Grantee Research Project Results
2003 Progress Report: Markers of Individual Susceptibility and Outcome Related to Fetal and Infant Growth and Development
EPA Grant Number: R830827Title: Markers of Individual Susceptibility and Outcome Related to Fetal and Infant Growth and Development
Investigators: Berkowitz, Gertrud S. , Wetmur, James G. , Canfield, Richard L , Wolff, Mary S. , Yehuda, Rachel
Current Investigators: Wolff, Mary S. , Wetmur, James G. , Canfield, Richard L , Engel, Stephanie M. , Berkowitz, Gertrud S. , Yehuda, Rachel
Institution: Mount Sinai School of Medicine
EPA Project Officer: Aja, Hayley
Project Period: August 1, 2002 through July 31, 2005 (Extended to July 31, 2006)
Project Period Covered by this Report: August 1, 2002 through July 31, 2003
Project Amount: $748,512
RFA: Biomarkers for the Assessment of Exposure and Toxicity in Children (2002) RFA Text | Recipients Lists
Research Category: Children's Health , Human Health
Objective:
The fire and collapse of the World Trade Center (WTC) was the largest acute environmental disaster that has befallen New York City. The objective of this research project is to establish a prospective epidemiologic study of 187 women who were pregnant and within or near the WTC on or about 9/11 to evaluate whether exposures to the resulting toxicants or the associated stress were related to impaired fetal growth or other adverse pregnancy outcomes.
Progress Summary:
Of the 187 women, 3 miscarried and 2 were lost to followup, leaving 182 for the analysis. Eligibility criteria were pregnancy on September 11, and presence in one of five "exposure" zones near the WTC at 9:00 a.m. that day or within the 2 succeeding weeks. This represents a group of women with acute and potentially high-level exposures to toxic air pollutants from the fire and explosions. Some of these women returned to lower Manhattan either to their residences or places of employment, or both, during their pregnancies, possibly incurring additional risk as a result of the continuing air pollution. Others remained outside the affected area for the duration of their pregnancies. Because there exists no WTC registry of pregnant women, it is not possible to estimate the total number of potential subjects.
The baseline assessments have been completed on the 187 women. An integral component of this project was the creation of a specimen bank for assessment of biological markers of exposure and for genotyping of selected polymorphisms. Maternal blood and urine were obtained, as well as a sample of breast milk, if available, at the time of the baseline visit. The participants also have completed six established instruments to determine levels of stress, anxiety, Post-Traumatic Stress Disorder (PTSD), and depression.
We also have completed followup assessments on 159 infants when they were 9 months old. This assessment included questionnaires, infant buccal cells for genotyping, and administration of two neurodevelopmental assessments. Saliva was obtained for cortisol analysis from both the mothers and children after they came in for the 9-month followup assessment. We are interested particularly in comparing the cortisol levels between those with and without probable PTSD, as well as the correlation between maternal and infant cortisol levels.
We also have undertaken reconstructive exposure analysis based on detailed questionnaire data on the location of each participant during the first month after 9/11. In collaboration with Drs. Paul Lioy and Panos Georgopoulos of The Environmental and Occupational Health Sciences Institute of the University of Medicine and Dentistry of New Jersey, plume reconstruction has been undertaken to determine exposure intensity levels for each participant.
Information on pregnancy outcome was obtained both from the mothers and by abstraction of medical records. As a comparison group, we utilized all private patients who delivered at Mount Sinai Medical Center on the Upper East Side of Manhattan during the same time period, and who were not known to have been in lower Manhattan on 9/11 (n = 2,367). No significant differences were found between the groups for mean gestational age (39.1 weeks in the WTC cohort vs. 39.0 weeks in the Mount Sinai cohort, P = 0.55), or mean birthweight (3,203 g vs. 3,267 g, P = 0.17). There were no significant differences in frequency of preterm births (< 37 weeks of gestation) or incidence of low birth weight.
