A Case-Control Study of Maternal Occupation and the Risk of Orofacial Clefts.

OBJECTIVES: The aim of this study was to examine the association between maternal occupation and risk of orofacial clefts in offspring. METHODS: Data were obtained from the Texas Birth Defects Registry and vital records for 1999 to 2009 deliveries. We used automated software to assist in classifying occupations into standard codes. Using multivariable logistic regression, the risk for cleft lip with or without cleft palate (CLP) or cleft palate only (CP) in offspring was compared between women in each of 20 major occupation groups to women in every other occupation group. RESULTS: Significant positive associations were observed between business/finance and architecture/engineering occupations and CP and between cleaning-related occupations and CLP. A significant negative association was observed between office and administrative support occupations and CLP. CONCLUSIONS: This study supports previous reports of increased risk of orofacial clefts in offspring among women in certain occupations.

Surveillance of congenital malformations in infants conceived through assisted reproductive technology or other fertility treatments.

BACKGROUND: As assisted reproductive technology (ART) becomes more common, it is important to understand the associated risks. The objective of this study was to determine if congenital malformations are associated with ART or other fertility treatments in New York. METHODS: In a retrospective cohort study of all live births in upstate New York from 1997 to 2005, exposure was defined using ART or other fertility treatments as noted on birth certificates. Outcomes were assessed from the New York State Congenital Malformations Registry. Specific malformations were examined to determine if there is elevated risk for exposed singleton infants compared with infants conceived naturally. RESULTS: The study included 7120 in the ART group, 11,890 in the other fertility treatments group and 1,118,162 in the comparison group. The relative risk for a congenital malformation was 1.43 (95% CI 1.19-1.72) for singleton infants conceived through ART compared with singleton infants conceived naturally. The specific defects associated with ART were patent ductus arteriosus, hypospadias, and obstructive defect in the renal pelvis and ureter, while spina bifida, other specific anomalies of the spinal cord, atresia or stenosis of the pulmonary valve, hypospadias, and obstructive defects of the renal pelvis and ureter were associated with other fertility treatment. CONCLUSION: Assisted reproductive technology is associated with a slight excess risk of birth defects. The specific congenital malformations with elevated risks for singleton infants vary depending on the exposure. Further research is necessary to understand the mechanism related to the increase in risk.

Comparison of patterns and knowledge of benefits and warnings of fish consumption between parents and children.

We examined generational differences in fish consumption and knowledge of benefits/warnings of fish consumption among parents and children. This cross-sectional study gathered self-administered questionnaire data, including demographics, fish consumption behavior (including specific fish species) and knowledge of fish consumption warnings and benefits. Fish were later grouped into four categories by potential mercury contamination. Descriptive statistics were conducted for all variables comparing all adults and children. Benefit/risk knowledge variables were also descriptively analyzed among parent-child pairs only. Multivariate Poisson regression was conducted on pairs to assess risk factors for children eating higher mercury fish. 421 adults and 207 children (171 adult-child pairs) participated (family response rate: 71%). Slightly more adults (97.6%) ate fish in the last year than children (92.3%); however, there was no difference between consumption of fish by category of potential mercury contamination. Both adults (44%) and children (45%) ate high-mercury fish. In 71% of parent-child pairs, both the parent and the child knew of benefits of consuming fish; only 31% knew of warnings. Parental consumption of high or moderately-high-mercury fish was related to the child's consumption of fish in the same category. Parents and children need additional education to make better choices about fish consumption. Education should target the family and include specifics about benefits and risks.

Maternal periconceptional occupational exposure to pesticides and selected musculoskeletal birth defects.

This population-based U.S. study investigated the association between major musculoskeletal malformations and periconceptional maternal occupational pesticide exposure for a wide range of occupations. We conducted a multi-site case-control analysis using data from the National Birth Defects Prevention Study among employed women with due dates from October 1, 1997 through December 31, 2002. Cases included 871 live-born, stillborn, or electively terminated fetuses with isolated craniosynostosis, gastroschisis, diaphragmatic hernia, or transverse limb deficiencies. Controls included 2857 live-born infants without major malformations. Using self-reported maternal occupational information, an industrial hygienist used a job-exposure matrix and expert opinion to evaluate the potential for exposure to insecticides, herbicides or fungicides for each job held during one month pre-conception through three months post-conception. Exposures analyzed included any exposure (yes/no) to pesticides, to insecticides only, to both insecticides and herbicides (I+H) and to insecticides, herbicides and fungicides (I+H+F). We used logistic regression to evaluate the association between exposures and defects, controlling for infant and maternal risk factors. Occupational exposure to I+H+F was associated with gastroschisis among infants of women aged 20 years or older (adjusted odds ratio [aOR]=1.88; 95% confidence interval [CI]: 1.16-3.05), but not for women under age 20 (aOR=0.48; 95% CI: 0.20-1.16). We found no significant associations for the other defects. Additional research is needed to validate these findings in a separate population.

