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