4E: Create a Birth Outcomes “Early Warning System”

Beginning three decades ago, growing concerns over the reproductive health impacts of pesticide exposure led to targeted studies at rural birth centers and hospitals.

Some three decades ago, concern over the reproductive health risks of 2,4-D and dicamba herbicides, and other pesticides, led to a series of government-funded birth center studies.

Important findings and insights emerged from this body of work that provides a foundation for scientists tasked with confronting today’s challenges.

A coordinated set of studies is again needed at rural hospitals and birth centers that would collectively comprise an early warning system to detect changes in the frequency and severity of adverse birth outcomes among women living in intensively farmed areas.

While all women are periodically exposed to herbicides via drinking water and/or food, women in rural areas incur additional exposures that often result in at least 10-fold higher levels in their urine during, or soon after the herbicide spray season (Acquavella et al., 2004; Garry et al., 2002a).

Exposure to recently applied herbicides is the most plausible explanation for the substantial difference in herbicide biomonitoring levels in women living on or near farms, compared to those in cities or suburbs.

Rural birth centers should be provided resources and technical support in order to:

  • Collect additional health, lifestyle, and home environment data during pre-natal visits and the perinatal period (gestation day 154 through 7 days after birth);
  • Take and store blood (monocytes)/buccal swabs, and/or urine samples from pregnant women in the first half of pregnancy, for testing in the event complications arise with the health of the child or mother; and
  • Gather additional information on possible herbicide exposures in and around the home, especially in cases where an ultrasound or other procedure points to a high risk of a difficult birth or post-birth complications.

Develop and deploy new tools to detect herbicide-adverse birth outcome linkages.

The ability to link or access all official birth and medical records over a person’s life is not part of the US health care system, as now the case in most European countries.

Given the multigenerational consequences of some chemical exposures, better ways must be found to integrate health records (obstetrical records, birth certificates, adult health records, death certificates) with measures of well being and achievement (academic achievement, IQ, criminal and social services records).

Failure to link vital health and well being data across a person’s life span is clearly holding back progress in identifying and ranking risk factors for chronic disease, and is one of the most egregious shortcomings in our current public health system.

Medical records, such as this famous birth certificate, can provide important insight into the impacts of pesticide exposure.

Protocols need to be developed and disseminated for additional diagnostic testing and blood work during pregnancy, as well as at birth (what to look for, analytical methods, data reporting specifications).  Likewise, protocols are needed for environmental sample collection and testing.

USDA data on herbicide use by crop and state should be used to identify significant changes in herbicide use intensity, in order to help scientists chose which herbicides to monitor in urine and blood, and environmental sampling.

Refined exposure estimates dependent on biomonitoring data, coupled with more sophisticated use of regional pesticide use data, will markedly improve the statistical power of epidemiological studies.

Past research needs to be summarized and integrated into a system designed to identify regionally significant, possibly high-risk herbicide uses.

Such data needs to be disseminated through multiple channels. A targeted effort is warranted to reach health-care professionals that interact with patients and play a role in either the delivery of information to patients, or the collection of information from patients.

Some of the epigenetic and endocrine-system effects following prenatal herbicide exposures are not evident at birth. For this reason, it will be important to query mothers who give birth to a child with a recognized birth defect about how older siblings are doing.

Much more effort is also needed to collect information on children as they grow up and start to have their own children, in order for the nation to have a realistic chance of documenting, and eventually understanding transgenerational effects.

Last, government agencies need to develop a coordinated strategy to track the levels of widely used herbicides in human blood and urine. In recent years, the CDC has monitored levels of 2,4-D and 17 sulfonyl urea herbicides in human urine (CDC, 2013 and 2015), but has not measured levels of any herbicide that falls within the three most widely used herbicide families of chemistry – glycines (glyphosate), traizines (atrazine), and acetanilides (acetochlor, s-metalochlor).

To truly understand the complex impacts of pesticide exposure, we need to track the health of parents, newborns, developing children, and the babies these kids go on to have as adults.

Because of the complexity of the science, and time required for EPA to propose and complete regulatory restrictions, it is common for farmers and industry to move onto “new generation” technology years before the consequences of the previous generation of technology is rigorously assessed.

This pattern may well repeat itself as herbicide use intensifies in the Midwest.

For these reasons, federal and state public health and research agencies will need to provide additional funding to support data compilation and research in rural birth centers and hospitals, state agencies, and the CDC, so that trends in specific reproductive outcomes can be more accurately monitored and more quickly linked to risk factors.

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