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      Project TENDR: Targeting Environmental Neuro-Developmental Risks The TENDR Consensus Statement

      brief-report
      , PhD , PhD, MSc , PhD, DABT, A.T.S , PhD, MS , MD, PhD , PhD , PhD , PhD , PhD , MD, ScD, MPH , PhD , PhD , MD, MPH , PhD , PhD , PhD , PhD , DrPH , PhD , DrPH, PhD , MD, PhD , PhD , PhD , DSc , DrPH , PhD, MPH , PhD , PhD, RN , MD, MS, FAAP , MD, PhD , MD, MSHP, FACOG , MD , MD , RN, MS, CNM , MD, MSc, FAAP , MD, FAAP , MD, MPH , MD, MPH , MD , MD, MPH , MD, MPH , RN , MEd , MS , MPA , MPH American College of Obstetricians and Gynecologists (ACOG) Child Neurology Society, Endocrine Society, International Neurotoxicology Association, International Society for Children's Health and the Environment, International Society for Environmental Epidemiology, National Council of Asian Pacific Islander Physicians, National Hispanic Medical Association, National Medical Association
      Environmental Health Perspectives
      National Institute of Environmental Health Sciences

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          Abstract

          Summary: Children in America today are at an unacceptably high risk of developing neurodevelopmental disorders that affect the brain and nervous system including autism, attention deficit hyperactivity disorder, intellectual disabilities, and other learning and behavioral disabilities. These are complex disorders with multiple causes—genetic, social, and environmental. The contribution of toxic chemicals to these disorders can be prevented. Approach: Leading scientific and medical experts, along with children’s health advocates, came together in 2015 under the auspices of Project TENDR: Targeting Environmental Neuro-Developmental Risks to issue a call to action to reduce widespread exposures to chemicals that interfere with fetal and children’s brain development. Based on the available scientific evidence, the TENDR authors have identified prime examples of toxic chemicals and pollutants that increase children’s risks for neurodevelopmental disorders. These include chemicals that are used extensively in consumer products and that have become widespread in the environment. Some are chemicals to which children and pregnant women are regularly exposed, and they are detected in the bodies of virtually all Americans in national surveys conducted by the U.S. Centers for Disease Control and Prevention. The vast majority of chemicals in industrial and consumer products undergo almost no testing for developmental neurotoxicity or other health effects. Conclusion: Based on these findings, we assert that the current system in the United States for evaluating scientific evidence and making health-based decisions about environmental chemicals is fundamentally broken. To help reduce the unacceptably high prevalence of neurodevelopmental disorders in our children, we must eliminate or significantly reduce exposures to chemicals that contribute to these conditions. We must adopt a new framework for assessing chemicals that have the potential to disrupt brain development and prevent the use of those that may pose a risk. This consensus statement lays the foundation for developing recommendations to monitor, assess, and reduce exposures to neurotoxic chemicals. These measures are urgently needed if we are to protect healthy brain development so that current and future generations can reach their fullest potential.

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          Most cited references47

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          Low-Level Environmental Lead Exposure and Children’s Intellectual Function: An International Pooled Analysis

          Lead is a confirmed neurotoxin, but questions remain about lead-associated intellectual deficits at blood lead levels < 10 μg/dL and whether lower exposures are, for a given change in exposure, associated with greater deficits. The objective of this study was to examine the association of intelligence test scores and blood lead concentration, especially for children who had maximal measured blood lead levels < 10 μg/dL. We examined data collected from 1,333 children who participated in seven international population-based longitudinal cohort studies, followed from birth or infancy until 5–10 years of age. The full-scale IQ score was the primary outcome measure. The geometric mean blood lead concentration of the children peaked at 17.8 μg/dL and declined to 9.4 μg/dL by 5–7 years of age; 244 (18%) children had a maximal blood lead concentration < 10 μg/dL, and 103 (8%) had a maximal blood lead concentration < 7.5 μg/dL. After adjustment for covariates, we found an inverse relationship between blood lead concentration and IQ score. Using a log-linear model, we found a 6.9 IQ point decrement [95% confidence interval (CI), 4.2–9.4] associated with an increase in concurrent blood lead levels from 2.4 to 30 μg/dL. The estimated IQ point decrements associated with an increase in blood lead from 2.4 to 10 μg/dL, 10 to 20 μg/dL, and 20 to 30 μg/dL were 3.9 (95% CI, 2.4–5.3), 1.9 (95% CI, 1.2–2.6), and 1.1 (95% CI, 0.7–1.5), respectively. For a given increase in blood lead, the lead-associated intellectual decrement for children with a maximal blood lead level < 7.5 μg/dL was significantly greater than that observed for those with a maximal blood lead level ≥7.5 μg/dL (p = 0.015). We conclude that environmental lead exposure in children who have maximal blood lead levels < 7.5 μg/dL is associated with intellectual deficits.
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            Environmental Chemicals in Pregnant Women in the United States: NHANES 2003–2004