The WTC cohort had a twofold-increased risk of small-for-gestational age (SGA) infants compared to the Mount Sinai cohort, even after controlling for relevant covariates. Potential confounders such as marital status, education, prepregnancy weight, and pregnancy-induced hypertension were not statistically significant. No significant difference in the frequency of SGA was observed according to the trimester of exposure to 9/11. No association was evident in the WTC cohort between probable PTSD and either preterm birth, low birth weight, or SGA.
SGA is a potential marker for intrauterine growth restriction (IUGR). Previous studies have found associations between particulate air pollution and IUGR. Other investigations have linked air pollution to preterm births. Prenatal exposure to cigarette smoke, which contains polycyclic aromatic hydrocarbons (PAHs) among other toxins, is a well-established risk factor for SGA. Thus, it is possible that prenatal exposures to particulates as well as to PAH impair intrauterine growth. Our observation of an apparent association between maternal exposure to the WTC disaster and SGA infants suggests that this event had a detrimental impact on exposed pregnancies. The long-term effects of these exposures on infant development are unknown, and will be evaluated during continuing prospective followup.
Future Activities:
We currently have begun the 2-year followup evaluations of the infants, which include assessment of childhood growth, the Bayley Scales of Infant Development, a brief followup questionnaire, and the Home Inventory (which assesses the quality of the home environment and parent/child interaction). We also are collecting infant urine at this visit. We plan to follow the infants to age 3 with the same assessments.
A control group of 9-month-old infants currently is being recruited with support from the National Institute of Environmental Health Sciences. The control group is being recruited from two private pediatric groups near Mount Sinai Medical Center. The sociodemographic characteristics of the mothers of these infants appear to be similar to those of the WTC mothers. The same questionnaires, stress instruments, growth assessments, and neurodevelopment tests are administered.
During the coming year, we plan to finalize the analysis of the stress data, the exposure data, pregnancy and newborn complications, the postnatal growth measures, and the neurodevelopmental assessments at 9 months. We also will prepare manuscripts as the data become available.
Journal Articles on this Report : 1 Displayed | Download in RIS Format
Other project views: | All 27 publications | 6 publications in selected types | All 6 journal articles |
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Type | Citation | ||
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Berkowitz GS, Wolff MS, Janevic TM, Holzman IR, Yehuda R, Landrigan PJ. The World Trade Center disaster and intrauterine growth restriction. Journal of the American Medical Association 2003;290(5):595-596. |
R830827 (2003) R830827 (2004) R830827 (Final) |
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Supplemental Keywords:
air, plume, exposure, risk, effects, metabolism, infants, children, age, polymorphisms, toxicants, particulates, volatile organic compound, VOC, polycyclic aromatic hydrocarbon, PAH, halogenated aromatic hydrocarbons, HAHs, lead, cadmium, mercury, cotinine, psychological, epidemiology, genetics, New York, NY, New Jersey, NJ, toxics, infant growth, infant neurodevelopment, genetic polymorphisms, disasters, in utero, P450, genetic susceptibility, adolescence, air pollution, airway disease, exposure assessment, biomarker, childhood respiratory disease, children's environmental health, children's vulnerability, endocrine disrupting chemicals, environmental triggers, epidemiology, genetic predisposition, growth and development, harmful environmental agents, health effects, human exposure, human health risk, human susceptibility, pregnant women, in utero exposure, World Trade Center, WTC, 9/11., RFA, Health, Scientific Discipline, ENVIRONMENTAL MANAGEMENT, Environmental Chemistry, Health Risk Assessment, Susceptibility/Sensitive Population/Genetic Susceptibility, Risk Assessments, Biochemistry, genetic susceptability, Children's Health, Risk Assessment, environmental triggers, health effects, adolescence, infants, exposure, genetic predisposition, airway disease, endocrine disrupting chemicals, air pollution, children, Human Health Risk Assessment, assessment of exposure, growth and development, childhood respiratory disease, children's vulnerablity, stress, human exposure, children's environmental health, human susceptibility, harmful environmental agents, biomarkerRelevant Websites:
http://www.mssm.edu/cpm/wtc_pregnant/ Exit
Progress and Final Reports:
Original AbstractThe perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Conclusions drawn by the principal investigators have not been reviewed by the Agency.