This thesis consists of three essays in applied microeconomics: First, heat and school absence: evidence from a survey of Indian children. Second, heatwaves and short-term morbidity in India. Third, intra-family marriage and pregnancy outcomes. Chapter 1. India is the second most populous country on earth with young people representing a significant number of the population resulting in data that indicates such figures at 38 per cent. With such high numbers, major consideration must be given into developing informed and targeted policies to ensure positive educational outcomes for young people. This paper contributes to existing literature by investigating the impact of high temperatures on students’ rates of absenteeism, relying on the short-term exogenous variation in daily maximum temperatures. The paper highlights the heterogeneity of the effect of temperature by climate zone. To create data, we link information on children’s school absences from the India Human Development Survey (IHDS-II) in combination with meteorological data from the ERA-Interim archive taken from a thirty day period prior to individual interview dates. Our findings suggest that high temperatures have a substantial negative impact on students’ attendance in rural areas. However, limited evidence of such an effect is found in urban areas. Our results therefore indicate a need to implement future in-depth studies. Chapter 2. Within this chapter, we investigate the impact of prolonged heat exposure on individuals short-term morbidity rates over a thirty day period prior to the interview date. We work with a broad dataset and use an econometric model that utilizes plausibly exogenous variation in high weather temperatures. We implement the percentile-based approach and three different heatwave metrics as a innovative way of defining and capturing the impact of heatwaves on health outcomes. Our results show that heatwave intensity of the eighty-fifth percentile over the duration of three consecutive days of extensive heat has a significant adverse effect on individuals short-term morbidity. More so, our findings indicate a disparity between genders in relation to the impact of heatwaves. Finally, it can be suggested that individuals having to travel an extensive distance in order to access water are most affected by high temperatures. Chapter 3. Millions of people worldwide are married to their blood relatives, yet the resulting impact on offspring health continues to be debated. Within this paper, we provide evidence around this debate by studying the birth outcomes from a large, representative sample of Indian women in varying marital circumstances. We explore the impact of intra-family marriage on negative pregnancy outcomes including stillbirth, miscarriage, and child death after birth. We utilize an ordinary least squares model (OLS), which controls for a wide range of financial and family factors. The results show that being a woman related to her husband by blood increases the probability of experiencing negative pregnancy outcomes by 2.8 percentage points. Our finding is robust using the instrumental variable approach (IV). The instrumental variable represents the ambient level of violence against women, which positively affects the probability of consanguineous marriage. The IV approach leads to a slightly smaller adverse impact of 2.2 percentage points. In addition, the OLS results provide suggestive evidence that intra-family marriage has no heterogeneous impact across religion types.

In addition to fetal alcohol syndrome and fetal alcohol spectrum disorders, prenatal alcohol exposure is associated with many other adverse pregnancy and birth outcomes. Research suggests that alcohol use during pregnancy may increase the risk of miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. This research has some inherent difficulties, such as the collection of accurate information about alcohol consumption during pregnancy and controlling for comorbid exposures and conditions. Consequently, attributing poor birth outcomes to prenatal alcohol exposure is a complicated and ongoing task, requiring continued attention to validated methodology and to identifying specific biological mechanisms.

