the new hampshire birth cohort study learning how the environment affects the health of your baby...
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The New Hampshire
Birth Cohort Study
Learning how the environment affects the health of your baby
Project 4:
Arsenic Epidemiology, Biomarkers &
Exposure Assessment in New Hampshire
Arsenic passes through the placenta
Among Andean women exposed to 200 mg/L of arsenic in drinking water
– median arsenic levels in maternal blood (11 mg/L) were nearly as high in infant cord blood (9 mg/L)
– Concentrations of arsenic in placental tissue also elevated.
Concha et al, 1998
Arsenic – Fetal/Infant Effects
• In utero/early life exposure to arsenic via drinking water contamination, observed to increase risk of:
• Adverse fetal outcomes:– fetal and neonatal mortality, spontaneous abortion
and stillbirths– low birth weight and preterm delivery
• Decline in childhood intellectual function
• Cancer risk later in life, in particular liver and lung cancers
Arsenic & Birth weight
Decreased birth weight < 100 mg/L urinary Asof 1. 7 g per mg/L
Rahman et al., 2009
No data on these outcomes in a US population
Dietary Mercury• Much of the data pertain to unique study populations (e.g.-
those who subsist primarily on whale and seal meat), which are not generalizable to women in the United States.
• New England has the highest atmospheric levels of mercury in the country and mercury has contaminated pristine lakes and accumulated in local fish populations.
• Due to increased dietary reliance on fish and shellfish in coastal states, New Hampshire provides an excellent opportunity to assemble a birth cohort where both the effects of arsenic in drinking water and mercury in seafood can be assessed.
Specific Aims• To test whether in utero arsenic is associated with
reduced birth weight, fetal growth and gestational age (i.e., premature births).
• Whether nutritional or genetic factors modify these associations.
• To test whether in utero methylmercury exposure influences fetal growth and gestational age.
• To evaluate the reliability of multiple measures of metal exposure (e.g., drinking water, hair, nails and urine concentrations) in mothers and in mother-infant pairs.
Elevated exposures
Birth CohortStudy Area
20% of pregnant women enrolled in our study – tap water exceeds the MCL of 10 mg/L As
Enrollment StatusEnrollments started January 1, 2009 at 3
Concord Clinics– April 2010: Enrollment expanded to include an
OB/GYN clinic in Concord– July 2010: Enrollment expanded to include a
family clinic in Warner– December 2010: Enrollment expanded to include
DHMC Lebanon
To date we have enrolled 321 subjects,
70-80% response rate
The New Hampshire
Birth Cohort Study
Learning how the environment affects the health of your baby
10
Status of Sample Collection
263
154Maternal: 146(PN) 162 (PP)
Infant:145
277
Cord blood: 203Meconium: 148Placenta: 151
309
302
The New Hampshire
Birth Cohort Study
Learning how the environment affects the health of your baby
MMA:InAs DMA:MMA0
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Pregnant women more efficient metabolizers than non-pregnant women
Non-pregnant Women (N=279)
Pregnant Women (N=201)
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1st Step
2nd Step
The New Hampshire
Birth Cohort Study
Learning how the environment affects the health of your baby
As III
As V
Total I
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DMA V
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Lower arsenobetainein Pregnant and Non-pregnant Women
Non-pregnant Women (N=279)Pregnant Women (N=201)
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The New Hampshire
Birth Cohort Study
Learning how the environment affects the health of your baby
The New Hampshire
Birth Cohort Study
Learning how the environment affects the health of your baby
Emily Baker, DHMCJudy Rees, DMSRebecca Troisi, NCI, DMSSusan Korrick, HarvardKarl Kelsey, BrownVictoria Flanagan, DHMCVicki Sayarath, DMSJennifer Egner, DMSCaitie Dayman, DMSStephanie Jackson, DMSNadia Gorman, DMSTom Caldwell, DMSDiane Gilbert –Sullivan (postdoc)Elizabeth Kamai (presidential scholar)
Ongoing Project 4 Collaborative Work:Angeline Andrew, DMSJason Moore, DMSBrian Jackson, DMSScot Zens, DMSGeorge Li, DMSCarmen Marsit, Brown, Jay Gandolfii and others
Dartmouth Superfund Cores, and ProjectsObstetricians throughout the State