(NOTE: Goals, Agenda and list of Workshop participants are available at
http://publichealth.sdsu.edu/mfewg/ under the May 13 Workshop Link)
Minutes: May 13th, 2005/ 13 de Mayo del 2005
‘BINATIONAL WORKSHOP ON TRACKING ENVIRONMENTAL EXPOSURES
AND BIRTH DEFECTS AT THE CALIFORNIA -BAJA CALIFORNIA BORDER’
‘TALLER BINACIONAL SOBRE LA DETECCION DE EXPOSICIONES
AMBIENTALES Y DEFECTOS DE NACIMIENTO EN LA FRONTERA DE
CALIFORNIA – BAJA CALIFORNIA’
Heritage of the Americas Museum
El Cajon, California
Organizers:
PJE (Jenny) Quintana, PhD, MPH Associate Professor, Environmental Health,
Graduate School of Public Health, San Diego State University
email jquintan@mail.sdsu.edu
Web: http://publichealth.sdsu.edu/facultydetail.php?ID=106
Teresa Dodd- Butera, MPH, DABAT Adjunct Professor of Toxicology, Graduate
School of Public Health, San Diego State University
Sponsors:
Sponsored by the Graduate School of Public Health at San Diego State University
http://publichealth.sdsu.edu/ and the California Environmental Health Tracking Network
http://www.catracking.com/ . This project is supported in part by funding from the
Centers for Disease Control and Prevention (CDC). Its contents are solely the
responsibility of the authors and do not necessarily represent the official views of CDC.
Minutes:
Morning Session (presentations and discussion):
The day began with ‘Welcome, challenges and opportunities’ from Dr. Joe Mulinare,
MD, MSPH, Medical Epidemiologist, National Center on Birth Defects &
Developmental Disabilities, CDC, Atlanta, GA who went over some success stories in
prevention of birth defects, namely the use of folic acid in the prevention of neural tube
defects (NTDs). He pointed out that even in the case of NTDs many causes not yet
identified, and are likely environmental. He urged the study of links between the
environment and adverse birth outcomes, to encompass surveillance, outreach and
education.
Ambient air pollution and adverse reproductive outcomes.
Dr. Michelle Wilhelm, PhD Adjunct Professor of Epidemiology, UCLA School of Public
Health gave an informative presentation on recent studies from her group on ambient air
pollution and adverse reproductive outcomes, which gave examples of data linkages and
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how the link between environmental exposures and birth defects can be made. She
highlighted the air pollutants carbon monoxide (effects on low birth weight and preterm
birth, heart defects) and ozone (effects on heart defects). Exposure to traffic was also
associated with an increased risk of preterm births and low birth weight. (This
Powerpoint presentation available on website for download
http://publichealth.sdsu.edu/mfewg/binational-presentations.php)*
Epidemiological Transition and Needs for Action: the Mexican Experience
Osvaldo M. Mutchinick, MD, PhD Director, WHO/PAHO Collaborating Centre for
Community Genetic Services Professor of Medical Genetics and Chief, Department of
Genetics National Institute of Medical Sciences and Nutrition, Mexico DF. Dr Mutchnick
gave a presentation on birth defects, etiology and rates in Mexico, and steps in
developing a plan of action. (This Powerpoint presentation available on website for
download http://publichealth.sdsu.edu/mfewg/binational-presentations.php)*
Adverse reproductive outcomes surveillance and outreach at the border
Dra. Martha Ramirez-Zetina Epidemiologist, Instituto Mexicano de Seguro Social,
Tijuana Dra Ramirez-Zetina gave a presentation on an example of a collaborative study
taking place in the border region, a study of low birth weight and occupation in IMSS in
collaboration with CTIS. She also discussed difficulties in studying adverse birth
outcomes and suggestions for proceeding.
Kenneth L. Jones, MD Chief, Division of Dysmorphology/Teratology, Department of
Pediatrics, UCSD and Medical Director of CTIS Pregnancy Risk Information Line
discussed activities California Teratogen Information Service and the San Diego Birth
Defects Surveillance Program and offered suggestions for outreach in Hispanic
populations, especially by extending the Pregnancy Risk Information idea to Tijuana and
providing training for a medical specialist in dysmorphology to be a resource for the Baja
California region. (This Powerpoint presentation available on website for download
http://publichealth.sdsu.edu/mfewg/binational-presentations.php)*
San Diego County Department of Environmental Health GIS and other data
Steve Durham, REHS Department of Environmental Health San Diego County
presented an example of the power of GIS mapping of environmental data. He presented
some examples of data being collected in San Diego, and the use of spatial clustering to
assess risks. (This Powerpoint presentation available on website for download
http://publichealth.sdsu.edu/mfewg/binational-presentations.php)*
Comments arising from Morning Presentations:
-Q. Should pediatricians tell pregnant women to avoid air pollution?
