1. Program on Reproductive Health and the Environment Moving into the Future: New Science and Decision Making Tracey J Woodruff, PhD, MPH Associate Professor, Director Program on Reproductive Health and the Environment University of California, San Francisco

2. Program on Reproductive Health and the Environment The Effect Of Biological Susceptibility And Co-exposure To Other Chemicals On The Relationship Between Individual Chemical Exposure And Adverse Health Outcomes. Woodruff T J et al. Health Aff 2011;30:957-967 ©2011 by Project HOPE - The People-to-People Health Foundation, Inc. No co-exposures or susceptibility Co-exposures and susceptibility Co-exposures, no susceptibility Susceptibility from life stage, genetics, health disease status

3. Program on Reproductive Health and the Environment Adverse Effect (USEPA) A biochemical change, functional impairment, or pathologic lesion that affects the performance of the whole organism, or reduces an organism's ability to respond to an additional environmental challenge

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5. Program on Reproductive Health and the Environment Percent of Pregnant Women with Chemicals in their Body 5 Zero 100 % BANNED BPA 43 Chemicals found in Virtually Every Pregnant Woman in the US

6. Program on Reproductive Health and the Environment And that’s not all………

7. Program on Reproductive Health and the Environment And these chemicals pass to the fetus Found in Cord Blood – Metals Lead, mercury, cadmium – Perfluorinated compounds – Polybrominated diphenyl ethers (PBDEs) – Polychlorinated biphenyls (PCBs) – Organochlorine pesticides DDE, Hexachlorobenzene 7

8. Program on Reproductive Health and the Environment Populations at risk About 1/3 U.S. women have low iodine intake – Iodine necessary to make thyroid hormones ~ 7% of U.S. adults report thyroid disease or take thyroid medication Pregnancy a time of increased demand on thyroid

9. Program on Reproductive Health and the Environment Harris KB, Pass KA. 2007. Mol Genet Metab 91(3):2268-77. Woodruff EHP 2008 Increase in Newborn thyroid disease

10. Program on Reproductive Health and the Environment 10 Current approach to assessing chemical risk For Cancer For NonCancer Assume risk at every exposure, Whether it is small (1 in a billion) or large (1 in a 100) Assume there is a “safe” level

11. Program on Reproductive Health and the Environment 11 Upgrade - use same approach for cancer and noncancer Assume risk at every exposure, Whether it is small (1 in a billion) or large (1 in a 100) “Develop or select conceptual model: From linear conceptual models unless data sufficient to reject low-dose linearity From nonlinear conceptual models otherwise” (page 144 NAS Science and Decisions, Figure 5-8)

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13. Program on Reproductive Health and the Environment 13 Program on Reproductive Health and the Environment Mission To create a healthier environment for human reproduction and development by advancing scientific inquiry, clinical care, and health policies that prevent exposures to harmful chemicals in our environment Jackie Schwartz Jason Harless Ami Zota Tracey Woodruff (director) Patrice Sutton Joanne Perron Carrie Dickenson Linda Giudice (chair Ob/Gyn and founder)

14. Program on Reproductive Health and the Environment Low Doses Matters Flame RetardantMedian Cord Blood in NYC (ng/g lipid) Median Level US Pregnant Women (ng/g lipid) PBDE-471124 PBDE-9935 PBDE-10017 Herbstman 2010 EHP

15. Program on Reproductive Health and the Environment Low Doses Matters Children with higher concentrations of BDEs 47, 99, or 100 scored lower on tests of mental and physical development Herbstman 2010 EHP