1. The New Hampshire Birth Cohort Study Learning how the environment affects the health of your baby Project 4: Arsenic Epidemiology, Biomarkers & Exposure Assessment in New Hampshire

2. Arsenic passes through the placenta Among Andean women exposed to 200 mg/L of arsenic in drinking water –median arsenic levels in maternal blood (11 mg/L) were nearly as high in infant cord blood (9 mg/L) –Concentrations of arsenic in placental tissue also elevated. Concha et al, 1998

3. Arsenic – Fetal/Infant Effects In utero/early life exposure to arsenic via drinking water contamination, observed to increase risk of: Adverse fetal outcomes: –fetal and neonatal mortality, spontaneous abortion and stillbirths –low birth weight and preterm delivery Decline in childhood intellectual function Cancer risk later in life, in particular liver and lung cancers

4. Arsenic & Birth weight Decreased birth weight < 100  g/L urinary As of 1. 7 g per  g/L Rahman et al., 2009 No data on these outcomes in a US population

5. Dietary Mercury Much of the data pertain to unique study populations (e.g.- those who subsist primarily on whale and seal meat), which are not generalizable to women in the United States. New England has the highest atmospheric levels of mercury in the country and mercury has contaminated pristine lakes and accumulated in local fish populations. Due to increased dietary reliance on fish and shellfish in coastal states, New Hampshire provides an excellent opportunity to assemble a birth cohort where both the effects of arsenic in drinking water and mercury in seafood can be assessed.

6. Specific Aims To test whether in utero arsenic is associated with reduced birth weight, fetal growth and gestational age (i.e., premature births). Whether nutritional or genetic factors modify these associations. To test whether in utero methylmercury exposure influences fetal growth and gestational age. To evaluate the reliability of multiple measures of metal exposure (e.g., drinking water, hair, nails and urine concentrations) in mothers and in mother-infant pairs.

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8. Elevated exposures Birth Cohort Study Area 20% of pregnant women enrolled in our study – tap water exceeds the MCL of 10  g/L As

9. Enrollment Status Enrollments started January 1, 2009 at 3 Concord Clinics –April 2010: Enrollment expanded to include an OB/GYN clinic in Concord – July 2010: Enrollment expanded to include a family clinic in Warner –December 2010: Enrollment expanded to include DHMC Lebanon To date we have enrolled 321 subjects, 70-80% response rate

10. The New Hampshire Birth Cohort Study Learning how the environment affects the health of your baby 10 263 154 Maternal: 146(PN) 162 (PP) Infant:145 277 Cord blood: 203 Meconium: 148 Placenta: 151 309 302

11. Urinary Arsenic Metabolism As3  As5  MA  DMA

12. The New Hampshire Birth Cohort Study Learning how the environment affects the health of your baby 1 st Step 2nd Step

13. The New Hampshire Birth Cohort Study Learning how the environment affects the health of your baby

14. The New Hampshire Birth Cohort Study Learning how the environment affects the health of your baby The New Hampshire Birth Cohort Study Learning how the environment affects the health of your baby Emily Baker, DHMC Judy Rees, DMS Rebecca Troisi, NCI, DMS Susan Korrick, Harvard Karl Kelsey, Brown Victoria Flanagan, DHMC Vicki Sayarath, DMS Jennifer Egner, DMS Caitie Dayman, DMS Stephanie Jackson, DMS Nadia Gorman, DMS Tom Caldwell, DMS Diane Gilbert –Sullivan (postdoc) Elizabeth Kamai (presidential scholar) Ongoing Project 4 Collaborative Work: Angeline Andrew, DMS Jason Moore, DMS Brian Jackson, DMS Scot Zens, DMS George Li, DMS Carmen Marsit, Brown, Jay Gandolfii and others Dartmouth Superfund Cores, and Projects Obstetricians throughout the State