1. Adverse Reproductive Outcomes Surveillance and Outreach at the Border: California Teratogen Information Service and the San Diego Birth Defects Surveillance Program Kenneth Lyons Jones Christina D Chambers Department of Pediatrics Division of Teratology/Dysmorphology University of California, San Diego, School of Medicine La Jolla, California

4. California Teratogen Information Service: Goals To provide a service to pregnant women and their physicians throughout California regarding the effects of various agents on fetal development. To gain new information about the potential teratogenicity of drugs, chemicals, and environmental agents

5. Hispanic Women Registered (%) 1998 - 7.5% (>40% of births in CA to Mexican- American women) 1999 – 11% (hired first Spanish speaking counselor) 2000 – 18% 2002 – 26% (received grant to develop strategies for providing information to pregnant women regarding exposures during pregnancy) 2004 – 26%

6. Future Directions Establish face-to-face, hospital-based teratogen counseling as part of the existing health system that is provided to pregnant women in Tijuana Establishment of telephone-based Teratogen Information Service in Tijuana to provide service to women and their physicians throughout Baja Norte. Acquire fellowship funding to train a Mexican physician in Teratology/Dysmorphology who could then extend our research agenda on the Mexican side of the border.

7. San Diego Birth Defects Surveillance Program Part of Slone Epidemiology Center at Boston University. 4 sites including Boston, Toronto, Philadelphia, and San Diego. Case-control study involving all birthing hospitals in San Diego County. Interviews of cases and controls occur in first 6 months of life and document over-the –counter as well as prescription medications

8. Importance of Birth Defects Surveillance that includes Both Sides of the Border Environmental factors that may affect the incidence of birth defects in San Diego may impact the incidence of birth defects in Tijuana and vice versa

9. Examples Congenital rubella Differences in uptake of folic acid supplementation Alcohol consumption by pregnant women – high in San Diego, but not in Tijuana? Safety regulations re environmental pollution – more stringent in San Diego? Availability of teratogenic drugs over-the-counter in Tijuana, e. g., Ro-accutane Unknown environmental factors that may affect both sides of the border, e.g., air quality.