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Frederica Perera, DrPH
Professor, School of Public Health Director, Columbia Center for Children’s Environmental
Health
Mailman School of Public Health - Columbia University
April 20, 2007
Effects of Environmental Pollutants
on Women’s Reproductive Health
and Child Health and Development
2
Need for Prevention
Low birth weight Asthma
Child developmental
disorders
Cancer
ObesityAdult chronic diseases
3
Environmentaltoxicants
Psychosocial
factors
Nutritional deficiencies
Genes
4
• Differential exposure
• Greater absorption and retention of toxics
• Lower efficiency in detoxification/repair
• Higher rate of cell proliferation
• Time for cancer to develop
Maternal and Fetal/Child Susceptibility to Environmental Toxicants
5
Study Populations:NYC, Poland, and China Cohorts
• Young, healthy pregnant women recruited during pregnancy
• Non-smokers; some passive smokers
• Subject to varying levels of environmental toxicants
6
Coal burning
DieselEnvironmental
tobacco smoke (ETS)
Pesticides
Outdoor and Indoor Air Pollution
7
Pregnancy Through Age 11
• Pesticides• Phthalates• Cotinine• Lead, Mercury• PAH-DNA Adducts• Chromosomal Aberrations• Immune Changes• Gene Expression• Proteomic Pattern• Genetic Polymorphisms• Antioxidant Vitamins
• Asthma
• Cancer Risk (chromosomal abnormalities)
• Growth & Neurobehavioral
Development
• Monitoring
• Questionnaire
• Psychosocial factors
• GIS
Exposure Assessment
Biomarkers of Exposure/Effect/Susceptibility
Outcomes
8
The Mother and Fetus are Exposed to Multiple Toxicants in Air
Air Monitoring/Questionnaire:
Air
Sampler
100% of pregnant mothers exposedover a wide range:• Polycyclic aromatic
hydrocarbons (PAHs)
• Organophosphate pesticides
• Pyrethroid pesticides
• Phthalates
Whyatt et al.; Perera et al.; Horton et al.
40% exposed to ETS
9
Biomarkers in Mothers and Newborns
• PAH-DNA adducts
• detected in 40% to 70% of maternal and newborn cord bloods
• higher in newborns than mothers relative to estimated dose
• Chlorpyrifos, diazinon, and/or propoxur detected in 100% of maternal and cord blood samples
• 8 phthalate metabolites detected in urine of 100% of women
Tang et al.; Perera et al.; Whyatt et al.
10
Biomarkers of Effect in Newborns Associated with PAH Exposure
M MB M MB M MB M MB M MB M MB#38 #75 #154 #291 #104 #404 Clone
Low PAH High PAH
No diff erential pattern
Genetic changes• Chromosomal aberrations
Epigenetic changes• Gene methylation changes
(pilot data)
Bocskay et al.; Ho et al.
11
Prenatal Exposures Adversely Affect Reproductive Outcomes
•PAHs/PAH-DNA adducts: reduction in birth weight and/or head circumference and child growth
•Chlorpyrifos: reduction in birth weight
•ETS: reduction in birth weight
Perera et al.; Whyatt et al.; Rauh et al.
12
Prenatal Exposures Adversely Affect Child Development
• PAHs/PAH-DNA adducts: lower developmental scores and higher risk of developmental delay in young children
• Chlorpyrifos: lower developmental scores, higher risk of developmental delay, ADHD and other attentional deficits
• ETS: lower developmental scores, developmental delay
Tang, Perera, et al.;Rauh, Whyatt, et al.
13
Prenatal Exposures Increase Risk of Childhood Asthma
• Over 30% of children have asthma
• Combined prenatal PAHs and postnatal ETS associated with asthma diagnosis at ages 2 and 5
Miller et al.
14
Conclusions
• Exposures to pollutants during pregnancy are associated with:
- reduced fetal growth
- childhood asthma
- developmental disorders
- a biomarker of increased cancer risk
• Pollutants can interact to worsen effects
15
Environmental
toxicants
Opportunities for Prevention
Better health outcomes
16
Acknowledgements
Special thanks to: The women and children participating in the studiesCCEH Key Investigators: H. Andrews, K. Bocskay,, R. Garfinkel, M. Horton, P. Kinney, R. Miller, V. Rauh, D. Tang, R. Whyatt, CUMC Genetics Lab: D. WarburtonNCI: S. ChanockUniversity of Cincinnati: S. M. Ho, W. Tang CDC: D. Barr, T. Bernert, R. Schleicher, L. Needham, J. PirkleSWRI: D. Camann Funding: NIEHS, EPA New York Community Trust, Gladys & Roland Harriman Foundation, Bauman Family Foundation, Educational Foundation of America, New York Times Company Foundation, The Horace W. Goldsmith Foundation, JMF, Beldon Foundation,Johnson Family Foundation, Rockefeller Brothers, Rockefeller Financial Services, Blanchette Hooker Rockefeller, National Philanthropic Trust
17
Changing residential insecticide exposure: Pre- and post- regulation of
OPs
Change in levels of insecticides (ng/m3) detected in 48-hr personal air samples collected from pregnant African American and Dominican women living in New York City between 2000-05
0
1
2
3
4
5
CHLORPYRIFOS0
5
10
15
20
DIAZINON0
0.1
0.2
0.3
0.4
0.5
0.6
PBO
* *
p < 0.05 p < 0.05 p = 0.15