La pollution atmosphérique et les évènements météorologiques sont reconnus pour avoir des graves conséquences sur la santé telles que la mortalité cardiovasculaire et respiratoire, et par conséquent représentent un enjeu majeur de santé publique. Des travaux plus récents ont suggéré un effet des expositions à ces facteurs environnementaux durant la période intra-utérine. La vie fœtale est déterminante pour le bon développement de l’enfant. L’exposition maternelle aux facteurs environnementaux pendant la grossesse pourrait avoir des conséquences sur les issues de grossesse et la santé à court ou long terme. Par ailleurs, les mécanismes biologiques qui pourraient expliquer l’effet des expositions environnementales sur les issues de grossesse indésirables sont à l’heure actuelle très peu connus. Les objectifs de la thèse étaient : 1) d’étudier les associations entre d’une part la température et l’humidité relative pendant la grossesse et d’autre part le poids de naissance, la durée de gestation et la prématurité ; 2) d’étudier les associations entre l’exposition maternelle aux polluant de l’air et aux évènements météorologiques pendant la grossesse et la méthylation de l’ADN placentaire en utilisant A) une approche agnostique et B) une approche avec a priori basée sur l’intégration de connaissances biologiques. Le premier objectif s’est appuyé les données issues de deux cohortes mère-enfant, EDEN (avec un recrutement à Poitiers et Nancy en 2003-2006) et PELAGIE (Bretagne, 2002-2006) soit au total 5185 couples mère-enfant ; le deuxième objectif s’est appuyé sur un échantillon de 668 femmes de la cohorte EDEN chez qui le placenta a été prélevé et le niveau de méthylation de son ADN caractérisé. Les données quotidiennes de température et d’humidité ont été obtenues de Météo-France et l’exposition à la pollution atmosphérique a été estimée par un modèle de dispersion atmosphérique. Différentes fenêtres d’exposition au cours de la grossesse ont été considérées. Des échantillons de placenta centraux ont été collectés à l’accouchement et la méthylation de l’ADN a été analysée en utilisant la puce Illumina 450K. Pour répondre au premier objectif, des modèles de régression linéaire et des modèles de Cox ont été réalisés. Pour répondre au second objectif, des modèles de régression linéaire robuste, notamment à l’échelle du génome entier, ont été réalisés en appliquant des méthodes de correction de tests multiples telles que Bonferroni et Benjamini-Hochberg. Nos résultats suggèrent un effet délétère de la température et l’humidité sur le poids de naissance et ne mettent pas en évidence d’association entre pollution atmosphérique et issues de grossesse. L’exposition aux polluants atmosphériques (NO2 et PM10) pendant la grossesse était associée à une diminution de la méthylation de l’ADN placentaire pour les gènes ADORA2B et ADARB2 ; le premier gène étant connu pour être potentiellement impliqué dans la pré-éclampsie et l’hypoxie de la femme enceinte et le deuxième étant potentiellement impliqué dans les troubles métaboliques chez l'adulte tels que la circonférence abdominale et l'IMC. Les résultats des approches agnostique et avec a priori étaient cohérents pour le gène ADORA2B. Nous n’avons pas identifié d’association entre les conditions météorologiques et la méthylation de l’ADN placentaire. A notre connaissance, nous sommes les premiers à avoir étudié l’association entre la méthylation de l’ADN dans le tissu placentaire et l’exposition prénatale aux polluants de l’air et aux conditions météorologiques en utilisant des données de l’épigénome entier. Ce travail de thèse ouvre de nouvelles voies possibles concernant les mécanismes d’actions des polluants environnementaux et fournit des pistes quant aux effets à long terme possibles de ces expositions. / Nowadays, air pollution and weather conditions represent a major public health issue. It is recognized that they may have serious consequences for health especially in the most sensitive populations such as pregnant women. More recent studies have suggested an effect of exposure to these environmental factors during the fetal period. Fetal life is a critical period for the healthy development of the child. Maternal exposure to environmental exposures during pregnancy could have serious consequences on pregnancy outcomes and short- and long- term health. Furthermore, the biological mechanisms that could explain the effect of environmental exposures on adverse pregnancy outcomes are largely unknown up to now. The objectives of the thesis were: 1) to study the association between maternal exposure to temperature and relative humidity during pregnancy and birth weight, gestational duration and preterm birth; 2) to study the association between maternal exposure to air pollutants and meteorological conditions during pregnancy and placental DNA methylation using A) an agnostic approach and B) a priori approach based on integration of biological knowledge. The first part of this work relied on data from two mother-child cohorts EDEN (Poitiers and Nancy, 2003-2006) and PELAGIE (Britain, 2002-2006) corresponding to 5185 mother-infant pairs analyzed; and the second part relied on a sample of the EDEN cohort for which methylation data were available (n = 668). Daily data of temperature and humidity were obtained from Météo-France and pollution data were obtained using a dispersion model. Their exposure was averaged over different periods during pregnancy. Central placenta samples were collected at delivery and DNA methylation was analyzed using Illumina 450K chip. For the first objective, linear regression models and Cox models were used. For the second objective, robust linear regression models, especially across the genome-wide, were used and correction methods for multiple testing such as Bonferroni and Benjamini-Hochberg were applied. Our results suggest a deleterious effect of temperature and relative humidity on birth weight and did not show an association between air pollution and pregnancy outcomes. Exposure to air pollutants (NO2 and PM10) during pregnancy was associated with a decrease in placental DNA methylation for ADORA2B and ADARB2 genes; the first gene is known to be potentially involved in preeclampsia and hypoxia of the pregnant woman and the second being potentially involved in metabolic disorders in adults such as abdominal circumference and BMI. The results of agnostic and a priori approaches were consistent for ADORA2B gene. We did not found association between weather conditions and placental DNA methylation. To our knowledge, we are the first to study the association between DNA methylation in the placental tissue and prenatal exposure to air pollutants and weather conditions using data from the entire epigenome. This work opens up new possible pathways regarding mechanisms of action of environmental pollutants and provides pointers as to the possible long-term effects of these exposures.