Fish consumption patterns, knowledge and potential exposure to mercury by race.

OBJECTIVE: Compared fish consumption patterns, fish advisory/benefit awareness and risk factors of consuming high-mercury (Hg) fish between Chinese and non-Chinese adults. METHODS: 301 Chinese and 120 non-Chinese participated in this cross-sectional study. Participants self-reported demographics, fish consumption behavior, and awareness of warnings/benefits of fish consumption. RESULTS: non-Chinese (62.5%) ate more high-Hg fish than Chinese (35.9%) although more Chinese ate fish in the last year. Over 90% of both groups knew general benefits of consuming fish; fewer knew specific benefits. Chinese were less aware of fish warnings (49.8%) than non-Chinese (86.7%); knowledge did not appear to affect their fish consumption. CONCLUSIONS: There were significant differences in fish consumption patterns and fish benefit/warning knowledge between the two groups. A higher proportion of non-Chinese reported consumption of high-Hg fish. Fish knowledge did not affect fish consumption behavior for either group. Public education efforts regarding fish consumption should emphasize details such as species and amounts.

Maternal occupation and the risk of major birth defects: a follow-up analysis from the National Birth Defects Prevention Study.

This study further examined the association between selected maternal occupations and a variety of birth defects identified from prior analysis and explored the effect of work hours and number of jobs held and potential interaction between folic acid and occupation. Data from a population-based, multi-center case-control study was used. Analyses included 45 major defects and specific sub-occupations under five occupational groups: healthcare workers, cleaners, scientists, teachers and personal service workers. Both logistic regression and Bayesian models (to minimize type-1 errors) were used, adjusted for potential confounders. Effect modification by folic acid was also assessed. More than any other occupation, nine different defects were positively associated with maids or janitors [odds ratio (OR) range: 1.72-3.99]. Positive associations were also seen between the following maternal occupations and defects in their children (OR range: 1.35-3.48): chemists/conotruncal heart and neural tube defects (NTDs), engineers/conotruncal defects, preschool teachers/cataracts and cleft lip with/without cleft palate (CL/P), entertainers/athletes/gastroschisis, and nurses/hydrocephalus and left ventricular outflow tract heart defects. Non-preschool teachers had significantly lower odds of oral clefts and gastroschisis in their offspring (OR range: 0.53-0.76). There was a suggestion that maternal folic acid use modified the effects with occupations including lowering the risk of NTDs and CL/P. No consistent patterns were found between maternal work hours or multiple jobs by occupation and the risk of birth defects. Overall, mothers working as maids, janitors, biologists, chemists, engineers, nurses, entertainers, child care workers and preschool teachers had increased risks of several malformations and non-preschool teachers had a lower risk of some defects. Maternal folic acid use reduced the odds of NTDs and CL/P among those with certain occupations. This hypothesis-generating study will provide clues for future studies with better exposure data.

Differences in folic acid use, prenatal care, smoking, and drinking in early pregnancy by occupation.

OBJECTIVE: To describe differences in four high risk periconceptional behaviors (lack of folic acid supplementation, lack of early prenatal care, smoking, and drinking) by maternal occupation. METHODS: Analyses were conducted among women in the National Birth Defects Prevention Study who delivered liveborn infants without birth defects. Periconceptional occupational data were collected using a computer-assisted telephone interview and occupational coding was performed using the 2000 Standard Occupational Classification System. Logistic regression analyses were conducted to determine whether prevalence of behaviors differed between occupational groups. RESULTS: Subjects included 5153 women employed during early pregnancy from 1997 to 2007. Compared to women in management, business, science, and arts occupations, women in other occupations (e.g., service occupations) were significantly more likely to engage in all four high risk behaviors. Specifically, women in food preparation/serving-related occupations were significantly more likely to engage in all four behaviors compared to women in all other occupational groups (odds ratios: 1.8-3.0), while women in education/training/library occupations were significantly less likely to do so (odds ratios: 0.2-0.5). CONCLUSION: We identified several occupational groups with an increased prevalence of high-risk maternal behaviors during pregnancy. Our findings could aid in developing interventions targeted towards women in these occupational groups.

