Ann Aschengrau

Paternal military service in Vietnam and the risk of late adverse pregnancy outcomes.

To investigate the relationship between paternal military service in Vietnam and the risk of late adverse pregnancy outcomes, we conducted a case-control study of women who delivered infants from August 1977 until March 1980 at Boston Hospital for Women. Paternal military service history among 857 congenital anomaly cases, 61 stillbirth cases, and 48 neonatal death cases were compared with that of 998 normal controls. Military service veterans were identified by crossmatching identifying information from obstetric records with state and national military records. After controlling for confounding variables, we found that the Vietnam veterans relative risk of fathering an infant with one or more major malformations was 1.7 (95% CI = 0.8, 3.5) compared to non-Vietnam veterans. The increased risk was present in several organ systems and did not seem to be related to a particular type of defect. No associations or highly unstable associations were found between paternal military service in Vietnam and the occurrence of congenital anomalies overall, minor malformations, normal variants, stillbirths, and neonatal deaths. These findings should be viewed with caution since maternal and delivery characteristics appear to have contributed to the etiology of several of the major malformations among the Vietnam veterans children.

Paternal Military Service in Vietnam and Risk of Spontaneous Abortion

To investigate the relationship between paternal military service in Vietnam and the risk of spontaneous abortion, we compared the military service history among husbands of 201 women having a spontaneous abortion through 27 weeks gestation with that of women having full-term live-born infants at Boston Hospital for Women from July 1976 until February 1978. Paternal military veterans were identified by cross-matching identifying information from obstetric records with state and national military records. Compared with men with no known military service, the adjusted relative odds of spontaneous abortion through 27 weeks gestation was 0.88 for the wives of Vietnam veterans (95% confidence interval, 0.42 to 1.86) and 0.74 (95% confidence interval, 0.46 to 1.17) for wives of non-Vietnam veterans. These data suggest that the risk of spontaneous abortion was not increased in this population of married US Vietnam veterans.

Prenatal Exposure to Endocrine Disruptors: A Developmental Etiology for Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is one of the most common and complex endocrinopathies among reproductive-age women. Polycystic ovary syndrome is characterized by symptomatology of oligomenorrhea and androgen excess, with or without presence of polycystic ovarian morphology. The etiology of PCOS is multifactorial, including genetic and environmental components. It has been previously established that prenatal androgen exposure results in a PCOS phenotype in experimental animal models and epidemiologic human studies. Investigators hypothesize that prenatal exposure to endocrine-disrupting chemicals (EDCs) may contribute to PCOS development. This review examines the emerging research investigating prenatal exposure to 3 major classes of EDCs—bisphenol A (BPA), phthalates, and androgenic EDCs—and the development of PCOS and/or PCOS-related abnormalities in humans and animal models. Highlights of this review are as follows: (1) In rodent studies, maternal BPA exposure alters postnatal development and sexual maturation;, (2) gestational exposure to dibutyl phthalate and di(2-ethylhexyl)phthalate results in polycystic ovaries and a hormonal profile similar to PCOS; and (3) androgenic EDCs, nicotine and 3,4,4’-trichlorocarbanilide, create a hyperandrogenic fetal environment and may pose a potential concern. In summary, prenatal exposure to EDCs may contribute to the altered fetal programming hypothesis and explain the significant variability in severity and presentation.

Childhood Fish Consumption and Learning and Behavioral Disorders

Fish is a major source of nutrients critical for brain development during early life. The importance of childhood fish consumption is supported by several studies reporting associations of n-3 polyunsaturated fatty acid (n-3 PUFA) supplementation with better behavior and school performance. However, fish may have a different effect than n-3 PUFA alone due to the neurotoxic effects of methylmercury, a frequent contaminant. We investigated associations of childhood fish consumption with learning and behavioral disorders in birth cohort study of the neurotoxic effects of early life exposure to solvent-contaminated drinking water. Childhood (age 7–12 years) fish consumption and learning and behavioral problems were reported in self-administered questionnaires (age 23–41 at questionnaire completion). Fish consumption was not meaningfully associated with repeating a grade, tutoring, attending summer school, special class placement, or low educational attainment. However, participants who ate fish several times a week had an elevated odds of Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (odds ratio: 5.2; 95% confidence interval: 1.5–18) compared to participants who did not eat fish. While these findings generally support the safety of the observed level of fish consumption, the absence of a beneficial effect may be attributed to insufficient fish intake or the choice of relatively low n-3 PUFA fish.