Les pathologies vasculaires placentaires sont fréquentes et graves. La forme maternelle prédominante est la pré-éclampsie et la forme fœtale le retard de croissance intra-utérin. Les questions posées autour de ce sujet concernent tout d'abord la prédiction de la survenue de ces pathologies suffisamment tôt afin de permettre une surveillance rapprochée, une administration de corticoïdes et une prise en charge dans une maternité de niveau adaptée. La prévention de la survenue et de la récidive ainsi que le traitement de ces pathologies la phase constituée sont aussi des problématiques encore non résolues. Notre objectif était de travailler sur ces différentes questions pa l'intermédiaire de trois études : l'étude ANGIOPRED), l'étude VOLUPLA et l'étude GROWTH. Les résultats de ces travaux et une revue d la littérature mettent en évidence une perturbation des facteurs de l'hémostase et des facteurs angiogéniques dans la pré-éclampsie et dans le retard de croissance. L'association des facteurs maternels, échographiques, angiogéniques et sériques constitue un modèle prédictif efficace principalement du fait d'une excellente valeur prédictive négative. Le volume placentaire est corrélé au taux de D- Dimères et est intéressant pour la prédiction des pathologies vasculaires placentaires. De nouveaux travaux devront poursuivre l'étude d la prédiction, de la prévention et du traitement des pathologies liées au placenta. Le traitement est notamment l'objet de l'étude Growth qui vise à évaluer l'efficacité de l'énoxaparine dans le traitement du retard de croissance vasculaire constitué. / Placenta-mediated adverse pregnancy outcomes are frequent and severe pathologies whose predominant maternal form is preeclampsia and fetal form, intrauterine growth retardation. The questions asked about this subject concern first of all the prediction of the occurrence of its pathologies in a sufficiently early way to allow for close monitoring, administration of corticosteroids, and management in an appropriate level of maternity. The prevention of the occurrence and recurrence and the treatment of its pathologies in the constituted phase are also unresolved problems. Our objective was therefore to work on its various questions through three studies: the ANGIOPREI study, the VOLUPLA study and the GROWTH study. The results of his work and of the literature show that the factors of haemostasis anc angiogenic factors are disturbed in preeclampsia and in growth retardation. The association of maternal, ultrasound, angiogenic and serum factors constitutes a predictive model that is effective mainly by an excellent negative predictive value. The placental volume is correlated with the D-dimer level and is interesting for placenta-mediated adverse pregnancy outcomes prediction. New studies will have to continue the exploration of the prediction, prevention and treatment of this pathologies related to the placenta. The treatment is notably the object of the study Growth which aims to evaluate the effectiveness of the Enoxaparin for the treatment of constituted vascular growt retardation.

