Residential pesticide exposure among a cohort of urban minority mothers and newborns

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

2. Columbia Center for Children’s Environmental Health Pregnancy . . . . . . 2-5 years Exposure Biomarkers of Exposure Outcome Assessment Effect/Susceptibility Environmental ExposuresBiomarkers Clinical Outcomes PAH PAH-DNA Adducts Growth ETS Cotinine, 4-ABP Neurodevelopment Allergens Immune changes Asthma/Persistent Wheeze PM 2.5 DEP NO2 Lead, Mercury PCBs PCBs, DDT/DDE Pesticides Contemporary-use pesticides Susceptibility Factors Nutritional deficits Vitamins A,C,E Socioeconomic stressors

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

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 N=459 Age24.6  4.8 Ethnicity Hispanic 61% African American39% Marital Status Never married 67% Education < High School 35% Annual Household Income < $10,000 42% Lacked basic necessities shelter, food, clothing, heat, medicine 41%

11. Columbia Center for Children’s Environmental Health Percent of women reporting indicators of housing disrepair Paint chips or dust 41% Holes in ceiling or walls 31% Leaky pipes 22% Water damage 22% Visible mold 17% 60% reported at least 1 indicator of disrepair and 17% reported 3 or more.

12. Columbia Center for Children’s Environmental Health Proportion of women reporting pest sightings in the home during pregnancy N=459 • Total with pest sightings 85% • Cockroaches 68% • Rodents 53% • Other insects 29% • insect pests 29%

13. Columbia Center for Children’s Environmental Health Proportion of women using pest control measures during pregnancy N=459 • Total using pest control measures 84% • By exterminator 34% • By others 50% 90% of women with pest sightings, versus 57% without, reported using pest control measures during pregnancy (2 = 51, p<0.001).

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 Gels, baits and traps only 42% Cans sprays, bombs and exterminator 58% 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.

16. Columbia Center for Children’s Environmental Health Association1 between housing disrepair and whether or not pests were sighted or pest control measures used Odds Ratio (C.I.)2 p-value Pests sighted* 2.0 (1.5-2.8) <0.001 Any pest control used 1.4 (1.1-1.8) <0.01 Lower toxicity only 1.3 (1.0-1.7) 0.05 Higher toxicity 1.5 (1.2-1.9) <0.01 1Logistic regression analyses controlling for ethnicity and neighborhood of residence 2For each unit increase in the degree of housing disrepair reported (0-5) *Rodents, cockroaches, other pests

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

18. Columbia Center for Children’s Environmental Health Pesticides in personal air and blood samples Personal air Maternal blood Cord blood (ng/m3, n=260) (pg/g, n=174) (pg/g, n=186) %>LOD Mean±SD %>LOD Mean±SD %>LOD Mean±SD Chlorpyrifos 100% 18.3±36.5 95% 6.0±5.3 96% 6.1±6.6 Diazinon 100% 122±544 47% 1.1±2.3 53% 1.1±1.7 Propoxur2 100% 64.6±148 55% 3.3±2.5 59% 3.6±3.3 Bendiocarb NC NC 68% 5.6±4.1 48% 4.3±2.8 2isopropoxyphenol measured in blood samples NC = not calculated

19. Correlation1 between maternal and cord blood pesticide levels N=147 pairs Columbia Center for Children’s Environmental Health Chlorpyrifos r = 0.57, p < 0.001 Diazinon r = 0.45, p < 0.001 Propoxur2 r = 0.49, p < 0.001 Bendiocarb r = 0.27, p = 0.001 1Spearman’s rank 22-isopropoxyphenol

20. Higher toxicity > once per month Higher toxicity  once per month Lower toxicity methods only No pest control methods Columbia Center for Children’s Environmental Health Pesticides in personal airby 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 Association between pesticide levels and ethnicity (African American versus Dominican) Personal air Maternal blood Cord blood Clorpyrifos NS B=0.3, p=0.08 B=0.4, p=0.009 Diazinon NS B=0.4, p=0.02 B=0.5, p=0.009 Propoxur B=0.7, p<0.001 NS NS 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.

22. 1999 2000 2001 Columbia Center for Children’s Environmental Health Geometric mean pesticide levels by year of personal monitoring (#1) or year of delivery (#2) 1. Personal air samples (ng/m3) * * * 2. Cord blood levels (pg/g) ** ** ** ** **p<0.01 ANOVA * p<0.05 linearity trend test

23. Columbia Center for Children’s Environmental Health 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 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

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 Acknowlegements Co-Investigators Research Staff 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 OB/GYN and postpartum staff at NY Presbyterian and Harlem Hospital, Study Participants, U.S. EPA and NIEHS