Impact of Maternal Occupation in the Ecuadorian Flower Industry on Child Development Signature Program for Child Health Research 3x5x5 Presentation 24 February 2010 Alexis J. Handal, Ph.D., M.P.H. Assistant Professor MPH Program Department of Family & Community Medicine

The Cut-Flower Industry in Ecuador Most important export following petroleum, bananas, shrimp Most important export following petroleum, bananas, shrimp $523.8 million between January & November 2008 $523.8 million between January & November 2008 Use of pesticides common Use of pesticides common Organophosphates (OP), carbamates, dithiocarbamates, pyrethroids Organophosphates (OP), carbamates, dithiocarbamates, pyrethroids ~50% workers are women of reproductive age ~50% workers are women of reproductive age typically, work through most of the pregnancy typically, work through most of the pregnancy OPs, carbamates pass readily across placenta OPs, carbamates pass readily across placenta pregnancy-related physiologic changes (dermal, renal, pulmonary) pregnancy-related physiologic changes (dermal, renal, pulmonary)

Review of the Literature Focused mainly on adverse neurobehavioral effects from exposure to PCBs, organic solvents, lead, methylmercury, organochlorine pesticides Focused mainly on adverse neurobehavioral effects from exposure to PCBs, organic solvents, lead, methylmercury, organochlorine pesticides Non-persistent pesticides have become a widely used alternative to OC pesticides Non-persistent pesticides have become a widely used alternative to OC pesticides do not accumulate in the body and are excreted within days via water-soluble metabolites in urine do not accumulate in the body and are excreted within days via water-soluble metabolites in urine they are acutely toxic they are acutely toxic Little research on effects of prenatal OP, carbamate exposure on NB development Little research on effects of prenatal OP, carbamate exposure on NB development Eskenazi (2007), Young (2005), Engle (2007), Grandjean (2006) Eskenazi (2007), Young (2005), Engle (2007), Grandjean (2006)

Preliminary Research In 2003, we conducted a preliminary investigation into the relationship between potential pesticide exposure and NB development in children ages 3 to 61 months residing in several communities in a flower-growing region of Ecuador In 2003, we conducted a preliminary investigation into the relationship between potential pesticide exposure and NB development in children ages 3 to 61 months residing in several communities in a flower-growing region of Ecuador Successfully recruited and enrolled 219 mothers with 283 young children living in three communities (over 90% participation) Successfully recruited and enrolled 219 mothers with 283 young children living in three communities (over 90% participation) Outcome measures: ASQ-II, specific hypothesis-based tests of prehension (motor tests), visual acuity, VMI Outcome measures: ASQ-II, specific hypothesis-based tests of prehension (motor tests), visual acuity, VMI Exposure measures: work-related, community- and residence-related variables Exposure measures: work-related, community- and residence-related variables

Preliminary Research Significant differences in developmental skills by community (Handal, et al., EHP 2007) Significant differences in developmental skills by community (Handal, et al., EHP 2007) High exposure communities worse scores overall despite displaying higher SES, higher maternal education, more maternal stimulation, and fewer cases of anemia High exposure communities worse scores overall despite displaying higher SES, higher maternal education, more maternal stimulation, and fewer cases of anemia Clearer relationship between prenatal exposure & infant development (Handal, et al., Epidemiology 2008) Clearer relationship between prenatal exposure & infant development (Handal, et al., Epidemiology 2008) Employment in flower industry during pregnancy was significantly associated with worse visual acuity, fine motor scores in infants Employment in flower industry during pregnancy was significantly associated with worse visual acuity, fine motor scores in infants Main limitations Main limitations Proxy exposure measures Proxy exposure measures Not able to distinguish between effect of pesticides and effect of other work conditions Not able to distinguish between effect of pesticides and effect of other work conditions Lacking specific measures of maternal stress and maternal-infant interaction and stimulation Lacking specific measures of maternal stress and maternal-infant interaction and stimulation

Next Steps NIH grant: characterize and quantify pesticide exposure levels and evaluate other work practices that might impact development of infants of women working in the flower industry NIH grant: characterize and quantify pesticide exposure levels and evaluate other work practices that might impact development of infants of women working in the flower industry Evaluate the feasibility of a set of developmental and maternal stress assessment tools for use in this culturally, linguistically, and economically distinct population Evaluate the feasibility of a set of developmental and maternal stress assessment tools for use in this culturally, linguistically, and economically distinct population Other research goals: Other research goals: Clinical validation of the screening tool in our population Clinical validation of the screening tool in our population Interdisciplinary research team Interdisciplinary research team Casa Campesina Cayambe (Community Partner) Casa Campesina Cayambe (Community Partner) University of Michigan, Emory University, University of Washington, Universidad San Francisco de Quito, University of New Mexico University of Michigan, Emory University, University of Washington, Universidad San Francisco de Quito, University of New Mexico

¡Gracias!