Orientador: Carlos Antonio Negrato / Resumo: Objetivo: Avaliar a exposição à síndrome metabólica (SM) pré-gestacional e seus efeitos nos desfechos perinatais (crianças grandes para a idade gestacional, macrossomicos e nascimento pré-termo) e no risco a curto e longo prazo para o desenvolvimento de SM e repercussões metabólicas em filhos de população de baixa renda de mãe brasileira. Desenho do estudo: Esta análise não planejada e exploratória inclui uma coorte de pares de mães-filhos diagnosticados e tratados no Centro de Pesquisa em Diabetes Perinatal - Hospital Universitário da UNESP, Brasil, de 2004 a 2011. Este estudo avaliou mulheres com diabetes mellitus gestacional anterior e o risco de desenvolver diabetes tipo 2 após 6-11 anos após o parto e os dados foram coletados de fevereiro de 2016 a julho de 2018. Mães e bebês (n = 152) foram selecionados como pares e um estudo de acompanhamento foi conduzido como análise de dados secundários dos efeitos da síndrome metabólica pré-gravidez. Exames de acompanhamento, incluindo a materna e a prole, foram realizados entre 0 e 2 anos e entre 6 e 11 anos após o parto. Todas as análises foram realizadas usando o SAS para windows, v.9.4. Em todos os testes, foi utilizado o nível de significância de 5% ou o valor p correspondente. Resultados: A prevalência de SM pré-gravidez foi de 9,1%, contribuindo para a ocorrência de LGA, crinaças macrossômicos e prematuros ao nascer. Nossos resultados confirmaram que as mães com SM pré-gestacional apresentaram correlação (p <0,0001) entre a ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objective: To assess the pre-pregnancy metabolic syndrome (MetS) exposure and its effects on the perinatal outcomes (large-for-gestational age infants, macrosomic and preterm birth) and on short and long-term risk for the development of MetS and metabolic repercussions among offspring of low income population of Brazilian mother. Study design: This unplanned, exploratory analysis includes a cohort of pairs of mother-offspring diagnosed and treated in the Perinatal Diabetes Research Center-University Hospital-UNESP, Brazil from 2004-2011. This study evaluated women with previous gestational diabetes mellitus and the risk of developing type 2 diabetes after 6-11 years after delivery and the data was collected from February 2016 to July 2018. Mothers and infants (n=152) were selected as pairs and a follow up study was conducted as secondary data analysis of the effects of pre-pregnancy MetS. Follow-up examinations, including maternal and offspring were performed at 0-2 years and from 6-11 years after delivery. All analyzes were performed using SAS for windows, v.9.4. In all tests the significance level of 5% or the corresponding p-value was used. Results: The prevalence of pre-pregnancy MetS was 9.1%, a contributor for the occurrence LGA, macrosomic infants and preterm at birth. Our results confirmed that, the pre-pregnancy MetS mothers had correlation (p<0.0001) between the hip circumference, waist circumference and weight which were also directly leading to higher levels (p<0.... (Complete abstract click electronic access below) / Mestre

Submitted by Tiago Bonomo (tiagobonomo@gmail.com) on 2018-07-17T17:34:29Z No. of bitstreams: 1 Tiago Bonomo - Impacts of Bolsa Familia Program on Infant Health.pdf: 1947491 bytes, checksum: 7336d2e5c14d12500d3129884a3a18e4 (MD5) / Approved for entry into archive by GILSON ROCHA MIRANDA (gilson.miranda@fgv.br) on 2018-07-19T19:38:06Z (GMT) No. of bitstreams: 1 Tiago Bonomo - Impacts of Bolsa Familia Program on Infant Health.pdf: 1947491 bytes, checksum: 7336d2e5c14d12500d3129884a3a18e4 (MD5) / Made available in DSpace on 2018-07-25T12:49:50Z (GMT). No. of bitstreams: 1 Tiago Bonomo - Impacts of Bolsa Familia Program on Infant Health.pdf: 1947491 bytes, checksum: 7336d2e5c14d12500d3129884a3a18e4 (MD5) Previous issue date: 2018-03-26 / The objective of this dissertation is to evaluate the impacts of the introduction of a cash transfer for pregnant women in the design of the Bolsa Família Program (BFP) on infant health. In particular, I focus on the effects on birth weight and on the incidence of low birth weight, but I also assess the impacts on pregnancy outcomes such as the incidence of preterm births and prenatal care. The new benefit consists of nine monthly transfers which start to be paid when the woman is identified as pregnant by the health management system of the BFP, regardless of the stage of pregnancy at the moment of the identification. The empiracal strategy explores the fact that when the transfer was implemented eligible women at different stages of pregnancy were exposed to different income shocks before giving birth. Using administrative data from the BFP and from the Brazilian Ministry of Health, I create links between benficiary women and their children's natality outcomes. The main results show that the transfer had a positive impact on birth weight and reduced significantly the likelihood of low birth weight. I also find that higher exposures to the transfer during pregnancy reduced the incidence of preterm births. While I don't find significant impacts on the number of prenatal visits, the results show that the transfer reduced the likelihood of delayed prenatal care.

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