History and Ginecology of the Miguel Hernández University; Dr. Blanca Lumbreras, full professor in the same Department; Dr. Antonio Nieto, Department Head of Respiratory Health and Allergies in the Hospital La Fe of Valencia; Dr. Yolanda Valcárcel, full professor of the Rey Juan Carlos University of Madrid, and Dr. Elena Ronda, full professor of the University of Alicante.

Some of the major findings of this thesis are, regarding the review of the literature on indoor air pollution and respiratory health in early childhood, that the scientific literature regarding gas sources and NO2 measurements represent the bulk of production in developed countries, while in developing countries it was the effect of biomass combustion what was more frequently studied; both with a clear association with lower airway infections. The number of studies with measurements of indoor and outdoor pollution for better characterization of exposure and relative contribution of different sources of exposure on respiratory variables studied is increasing.

In the original papers it was observed that the prevalence of smoking in Spain before the introduction of the smoking ban, was still high compared to that in other European countries, a fact that was confirmed in the cohort of Valencia with a 40.9{3effe4377b6f02be2524d084f7d03914ac32a2b62c0a056ca3444e58c1f10d0b} prevalence in early pregnancy. Loads at work, namely lifting heavy objects over 20 kg, were found to be associated with more smoking in early pregnancy, and with the persistence of the habit.

For the respiratory effects in children studied during their first year of life, prenatal exposure to maternal smoking was found to play a major role, compared to that of postnatal exposure, on the risk of respiratory events, namely: lower respiratory tract infections, wheezing and phlegm during the first year of life, of the children of four ‘de novo’ cohorts’ (Asturias, Gipuzkoa, Sabadell and Valencia ). Smoking during pregnancy also behaved as a modifying variable of the effect of exposure of pregnant women of all four cohorts to emissions from gas stoves, increasing the risk of wheezing during the first year of life of their children.