Childhood and adolescent fish consumption and adult neuropsychological performance: An analysis from the Cape Cod Health Study

OBJECTIVEnThis exploratory analysis examines the relationship between childhood and adolescent fish consumption and adult neuropsychological performance.nnnDESIGNnData from a retrospective cohort study that assessed fish consumption from age 7 to 18years via questionnaire were analyzed. A subset of the population underwent domain-specific neuropsychological assessment. Functions evaluated included omnibus intelligence, academic achievement, language, visuospatial skills, learning and memory, attention and executive function, fine motor coordination, mood, and motivation to perform.nnnSETTINGnEight towns in the Cape Cod region of Massachusetts, USA, an area characterized by high fish consumption and an active seafood industry.nnnSUBJECTSnA cohort of 1245 subjects was recruited based on Massachusetts birth records from 1969 to 1983. Sixty-five participants from the original cohort underwent neuropsychological testing in adulthood (average age=30years).nnnRESULTSnParticipant report of consuming fish at least twice per month was associated with better performance on tests of visual learning, memory, and attentional abilities. However, self-report of consuming fish at rates higher than twice per month was not associated with improved abilities. No statistically significant associations were observed between type of fish consumed (e.g., species known to be high in methylmercury content) and test outcomes.nnnCONCLUSIONSnThe results suggest that moderate fish consumption during childhood and adolescence may be associated with some cognitive benefits and that consumption of fish during this exposure window may potentially influence adult neuropsychological performance. Future prospective studies should take into account this time period of exposure.

School connectedness and high school graduation among maltreated youth

Maltreated youth have higher rates of school dropout than their non-maltreated peers. School connectedness is a modifiable predictor of school success. We hypothesized maltreated youths school connectedness (supportive relationships with adults at school and participation in school clubs) would be positively associated with high school graduation. We included youth with at least one Child Protective Services (CPS) report by age twelve from Longitudinal Studies of Child Abuse and Neglect, a prospective cohort study. Participation in extracurricular activities and adult relationships reported at age 16, high school graduation/General Education Development (GED) status reported at age 18, and demographics were provided by youth and caregivers. Maltreatment data were coded from CPS records. The outcome was graduation/receipt of GED. Multivariable logistic regressions examined the association between school connectedness and graduation/receipt of GED, controlling for confounders. In our sample of 318 maltreated youth, 73.3% graduated. School club was the only activity with a statistically significant association with graduation in bivariate analysis. Having supportive relationships with an adult at school was not significantly associated with graduation, though only 10.7% of youth reported this relationship. Maltreated youth who participated in school clubs had 2.54 times the odds of graduating, adjusted for study site, gender, poverty status, caregiver high school graduation status, and age at first CPS report (95% CI: [1.02, 6.33]). Few maltreated youth reported relationships with adults at school, and additional efforts may be needed to support these vulnerable youth. School club participation may represent an opportunity to modify maltreated youths risk for school dropout.

Residential Proximity to Roadways and Ischemic Placental Disease in a Cape Cod Family Health Study

Exposure to air pollution may adversely impact placental function through a variety of mechanisms; however, epidemiologic studies have found mixed results. We examined the association between traffic exposure and placental-related obstetric conditions in a retrospective cohort study on Cape Cod, MA, USA. We assessed exposure to traffic using proximity metrics (distance of residence to major roadways and length of major roadways within a buffer around the residence). The outcomes included self-reported ischemic placental disease (the presence of at least one of the following conditions: preeclampsia, placental abruption, small-for-gestational-age), stillbirth, and vaginal bleeding. We used log-binomial regression models to estimate risk ratios (RR) and 95% confidence intervals (CI), adjusting for potential confounders. We found no substantial association between traffic exposure and ischemic placental disease, small-for-gestational-age, preeclampsia, or vaginal bleeding. We found some evidence of an increased risk of stillbirth and placental abruption among women living the closest to major roadways (RRs comparing living <100 m vs. ≥200 m = 1.75 (95% CI: 0.82–3.76) and 1.71 (95% CI: 0.56–5.23), respectively). This study provides some support for the hypothesis that air pollution exposure adversely affects the risk of placental abruption and stillbirth; however, the results were imprecise due to the small number of cases, and may be impacted by non-differential exposure misclassification and selection bias.