Paternal occupation and birth defects: findings from the National Birth Defects Prevention Study.

OBJECTIVES: Several epidemiological studies have suggested that certain paternal occupations may be associated with an increased prevalence of birth defects in offspring. Using data from the National Birth Defects Prevention Study, the authors investigated the association between paternal occupation and birth defects in a case-control study of cases comprising over 60 different types of birth defects (n=9998) and non-malformed controls (n=4066) with dates of delivery between 1997 and 2004. METHODS: Using paternal occupational histories reported by mothers via telephone interview, jobs were systematically classified into 63 groups based on shared exposure profiles within occupation and industry. Data were analysed using bayesian logistic regression with a hierarchical prior for dependent shrinkage to stabilise estimation with sparse data. RESULTS: Several occupations were associated with an increased prevalence of various birth defect categories, including mathematical, physical and computer scientists; artists; photographers and photo processors; food service workers; landscapers and groundskeepers; hairdressers and cosmetologists; office and administrative support workers; sawmill workers; petroleum and gas workers; chemical workers; printers; material moving equipment operators; and motor vehicle operators. CONCLUSIONS: Findings from this study might be used to identify specific occupations worthy of further investigation and to generate hypotheses about chemical or physical exposures common to such occupations.

Lessons learned from the september 11th disaster: a state health agency perspective.

The New York State Department of Health has conducted a number of studies over the past 10 years investigating health impacts related to the September 11, 2001 (9/11) disaster among New York City residents and New York State World Trade Center (WTC) responders. Efforts to evaluate the health effects of WTC exposures in these cohorts presented numerous challenges, including study design and associated concerns about bias, identifying the affected populations, gaining community support and participation, and determining the most appropriate clinical testing and follow-up approaches. The unique position of a state public health agency provided multiple points of support for these efforts. An overview of what was found and the lessons learned during the response to the 9/11 disaster is presented, from the viewpoint of a state public health agency.

Maternal asthma medication use and the risk of selected birth defects.

OBJECTIVES: Approximately 4% to 12% of pregnant women have asthma; few studies have examined the effects of maternal asthma medication use on birth defects. We examined whether maternal asthma medication use during early pregnancy increased the risk of selected birth defects. METHODS: National Birth Defects Prevention Study data for 2853 infants with 1 or more selected birth defects (diaphragmatic hernia, esophageal atresia, small intestinal atresia, anorectal atresia, neural tube defects, omphalocele, or limb deficiencies) and 6726 unaffected control infants delivered from October 1997 through December 2005 were analyzed. Mothers of cases and controls provided telephone interviews of medication use and additional potential risk factors. Exposure was defined as maternal periconceptional (1 month prior through the third month of pregnancy) asthma medication use (bronchodilator or anti-inflammatory). Associations between maternal periconceptional asthma medication use and individual major birth defects were estimated by using adjusted odds ratios (aOR) and 95% confidence intervals (95%CI). RESULTS: No statistically significant associations were observed for maternal periconceptional asthma medication use and most defects studied; however, positive associations were observed between maternal asthma medication use and isolated esophageal atresia (bronchodilator use: aOR = 2.39, 95%CI = 1.23, 4.66), isolated anorectal atresia (anti-inflammatory use: aOR = 2.12, 95%CI = 1.09, 4.12), and omphalocele (bronchodilator and anti-inflammatory use: aOR = 4.13, 95%CI = 1.43, 11.95). CONCLUSIONS: Positive associations were observed for anorectal atresia, esophageal atresia, and omphalocele and maternal periconceptional asthma medication use, but not for other defects studied. It is possible that observed associations may be chance findings or may be a result of maternal asthma severity and related hypoxia rather than medication use.

A nested case-control study of low birthweight among cosmetologists.