-Some outdoor contaminants may be avoided by staying indoors (such as ozone) while
others penetrate inside the home (PM 2.5)
-Q.What birth defect data was being collected at the border as opposed to in Mexico
City?
-Proposal for a Cross Border Pregnancy Risk Information Line, extending the service to
Tijuana.
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-Ultrafine particles – (may have unique data from border monitoring, SCERP
consortium)
-Traffic data very good in San Diego County
Afternoon session I:
Recommendations, needs and gaps Discussion (all participants):
MODERATORS: Christina Chambers, PhD, MPH,Assistant Professor in
ResidenceDepartments of Pediatrics and Family and Preventive MedicineProgram
Director, California Pregnancy Risk Information LineUniversity of California, San
Diego Maria Mercedes Sierra, QBP Departamento de Microbiología, Facultad de
Medicina Universidad Autonoma de Baja California, Tijuana B.C.
Gaps:
Birth defects registry in some hospitals in Mexico
Gap: not in border hospitals
Birth outcomes, weight, etc. available but not systematically summarized
Training needed for medical staff
Birth defects registry in San Diego area – not all areas, passive only for California Birth
Defects Monitoring Program, only for certain defects/hospitals for Sloan program
Accurate exposure assessment during the pregnancy, (especially during the window of
time important for each birth defect or adverse outcome)
-Knowledge of relationship of ambient environmental measurements to personal
exposures (for example, how well do central site air pollution levels reflect actual
maternal exposures to air pollution)
-knowledge of surrogate exposure markers during each trimester of the pregnancy
(for example maternal zip code at first trimester)
-no biological monitoring
Needs:
-Multidisciplinary team necessary to effectively address our concerns/commitment
-Leadership both sides of border need to become sensitive to issue
Recommendations:
1. extend Pregnancy Risk Information Line/ Teratogen Registry (CTIS,
http://ctispregnancy.org/) to Tijuana–could be hospital-based at first – a phone line or
internet –based service may not be as effective as face-to face service
2. Practical plan - training of medical students to follow protocol in Tijuana
-explore other sources of notification, referral (for example, a maternal
questionnaire at the follow-up pediatric visit for child with birth defect)
3. Collection of data useful to link environmental exposures and birth defects on a routine
basis in chart or by abstractor
For example:
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Zip code of residence by trimester of pregnancy
Zip code of place of employment
Commuting history
Occupation and exposures
4. Exposure Assessment on personal level, rather than a group level
Biological monitoring (Powerpoint Presentation on Biological Monitoring by Dr,
Quintana available on website for download
http://publichealth.sdsu.edu/mfewg/binational-presentations.php)*
Validation of Ambient measures by relating ambient exposures to personal
exposures
5. Address behaviors related to exposures
6. Adverse reproductive outcomes such as prematurity and low birth weight are a
priority, as well as birth defects
7. Apply ‘precautionary principle’ to substances known to cause harm – limit exposure
before studies performed through education
8. Rather than focus on all birth defects/ adverse reproductive outcomes on the border in
the beginning, pick the ‘top six’ to start
Afternoon session II:
Priority areas for San Diego and Tijuana Discussion (all participants):
MODERATORS: PJE Jenny Quintana, PhD, MPH Associate Professor,
Environmental Health, Graduate School of Public Health, San Diego State University
Dra.Maura Patricia Garcia, Medico Cirujano, Centro de Estudios Universitarios
Xochicalco
Priority Areas San Diego/Tijuana
Priority Populations
1. Maquiladora workers (especially to solvents)
(workers see physician before employment, may be possibility for intervention or
study, workers feel that such investigations are a very sensitive issue)
2. Farm workers (especially to pesticides)
3. Traffic proximity - exposures of women in neighborhoods with high traffic and/or
many diesel trucks (exposure to air priority pollutants, air toxics)
Priority Pollutants
Traffic exposures
During driving
At residence in areas with high diesel traffic
Diesel exhaust
CO
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Air pollution
Ozone
Particulate matter
Ultrafine particles – (may have unique data from border monitoring)
Pesticides
Metals, especially lead
Solvents
Smoking and second hand smoke
Interaction of exposures with genetic susceptibility and nutritional status
Working Group, interest and Mission statement Teresa Dodd- Butera, MPH,
DABAT Adjunct Professor of Toxicology, Graduate School of Public Health, San Diego
State University. Participants were invited to join a Working Group called the MaternalFetal Environment Working Group to continue collaboration (join at
http://publichealth.sdsu.edu/mfewg/).
Reminders to participants at close of workshop:
-Request for everyone to e-mail funding sources that could be posted on website:
(March of Dimes representative announced that funding was available, especially for
issues of prematurity, other sources posted)
-Request to check resources in binder and email suggestions of additional resources to be
included on the website
(*download Powerpoint presentations at: http://publichealth.sdsu.edu/mfewg/binationalpresentations.php).
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