Cohort Profile: Zhejiang Environmental and Birth Health Research Alliance (ZEBRA) Maternity Cohort

The Zhejiang Environmental and Birth Health Research Alliance (ZEBRA) established a maternity cohort to investigate the relationship between perinatal abnormalities and various risk factors among the Chinese maternal population. The primary aim of ZEBRA is to explore the feasibility of early-stage risk prediction and the forecast of adverse perinatal symptoms and gestational outcomes. The cohort is ambidirectional, with a retrospective arm tracking 6,275 pregnant females enrolled between 2013 and 2016, and a prospective arm recruiting 112,414 participants since the baseline year of 2017. The current ZEBRA maternity cohort database comprises a diverse range of sociodemographic features, physiological characteristics, medical history, therapeutic interventions, and measurements of environmental exposures. Going forward, the cohort will continue to enrol a wider range of participants and collect an even more extensive array of features. ZEBRA is seeking collaborations with both national and international multi-cohort studies to contribute to the field of epidemiology, and provide valuable evidence-based insights for global maternal and child healthcare. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The research has received funding from various sources, including the Zhejiang Province Health Innovative Talent Project (A0466), the International Cooperation Seed Program of Women's Hospital, Zhejiang University (GH2022B008-01), the Australian Research Council (DP210102076), the Australian National Health and Medical Research Council (APP2000581), the UK Research and Innovation (UKRI) Centre for Application of Artificial Intelligence to the Study of Environmental Risks (AI4ER, EP/S022961/1), and the US-China Fulbright Program. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study obtained written informed consent from all participants, and the research involves the use of de-identified personal information for scientific purposes. The ZEBRA cohort study is approved by the ethics committee of the Women's Hospital, School of Medicine, Zhejiang University (IRB-20220189-R). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes While the study database is not publicly available, ZEBRA warmly welcomes potential collaborations, and such requests are considered on a case-by-case basis. Researchers seeking access to the dataset are required to obtain approval from the designated ZEBRA research proposal review committee, comprising the School of Medicine at Zhejiang University and the Maternal and Child Health Division of the Health Commission of Zhejiang Province. International researchers seeking additional information regarding collaboration and data access are encouraged to contact the corresponding authors, Dr. Xiaoxia Bai (baixiaoxia{at}zju.edu.cn) and Dr. Haitong Z. Sun (zs347{at}cam.ac.uk), and to specify their requests.