OBJECTIVE: This study was designed to determine whether licensed female cosmetologists with a low birthweight child were more likely to perform specific occupational tasks during pregnancy than cosmetologists who had a normal weight child. We also investigated certain salon characteristics in relation to low birthweight status. METHODS: This nested case-control study followed-up a positive association of low birthweight children among cosmetologists found in a retrospective cohort study previously reported. Cases were cosmetologists with children born between 1997 and 2003 weighing <2,500 g, selected from the retrospective cohort study. Controls were cosmetologists with full-term children who weighed >2,500 grams at birth, frequency matched on year of birth of the child. A mailed questionnaire gathered information on potential confounders and detailed exposure information about work environment and occupational tasks of cosmetologists. Frequency of product use was dichotomized into daily/less than daily for each task. Number of hours worked per week was also considered. Birth certificate data were used for information on some potential confounders and birthweight. Using logistic regression, adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were obtained. RESULTS: A total of 125 (30%) cases and 158 (35%) controls agreed to participate. Responders and non-responders were similar on birthweight and most demographic characteristics. None of the specific cosmetology tasks studied were associated with low birthweight. Working in a salon located in a house/building with other businesses was associated with having a low birthweight child [OR = 2.20, 95% CI (1.21, 4.02)]. CONCLUSIONS: We did not find any associations between specific tasks of cosmetologists and low birthweight.

Asthma and lower respiratory symptoms in New York State employees who responded to the World Trade Center disaster.

PURPOSE: To investigate whether New York State employees who responded to the World Trade Center disaster were more likely to report asthma or lower respiratory symptoms (LRS; cough, wheeze, chest tightness, shortness of breath) than non-exposed employees, 2 years post-September 11. METHODS: Participants (578 exposed, 702 non-exposed) completed mailed questionnaires in 2003. A unique exposure assessment method was used; exposure scores were divided at the mean (at/below, above). Poisson regression was used. RESULTS: Exposure was associated with LRS, but not asthma. Participants with exposure scores at/below the mean had a twofold increased risk of most LRS. Those with scores above the mean had a three to fourfold increased risk. For scores above the mean, the magnitude of effect was consistently higher for smoke exposure. CONCLUSIONS: Moderately exposed responders may experience health impacts from exposures in later stages of a disaster. Exposure to smoke may have had a greater lower respiratory impact than resuspended dust.

The risk of congenital malformations and other neonatal and maternal health outcomes among licensed cosmetologists.

This study sought to determine if cosmetologists in New York State (NYS) have a higher risk of complications of labor/delivery or congenital malformations and poor neonatal health indicators among their offspring compared with Realtors and the general population. This retrospective cohort study matched licensing records for cosmetologists and realtors to birth records and the NYS Congenital Malformations Registry from 1997 to 2003. A random sample of NYS birth certificates, frequency matched to cosmetologists on year of child's birth, mother's ethnicity, and education, was also formed. Outcomes include malformations of each major organ system, neonatal health indicators, and complications of labor/delivery. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), controlling for potential confounders. Compared with Realtors, cosmetologists had an increased risk of several maternal and neonatal health indicators, including postpartum hemorrhage (OR = 2.12; 95% CI 1.26, 3.58), failure to progress (OR = 1.31; 95% CI 1.12, 1.54), and newborn intubation (OR = 2.34; 95% CI 1.21, 4.51), among others. We did not observe an increased risk of congenital malformations among cosmetologists' offspring. Working as a cosmetologist was positively associated with several adverse maternal perinatal and neonatal health indicators but was not associated with congenital malformations in this study. These results are useful for hypothesis generating.

The risk of having a low birth weight or preterm infant among cosmetologists in New York State.

OBJECTIVES: This study sought to determine if female licensed cosmetologists have a higher risk of low birth weight, small-for-gestational-age, and preterm delivery compared to two different comparison groups. METHODS: This retrospective cohort study matched 15,003 licensed cosmetologists and a comparison group of 4,246 licensed realtors to birth records in New York State from 1997 to 2003. A second comparison group from the general population of New York State (n = 12,171) was frequency matched to cosmetologists on child's year of birth, mother's ethnicity and mother's education. RESULTS: A positive association was found for low birth weight when comparing cosmetologists to realtors (adjusted odds ratio 1.36 (95% confidence interval: 1.09, 1.70)). Associations were stronger in non-whites than in whites in each birth weight comparison. Associations observed for small-for-gestational-age or preterm births with either comparison group were close to the null or had wide confidence intervals that included the null. CONCLUSIONS: We observed a slightly increased risk for having a child born low birth weight among cosmetologists compared to another group of licensed professionals. The risk was greater among non-white races in each comparison.

Maternal asthma, asthma medication use, and the risk of congenital heart defects.

