Impact of Maternal Occupation in the Ecuadorian Flower Industry on Child Development

1. Impact of Maternal Occupation in the Ecuadorian Flower Industry on Child Development Alexis J. Handal, Ph.D., M.P.H. Assistant Professor MPH Program Department of Family & Community Medicine Signature Program for Child Health Research 3x5x5 Presentation 24 February 2010

2. The Cut-Flower Industry in Ecuador • Most important export following petroleum, bananas, shrimp • $523.8 million between January & November 2008 • Use of pesticides common • Organophosphates (OP), carbamates, dithiocarbamates, pyrethroids • ~50% workers are women of reproductive age • typically, work through most of the pregnancy • OPs, carbamates pass readily across placenta • pregnancy-related physiologic changes (dermal, renal, pulmonary)

3. Review of the Literature • Focused mainly on adverse neurobehavioral effects from exposure to PCBs, organic solvents, lead, methylmercury, organochlorinepesticides • Non-persistent pesticides have become a widely used alternative to OC pesticides • do not accumulate in the body and are excreted within days via water-soluble metabolites in urine • they are acutely toxic • Little research on effects of prenatal OP, carbamate exposure on NB development • Eskenazi (2007), Young (2005), Engle (2007), Grandjean (2006)

4. Preliminary Research • In 2003, we conducted a preliminary investigation into the relationship between potential pesticide exposure and NB development in children ages 3 to 61 months residing in several communities in a flower-growing region of Ecuador • Successfully recruited and enrolled 219 mothers with 283 young children living in three communities (over 90% participation) • Outcome measures: ASQ-II, specific hypothesis-based tests of prehension (motor tests), visual acuity, VMI • Exposure measures: work-related, community- and residence-related variables

5. Preliminary Research • Significant differences in developmental skills by community (Handal, et al., EHP 2007) • High exposure communities worse scores overall despite displaying higher SES, higher maternal education, more maternal stimulation, and fewer cases of anemia • Clearer relationship between prenatal exposure & infant development (Handal, et al., Epidemiology 2008) • Employment in flower industry during pregnancy was significantly associated with worse visual acuity, fine motor scores in infants • Main limitations • Proxy exposure measures • Not able to distinguish between effect of pesticides and effect of other work conditions • Lacking specific measures of maternal stress and maternal-infant interaction and stimulation

6. Next Steps • NIH grant: characterize and quantify pesticide exposure levels and evaluate other work practices that might impact development of infants of women working in the flower industry • Evaluate the feasibility of a set of developmental and maternal stress assessment tools for use in this culturally, linguistically, and economically distinct population • Other research goals: • Clinical validation of the screening tool in our population • Interdisciplinary research team • Casa CampesinaCayambe (Community Partner) • University of Michigan, Emory University, University of Washington, Universidad San Francisco de Quito, University of New Mexico

7. ¡Gracias!