1. Residential pesticide exposure among a cohort of urban minority mothers and newborns Robin M. Whyatt, Dr.P.H. Columbia Center for Children’s Environmental Health

2. Environmental ExposuresBiomarkersClinical Outcomes PAHPAH-DNA Adducts Growth ETSCotinine, 4-ABP Neurodevelopment AllergensImmune changes Asthma/Persistent Wheeze PM 2.5 DEP NO 2 Lead, Mercury PCBsPCBs, DDT/DDE PesticidesContemporary-use pesticides Susceptibility Factors Nutritional deficitsVitamins A,C,E Socioeconomic stressors Exposure Biomarkers of Exposure Outcome Assessment Effect/Susceptibility Pregnancy......2-5 years Columbia Center for Children’s Environmental Health

3. Background on Pesticides Residential use widespread in U. S. Heaviest applications in New York State in NYC Indoor exposures can be substantial Link between prenatal organophosphate exposure and adverse neurocognitive development Limited data on pesticide use among urban minority women during pregnancy

4. Columbia Center for Children’s Environmental Health Contemporary-use insecticides Organophosphates Mechanism: acetylcholinesterase inhibition Examples: chlorpyrifos, diazinon Carbamates Mechanism: acetylcholinesterase inhibition Examples: propoxur, bendiocarb Pyrethroids Mechanism: alters permeability of excited nerves Examples: permethrin

5. Columbia Center for Children’s Environmental Health Research Goals To determine the extent of prenatal pesticide use and exposure To evaluate predictors of prenatal pesticide exposure To assess effects of prenatal exposure on fetal growth and infant neurocognitive development To reduce prenatal pesticide use while controlling pest infestation levels

6. Columbia Center for Children’s Environmental Health Cohort Number: 459 mother/newborn pairs Ethnicity: African American and Dominican Residence: Northern Manhattan & South Bronx Non-smokers Non-illicit drug users No history of HIV, hypertension, diabetes

7. Columbia Center for Children’s Environmental Health Prenatal Interview

8. Columbia Center for Children’s Environmental Health 48-hour personal air monitoring

9. Columbia Center for Children’s Environmental Health Samples at delivery  umbilical cord blood  maternal blood

10. Columbia Center for Children’s Environmental Health Demographics Age 24.6  4.8 Ethnicity Hispanic 61% African American 39% Marital Status Never married 67% Education < High School 35% Annual Household Income < $10,000 42% Lacked basic necessities shelter, food, clothing, heat, medicine41% N=459

11. Columbia Center for Children’s Environmental Health Percent of women reporting indicators of housing disrepair Paint chips or dust41% Holes in ceiling or walls31% Leaky pipes22% Water damage22% Visible mold17% 60% reported at least 1 indicator of disrepair and 17% reported 3 or more.

12. Columbia Center for Children’s Environmental Health Total with pest sightings85% Cockroaches68% Rodents53% Other insects29% insect pests29% Proportion of women reporting pest sightings in the home during pregnancy N=459

13. Columbia Center for Children’s Environmental Health Total using pest control measures84% By exterminator34% By others50% 90% of women with pest sightings, versus 57% without, reported using pest control measures during pregnancy (  2 = 51, p<0.001). Proportion of women using pest control measures during pregnancy N=459

14. Columbia Center for Children’s Environmental Health Among users, percent using specific pest control measures 52% 44% 40% 29% 27% 14% 5% 11%

15. Columbia Center for Children’s Environmental Health Among users, percent using lower versus higher toxicity methods African Americans used more can sprays (p<0.001) and boric acid (p=0.001) and less baits (p=0.05) and gels (p<0.001) than Dominicans. Gels, baits and traps only42% Cans sprays, bombs and exterminator58%

16. Odds Ratio (C.I.) 2 p-value Pests sighted*2.0 (1.5-2.8)<0.001 Any pest control used1.4 (1.1-1.8)<0.01 Lower toxicity only1.3 (1.0-1.7) 0.05 Higher toxicity1.5 (1.2-1.9)<0.01 Columbia Center for Children’s Environmental Health Association 1 between housing disrepair and whether or not pests were sighted or pest control measures used 1 Logistic regression analyses controlling for ethnicity and neighborhood of residence 2 For each unit increase in the degree of housing disrepair reported (0-5) * Rodents, cockroaches, other pests

17. Columbia Center for Children’s Environmental Health Pesticides measured in prenatal maternal 48-hour personal air samples and delivery blood samples Organophosphates Chlorpyrifos Diazinon Malathion Methyl parathion Carbamates Bendiocarb Carbaryl Carbofuran Propoxur Pyrethroids cis-Permethrin trans-Permethrin

