Case Report: Three Farmworkers Who Gave Birth to Infants with Birth Defects Closely Grouped in Time and Place-Florida and North Carolina, 2004-2005

By Calvert, Geoffrey M.; Alarcon, Walter A. et al. | Environmental Health Perspectives, May 2007 | Go to article overview

Case Report: Three Farmworkers Who Gave Birth to Infants with Birth Defects Closely Grouped in Time and Place-Florida and North Carolina, 2004-2005


Calvert, Geoffrey M., Alarcon, Walter A., Chelminski, Ann, Crowley, Mark S., Barrett, Rosanna, Correa, Adolfo, Higgins, Sheila, Leon, Hugo L., Correia, Jane, Becker, Alan, Allen, Ruth H., Evans, Elizabeth, Environmental Health Perspectives


CONTEXT: There is little evidence linking adverse reproductive effects to exposure to specific pesticides during pregnancy.

CASE PRESENTATION: In February 2005, three infants with congenital anomalies were identified in Collier County, Florida, who were born within 8 weeks of one another and whose mothers worked for the same tomato grower. The mothers worked on the grower's Florida farms in 2004 before transferring to its North Carolina farms. All three worked during the period of organogenesis in fields recently treated with several pesticides. The Florida and North Carolina farms were inspected by regulatory agencies, and in each state a large number of violations were identified and record fines were levied.

DISCUSSION: Despite the suggestive evidence, a causal link could not be established between pesticide exposures and the birth defects in the three infants. Nonetheless, the prenatal pesticide exposures experienced by the mothers of the three infants is cause for concern. Farmworkers need greater protections against pesticides. These include increased efforts to publicize and comply with both the U.S. Environmental Protections Agency's Worker Protection Standard and pesticide label requirements, enhanced procedures to ensure pesticide applicator competency, and recommendations to growers to adopt work practices to reduce pesticide exposures.

RELEVANCE TO PROFESSIONAL PRACTICE: The findings from this report reinforce the need to reduce pesticide exposures among farmworkers. In addition, they support the need for epidemiologic studies to examine the role of pesticide exposure in the etiology of congenital anomalies.

KEY WORDS: congenital abnormalities, ectromelia, farmworkers, fungicides, Goldenhar Syndrome, insecticides, micrognathism, pesticides, prevention and control, toxicity. Environ Health Perspect 115:787-791 (2007). doi:10.1289/ehp.9647 available via http://dx.doi.org/ [Online 21 February 2007]

Case Reports

In February 2005, the Healthy Start program in the Collier County Health Department (CCHD) in Florida identified three infants with congenital anomalies who were born within 8 weeks of one another and determined that all three mothers had worked for the same tomato grower (CCHD 2005). All three women had worked on the grower's Florida farms in 2004 before transferring to its North Carolina farms later that year (Table 1). In August 2005, the North Carolina Department of Health and Human Services (NCDHHS) was notified of these births by the North Carolina Department of Agricultural and Consumer Services (NCDACS); this agency had been notified by U.S. Environmental Protection Agency (EPA) Region 4 in April 2005. The Centers for Disease Control and Prevention (CDC) was alerted in September 2005, and with the assistance of state health departments in Florida and North Carolina collected case reports and pesticide exposure histories.

The CCHD searched the Healthy Start program records for other birth defects cases born between December 2004 and February 2005 and whose parents had the potential for exposure to agricultural pesticides. No additional cases were identified. Medical records on the three mothers and their infants were obtained and reviewed by the CCHD and the state health departments in Florida and North Carolina. Charles A. Williams, a clinical geneticist and professor of pediatrics and genetics at the University of Florida, College of Medicine (Gainesville, FL) reviewed case summaries obtained from the medical records and provided the descriptions of the birth defects. Exposure information was obtained from NCDACS and the Florida Department of Agriculture and Consumer Services (FLDACS), which obtained pesticide application and worker assignment records from the grower. Additionally, each of the mothers and fathers were interviewed in early 2005 by CCHD. The mothers of case 1 and case 2 were also interviewed in 2006 by NCDHHS.

Because of the imprecision of the conception date, there is also imprecision in the calendar days that correspond to the maximal sensitivity period for any given birth defect. …

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