Frederica Perera, DrPH

1
Effects of Environmental Pollutants on Womens
Reproductive Health and Child Health and
Development

• Frederica Perera, DrPH
• Columbia Center for Childrens Environmental
  Health
• Mailman School of Public Health, Columbia
  University, New York,
• September 7, 2006

2
The Need for Prevention

• Low birth weight is an important cause of
  neonatal death (4 million neonatal deaths
  worldwide per year 98 in developing countries)
• Rates are highest in low-income populations
• Childhood leukemia incidence has increased in the
  U.S. and other countries
• Rates of asthma and developmental disability have
  also increased

3
Fossil Fuel-Related Outdoor Air Pollution
4
Sources of Indoor Air Pollution
5
Parallel/International Studies
China
Poland
New York City
Growth Development
Growth Development
Growth Development
Cancer Risk
Cancer Risk
Asthma
Asthma
Cancer Risk
Asthma
Serial Birth Samples 300M, 300N
Cohort N550M, 550C
Cohort 730M, 730N
Community-Based Intervention
Energy Policy
WTC Study 320 mothers, 320 newborns
6
International Cohort Studies
7
Mechanisms in Maternal and Fetal/Child
Susceptibility

• Differential exposure
• Greater absorption and retention of toxics
• Decreased efficiency in detoxification/repair
• Higher rate of cell proliferation
• Time for cancer to develop

8
Study Populations NYC, Poland, and China Cohorts

• Young, healthy pregnant women recruited during
  pregnancy
• Active smokers excluded passive smokers included
• Subject to varying levels of environmental
  exposures

9
Pregnancy Through Childhood
Repeat Measures on Women and Children

• Pesticides
• Cotinine
• Lead, mercury

• Growth Neurobehavioral
• Development

• PAH-DNA Adducts
• Chromosomal Aberrations
• Immune Changes
• Gene Expression
• Proteomic Pattern
• Genetic Polymorphisms
• Antioxidant Vitamins

• Asthma

• Cancer Risk (chromosomal abnormalities)

10
The Mother and Fetus are Exposed to Multiple
Toxicants
Air Monitoring/Questionnaire
Biomarkers

• 100 of pregnant mothers exposed to PAHs and
  pesticides
• 40 exposed to ETS

Air Sampler

• PAH-DNA adducts detected in 40 to 70 of
  maternal and newborn cord bloods
• Chlorpyrifos, diazinon, and/or propoxur detected
  in up to 100 of maternal and cord blood samples
  (NYC)

11
PAH-DNA Adducts in Mother/Newborn Samples
Indicate Fetal Susceptibility to Carcinogens
Perera et al., 2005
12
Prenatal Exposures Adversely Affect Reproductive
Outcomes
PAHs/PAH-DNA adducts reduction in birth weight
and/or head circumference and child growth
ETS reduction in birth weight Chlorpyrifos
reduction in birth weight
13
Prenatal Exposures Adversely Affect Child
Development
PAHs/PAH-DNA adducts lower developmental scores
and higher risk of developmental delay in young
children ETS lower developmental scores, more
delay Chlorpyrifos lower developmental scores,
higher risk of developmental delay, ADHD and
other attentional deficits
14
Prenatal Exposures Can Increase Risk of Childhood
Asthma

• Prenatal PAHs and postnatal ETS respiratory
  symptoms at 1-2 yrs
• Prenatal PAH/pyrene exposure elevated IgE at age
  2 IgE respiratory symptoms (Miller et al.,
  2003, 2005)

15
Prenatal Exposures Can Increase Risk of Childhood
Cancer
Airborne PAHs were associated with higher
chromosomal aberration frequencies in cord blood
after adjusting for ethnicity and ETS (plt0.007)
16
Conclusions

• Exposure to pollutants during pregnancy was
  associated with
• reduced fetal growth, childhood disease,
  developmental
• disorders and a biomarker of increased cancer
  risk
• Pollutants can interact to exacerbate effects
• Public health implications action needed to
  prevent early-life
• environmental exposures harmful to the
  pregnant woman and the
• fetus/developing child

17
Partnerships in Research
Special thanks to the women and children
participating in the studies, and to the many
investigators at CEHC CUMC Genetics Lab CDC NCI
University of Cincinnati
Jagiellonian University, Krakow ICR.
UK Childrens Hospital of Chongqing University of
Medical Sciences Chongqing Institute of
Environmental Sciences NRDC China Program
18
Funding
This research has been made possible by joint
funding from

• NIEHS and EPA grants
• 1 RO1 ES008977
• 5 PO1 ES009600
• 5 RO1 ES10165 5 RO1 ES11158 5 RO1 ES012468
• 2 EPA Star grants R-82860901 R-827027
• RD-832141
• Private foundations, including those for the
  WTC Study
• The New York Times Company Foundation, The
  September 11th
• Fund, established by the United Way and The
  New York Community
• Trust