1. Margaret R. Karagas, PhD Arsenic Epidemiology Carolyn Murray, MD, MPH Research Translation

2. Outline In utero/early life exposure as a vulnerable window for arsenic-induced health effects Potential sources of arsenic exposure during this vulnerable window Emerging epidemiologic evidence on health impacts

3. In utero/early life exposures and disease risk Smith et al., 2006

4. Pregnancy Delivery Months 4-8Year 1-5 3 day diary of water, fish/seafood and rice intake Feeding, infections, allergies & other health outcomes New Hampshire Pregnancy Cohort Private well users 1,000+ mother- infant pairs 75% response rate 100% urinary As Private well users 1,000+ mother- infant pairs 75% response rate 100% urinary As

5. Pregnancy/In Utero Infancy Childhood Vulnerable Windows of Exposure ½ cup of rice/day = 1 liter of 10 ug/L As water

6. Emerging Findings on Infection and Immunity …parallel those from Bangladesh Rahman et al., 2011 Epidemiologic data:  risk of infections requiring a doctor’s visit or prescription medicine; e.g., lower respiratory infections, diarrhea Farzan et al., 2013; under review Supportive Mechanistic evidence: Altered cord lymphocyte profiles Nadeau et al., 2014 Epigenetic changes in cord blood Koestler et al., 2013 Variation in placental gene expression Nadeau et al., 2014; Fei et al., 2013

7. Risk Communication Challenges Stakeholder concerns –Pediatric health care providers –Parents –Birth Cohort Participants Confusing and conflicting messaging –“organic” brown rice syrup –“healthy snacks”

8. Risk Communication Challenges Challenge of balancing message when: consumer/parent can’t reliably estimate exposure from rice/rice products Clinicians uncertain how to counsel patients Concern about unintended nutritional consequences (ex. Fish in pregnancy) Conflicting messages heighten risk perception