18. Columbia Center for Children’s Environmental Health Pesticides in personal air and blood samples Personal air Maternal blood Cord blood (ng/m 3, n=260) (pg/g, n=174) (pg/g, n=186) %>LOD Mean±SD %>LOD Mean±SD %>LOD Mean±SD Chlorpyrifos100% 18.3±36.595% 6.0±5.3 96% 6.1±6.6 Diazinon100% 122±54447% 1.1±2.3 53% 1.1±1.7 Propoxur 2 100% 64.6±14855% 3.3±2.5 59% 3.6±3.3 Bendiocarb NC NC68% 5.6±4.1 48% 4.3±2.8 2 isopropoxyphenol measured in blood samples NC = not calculated

19. Columbia Center for Children’s Environmental Health 1 Spearman’s rank 2 2-isopropoxyphenol Chlorpyrifosr = 0.57, p < 0.001 Diazinon r = 0.45, p < 0.001 Propoxur 2 r = 0.49, p < 0.001 Bendiocarb r = 0.27, p = 0.001 Correlation 1 between maternal and cord blood pesticide levels N=147 pairs

20. Columbia Center for Children’s Environmental Health * No pest control methods Higher toxicity > once per month Higher toxicity  once per month Lower toxicity methods only Pesticides in personal air by use of pest control during pregnancy (Geometric mean) * p<0.01 compared to other groups ** p<0.001 linear trend ANOVA * **

21. Columbia Center for Children’s Environmental Health Personal air Maternal blood Cord blood Clorpyrifos NSB=0.3, p=0.08 B=0.4, p=0.009 Diazinon NSB=0.4, p=0.02 B=0.5, p=0.009 Propoxur B=0.7, p<0.001NSNS Association between pesticide levels and ethnicity Multiple linear regression; dependent variable: log-transformed pesticide levels; independent variable: ethnicity (Domincans = 0, African Americans = 1), housing disrepair and neighborhood of residence. NS = not significant There was no association between indicators of housing disrepair and pesticide levels in personal air and blood. (African American versus Dominican)

22. Columbia Center for Children’s Environmental Health 1999 2001 2000 Geometric mean pesticide levels by year of personal monitoring (#1) or year of delivery (#2) * p<0.05 linearity trend test 1. Personal air samples (ng/m 3 ) 2. Cord blood levels (pg/g) * * * **p<0.01 ANOVA **

23. Columbia Center for Children’s Environmental Health Integrated Pest Management Repairing of holes in walls and ceilings Repairing of water damage Sealing of cracks and crevices Extensive cleaning Targeted application of pest gels Intervention study to reduce residential pesticide exposure during pregnancy Cohort 25 African American and Dominican women using higher toxicity pest control methods and match controls

24. Columbia Center for Children’s Environmental Health Intervention study to reduce residential pesticide exposure during pregnancy

25. Columbia Center for Children’s Environmental Health Intervention study to reduce residential pesticide exposure during pregnancy Education Written (all) One-on-one (cases) Air tight containers Food and trash

26. Columbia Center for Children’s Environmental Health Measures pre and post intervention Questionnaire data Pest infestation levels Integrated indoor air pesticide levels Measures post intervention Blood pesticide levels (maternal and newborn)

27. Columbia Center for Children’s Environmental Health Conclusions Results show widespread use of pest control measures among African American and Dominican women during pregnancy. Pest sightings and use of pest control increased significantly with the degreee of housing disrepair reported. Chlorpyrifos, diazinon, propoxur and bendiocarb were detected frequently in personal air and/or blood samples. Exposures were to mixtures of pesticides

28. Columbia Center for Children’s Environmental Health Conclusions Maternal and newborn blood levels were similar and highly correlated indicating that the pesticides are readily transferred from mother to the developing fetus Prenatal chlorpyrifos exposure is inversely associated with fetal growth among African Americans Pesticide exposures have decreased significantly between 1999-2001

29. Columbia Center for Children’s Environmental Health F.P. Perera P.L. Kinney H.F.Andrews W.Y. Tsai D.E.Camann D.B.Barr L.L.Needham R. Jackson D.Diaz J.Dietrich A.Reyes J.Ramirez D.Holmes M. Borjas Y. Cosme Co-Investigators Research Staff Acknowlegements OB/GYN and postpartum staff at NY Presbyterian and Harlem Hospital, Study Participants, U.S. EPA and NIEHS