1. Reproductive Effects of Pesticide Exposure Pesticide Health Effects Medical Education Database (PHEMED)

2. Reproductive Impact Menstrual Cycles Menstrual Cycles Birth defects Birth defects Time to pregnancy Time to pregnancy Small for Age at Birth Small for Age at Birth Miscarriages Miscarriages

3. Women using pesticides have 1.5 x increased odds of * Women using pesticides have 1.5 x increased odds of * Longer cycles Longer cycles Missing a period Missing a period Hormonally active pesticides increase odds of missed periods, long cycles, bleeding mid cycle. Hormonally active pesticides increase odds of missed periods, long cycles, bleeding mid cycle. Lindane Lindane Atrazine Atrazine Mancozeb or Maneb Mancozeb or Maneb Source: Farr SL, Cooper GS, Cai J, Savitz DA, Sandler DP. Pesticide use and menstrual cycle characteristics among premenopausal women in the Agricultural Health Study. (2004). American Journal of Epidemiology, 160(12):1194-204. Menstrual Cycle Changes

4. Birth Defects: Study Design Issues Indirect exposure measurements without biomarkers: Indirect exposure measurements without biomarkers: Work records Work records Places of residence Places of residence Databases Databases Questionnaires Questionnaires Only cases that survive birth are counted (miscarried fetuses?) Only cases that survive birth are counted (miscarried fetuses?)

5. Congenital Anomalies Consistent findings with Consistent findings with Limb reductions - Uro-genital defects Limb reductions - Uro-genital defects Central nervous system Central nervous system Cleft palates/lips: marginal significant w/maternal exposure Cleft palates/lips: marginal significant w/maternal exposure Eye – heart defects Eye – heart defects Not definitive until better exposure analysis with the US Children’s Health Study Not definitive until better exposure analysis with the US Children’s Health Study Source: Sanborn M, Cole D, Kerr K, Vakil C, Sanin LH, Bassil K. Pesticides Literature Review. Ontario College of Family Physicians. Toronto 2004.

6. Time to Pregnancy Studies suggest that occupational exposure increase time needed to become pregnant Studies suggest that occupational exposure increase time needed to become pregnant 20%  in women engaged in pesticide activities + husband also engaged in same– but imprecise due to small numbers 20%  in women engaged in pesticide activities + husband also engaged in same– but imprecise due to small numbers Associated with dicamba, glyphosate, 2,4-D, thiocarbamates, OP’s although not statistically significant Associated with dicamba, glyphosate, 2,4-D, thiocarbamates, OP’s although not statistically significant Source: Curtis KM, Savitz DA, Weinberg CR, Arbuckle TE. The effect of pesticide exposure on time to pregnancy. Epidemiology. 1999 Mar;10(2):112-7.

7. Probable link Probable link Fetal and maternal blood samples for OP by-products and newborn lengths Fetal and maternal blood samples for OP by-products and newborn lengths Chlorpyrifos and diazinon [by-products measured in fetal and maternal blood] associated to lower birth weight and length* Chlorpyrifos and diazinon [by-products measured in fetal and maternal blood] associated to lower birth weight and length* Small for Age at Birth * Whyatt RM et al. Biomarkers in assessing residential insecticide exposures during pregnancy and effects on fetal growth.Tox Applied Pharm 206 (2): 246-254 AUG 7 2005

8. Spontaneous Abortions Spontaneous Abortions Studies suggest an association Studies suggest an association Critical exposure windows and certain pesticides Critical exposure windows and certain pesticides One - four months before conception One - four months before conception Non use of PPE increased risk 5 fold in one study Non use of PPE increased risk 5 fold in one study Study method problems Study method problems No data on miscarriage rates in general population No data on miscarriage rates in general population High % go undetected High % go undetected ?? Role of other farm toxins (animal viruses, heavy metals) largely unknown in studies ?? Role of other farm toxins (animal viruses, heavy metals) largely unknown in studies Sources: Arbuckle et al 1999 and 2001; Garry VF et al 2002

9. Low Sperm Count Characteristic of Characteristic of Dibromochloropropane (DBCP) nematocide exposure Occurs with exposure to kepone