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.

7

Pregnancy Cohort

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

Urinary Arsenic Metabolism

As3 a As5 a MA a DMA

The New Hampshire

Birth Cohort Study

Learning how the environment affects the health of your baby

MMA:InAs DMA:MMA0

2

4

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12

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

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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