Exploring associations between prenatal solvent exposures and teenage drug and alcohol use: a retrospective cohort study

BackgroundInvestigating the effects of prenatal and childhood exposures on behavioral health outcomes in adolescence is challenging given the lengthy period between the exposure and outcomes. We conducted a retrospective cohort study in Cape Cod, Massachusetts to evaluate the impact of prenatal and early childhood exposure to tetrachloroethylene (PCE)-contaminated drinking water on the occurrence of risk-taking behaviors as a teenager. An increased occurrence of risk-taking behaviors, particularly illicit drug use, was observed in those highly exposed to PCE. We hypothesized that there may be other sources of prenatal solvent exposure such as maternal consumption of alcoholic beverages during pregnancy which might modify the previously observed associations between PCE and risk-taking behaviors and so we conducted an exploratory analysis using available cohort data. The current report presents the results of these analyses and describes the difficulties in conducting research on long-term behavioral effects of early life exposures.MethodsThe exploratory analysis compared a referent group of subjects with no early life exposure to PCE or alcohol (nu2009=u2009242) to subjects with only alcohol exposure (nu2009=u2009201), subjects with only PCE exposure (nu2009=u2009361), and subjects with exposure to both PCE and alcohol (nu2009=u2009302). Surveys completed by the subject’s mother included questions on prenatal alcoholic beverage consumption and available confounding variables such as cigarette smoking and marijuana use. Surveys completed by the subjects included questions on risk-taking behaviors such as alcoholic beverage consumption and illicit drug use as a teenager and available confounding variables. PCE exposure was modeled using a leaching and transport algorithm embedded in water distribution system modeling software that estimated the amount of PCE delivered to a subject’s residence during gestation and early childhood.ResultsSubjects with early life exposure to both PCE and alcohol had an increased risk of using two or more major drugs as a teen (RRu2009=u20091.9 (95% CI 1.2, 3.0)) compared to unexposed subjects. Increased risks for only PCE exposure (RRu2009=u20091.6 (95% CI 1.0, 2.4) and only alcohol exposure (RRu2009=u20091.3 (95% CI 0.7, 2.1)) were also evident but were smaller than the increased risk associated with both exposures. While available confounding variables were controlled, many relevant social risk factors were not obtained due to limitations in the retrospective study design.ConclusionsThis exploratory analysis found evidence for an additive effect of early life exposure to PCE and alcohol on the risk of use of multiple illicit drugs as a teenager. Because of numerous limitations in this retrospective study, further research is needed to examine longstanding behavioral effects of early life exposures. To be most informative, this research should involve long-term prospective data collection.

Association of prenatal and early life exposure to tetrachloroethylene (PCE) with polycystic ovary syndrome and other reproductive disorders in the cape cod health study: A retrospective cohort study

BACKGROUNDnTetrachloroethylene (PCE) is an organic lipophilic solvent with possible neuroendocrine toxicity. The objective of this study was to determine the association of prenatal and early childhood exposure to PCE-contaminated drinking water and development of adult-onset Polycystic Ovary Syndrome (PCOS), endometriosis, difficulty conceiving and miscarriage.nnnMETHODSnFive-hundred exposed and 331 unexposed female participants born between 1969 and 1983 completed questionnaires on demographic and lifestyle characteristics, and reproductive disorders. Residential locations from the prenatal period through five years of age were used to estimate early life PCE exposure with water modeling software.nnnRESULTSnFor any early life exposure to PCE, the adjusted risk ratio for PCOS was 0.9 (95% CI: 0.5-1.6). No statistically significant associations were observed for increasing levels of exposure with PCOS or the other reproductive disorders.nnnCONCLUSIONnNo meaningful associations were found among adult women with early life exposure to PCE-contaminated drinking water and adult-onset reproductive disorders.

No Association Between Unintentional Head Injuries and Early-Life Exposure to Tetrachloroethylene (PCE)-Contaminated Drinking Water.

Objective: Because of emerging evidence that early-life exposure to the solvent tetrachloroethylene (PCE) has long-lasting neurological consequences, we examined the risk of unintentional head injuries following prenatal and childhood exposure to PCE-contaminated drinking water. Methods: Participants provided information on head injuries and other relevant characteristics in a self-administered questionnaire. Exposure to PCE was modeled using a leaching and transport algorithm set in water system modeling software. Results: We did not observe any evidence of an increased risk of any type of head injury among exposed participants. Conclusions: PCE is a widespread water pollutant. Thus, documenting possible health effects of early-life exposure is vital for ensuring that drinking water regulations adequately protect vulnerable populations.