BACKGROUND: Asthma is a common problem that complicates pregnancy. Several drugs are considered acceptable for use during pregnancy, although none have been classified as safe. Few studies have assessed the health impact of maternal asthma/medication use on the fetus. METHODS: A population-based case-control study was conducted in New York State to determine if cardiac congenital malformations in offspring were associated with maternal use of asthma medication and/or maternal asthma. Cases were cardiac anomalies in the New York State Congenital Malformations Registry. Controls were live births without any major birth defects randomly selected from birth certificates and frequency matched by year of birth. Data were collected through a 30 min telephone interview. Exposure was maternal asthma/medication use, maternal asthma/no medication use, no asthma/medication use, and no asthma/no medication use (reference). RESULTS: A total of 502 (59.4%) cases and 1,066 (53.8%) controls participated. A positive association was seen between any heart defect and women with asthma who used medication (OR 2.38; 95% CI: 1.18, 4.82). No significant associations were observed between heart defects and either women with asthma who did not use medication or women without asthma who used asthma medications. When considering types of medication used, offspring of women with asthma who used bronchodilators had an increased risk of any heart defect (OR 2.20; 95%CI: 1.05, 4.61). CONCLUSIONS: These results suggest that both maternal asthma status (controlled vs. uncontrolled; severe vs. mild) and asthma medication use, particularly bronchodilators, may play a role in cardiac malformations in offspring.

Maternal asthma medication use and the risk of gastroschisis.

The objective of this study was to examine the association between maternal asthma medication use during the periconceptional period and the risk of gastroschisis. In this case-control study, the authors used data on deliveries enrolled in the National Birth Defects Prevention Study (1997-2002) from eight collaborating centers. The cases included 381 infants with isolated gastroschisis, and the controls were 4,121 liveborn infants without malformations. The asthma medications used during the periconceptional period (1 month prepregnancy through the third pregnancy month) were divided into two groups, antiinflammatory and bronchodilator, and analyzed separately. Users of multiple asthma medications during the periconceptional period were also examined. Logistic regression was used to estimate odds ratios and 95% confidence intervals while controlling for maternal age, race/ethnicity, education, smoking, folic acid/vitamin use, and other vasoactive medications. Maternal bronchodilator use showed an elevated statistically significant risk of gastroschisis (adjusted odds ratio = 2.06, 95% confidence interval: 1.19, 3.59). No significant association was found between maternal use of asthma antiinflammatory medications and gastroschisis. Because information on maternal asthma status/severity was not available, the effects of disease on the risk of gastroschisis cannot be ruled out. Additional research is needed in determining whether a real risk exists and for guiding asthma treatment.

Development of an exposure assessment method for epidemiological studies of New York State personnel who responded to the World Trade Center disaster.

OBJECTIVES: An exposure assessment method was developed for use in assigning an exposure score to New York State personnel who responded to the World Trade Center disaster site after the 11 September 2001 terrorist attacks. METHODS: The method consists of an algorithm with two instantiations. Each represents a major component of the overall exposures at the site: dust and smoke. The algorithm uses US Environmental Protection Agency air monitoring data collected between 23 September 2001 and 28 February 2002, as well as information on duration, location and time period of work assignment and type and frequency of personal protective respiratory equipment (PPE) use, collected by a self-administered mailed questionnaire. These data were used to calculate an overall exposure score for each participant. For each time period/location combination, individuals provided average number of hours and number of days worked. This was multiplied by a weighting factor derived from the median of the air monitoring data for the time period/location. Calcium was chosen as a surrogate for the dust exposure, so the weighting factors for the dust instantiation were calculated from calcium air monitoring data. Total hepta-chlorinated dibenzo-p-dioxin was chosen as a surrogate for the smoke exposure and was similarly used in the smoke instantiation. RESULTS: More individuals in the highest exposure score category performed tasks such as search/rescue and hand digging than those in the lowest exposure category. Also, those in the highest exposure category had a higher mean number of hours at the site than other exposure groups. CONCLUSIONS: The exposure assessment method presented accounts for PPE use, amount of time at the site, proximity to the site and ambient air monitoring results taken in the immediate vicinity. The algorithm can be used to rank individuals in the same study with very different patterns of exposure, such as high-level, short-term exposures and low-level, long-term exposures. The concepts could be modified for use in other epidemiological studies where long-term chronic exposure is a concern.