            Background Exposure to chemicals during fetal development can increase the risk of adverse health effects, and while biomonitoring studies suggest pregnant women are exposed to chemicals, little is known about the extent of multiple chemicals exposures among pregnant women in the United States. Objective We analyzed biomonitoring data from the National Health and Nutritional Examination Survey (NHANES) to characterize both individual and multiple chemical exposures in U.S. pregnant women. Methods We analyzed data for 163 chemical analytes in 12 chemical classes for subsamples of 268 pregnant women from NHANES 2003–2004, a nationally representative sample of the U.S. population. For each chemical analyte, we calculated descriptive statistics. We calculated the number of chemicals detected within the following chemical classes: polybrominated diphenyl ethers (PBDEs), perfluorinated compounds (PFCs), organochlorine pesticides, and phthalates and across multiple chemical classes. We compared chemical analyte concentrations for pregnant and nonpregnant women using least-squares geometric means, adjusting for demographic and physiological covariates. Results The percentage of pregnant women with detectable levels of an individual chemical ranged from 0 to 100%. Certain polychlorinated biphenyls, organochlorine pesticides, PFCs, phenols, PBDEs, phthalates, polycyclic aromatic hydrocarbons, and perchlorate were detected in 99–100% of pregnant women. The median number of detected chemicals by chemical class ranged from 4 of 12 PFCs to 9 of 13 phthalates. Across chemical classes, median number ranged from 8 of 17 chemical analytes to 50 of 71 chemical analytes. We found, generally, that levels in pregnant women were similar to or lower than levels in nonpregnant women; adjustment for covariates tended to increase levels in pregnant women compared with nonpregnant women. Conclusions Pregnant women in the U.S. are exposed to multiple chemicals. Further efforts are warranted to understand sources of exposure and implications for policy making.
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              Traffic-related air pollution, particulate matter, and autism.

              Autism is a heterogeneous disorder with genetic and environmental factors likely contributing to its origins. Examination of hazardous pollutants has suggested the importance of air toxics in the etiology of autism, yet little research has examined its association with local levels of air pollution using residence-specific exposure assignments. To examine the relationship between traffic-related air pollution, air quality, and autism. This population-based case-control study includes data obtained from children with autism and control children with typical development who were enrolled in the Childhood Autism Risks from Genetics and the Environment study in California. The mother's address from the birth certificate and addresses reported from a residential history questionnaire were used to estimate exposure for each trimester of pregnancy and first year of life. Traffic-related air pollution was assigned to each location using a line-source air-quality dispersion model. Regional air pollutant measures were based on the Environmental Protection Agency's Air Quality System data. Logistic regression models compared estimated and measured pollutant levels for children with autism and for control children with typical development. Case-control study from California. A total of 279 children with autism and a total of 245 control children with typical development. Crude and multivariable adjusted odds ratios (AORs) for autism. Children with autism were more likely to live at residences that had the highest quartile of exposure to traffic-related air pollution, during gestation (AOR, 1.98 [95% CI, 1.20-3.31]) and during the first year of life (AOR, 3.10 [95% CI, 1.76-5.57]), compared with control children. Regional exposure measures of nitrogen dioxide and particulate matter less than 2.5 and 10 μm in diameter (PM2.5 and PM10) were also associated with autism during gestation (exposure to nitrogen dioxide: AOR, 1.81 [95% CI, 1.37-3.09]; exposure to PM2.5: AOR, 2.08 [95% CI, 1.93-2.25]; exposure to PM10: AOR, 2.17 [95% CI, 1.49-3.16) and during the first year of life (exposure to nitrogen dioxide: AOR, 2.06 [95% CI, 1.37-3.09]; exposure to PM2.5: AOR, 2.12 [95% CI, 1.45-3.10]; exposure to PM10: AOR, 2.14 [95% CI, 1.46-3.12]). All regional pollutant estimates were scaled to twice the standard deviation of the distribution for all pregnancy estimates. Exposure to traffic-related air pollution, nitrogen dioxide, PM2.5, and PM10 during pregnancy and during the first year of life was associated with autism. Further epidemiological and toxicological examinations of likely biological pathways will help determine whether these associations are causal.
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                Author and article information

                Journal
                Environ Health Perspect
                Environ. Health Perspect
                EHP
                Environmental Health Perspectives
                National Institute of Environmental Health Sciences
                0091-6765
                1552-9924
                1 July 2016
                July 2016
                : 124
                : 7
                : A118-A122
                Affiliations
                [1]Associate Professor, Department of Public Health Sciences, School of Medicine,
                [2]University of California, Davis
                [3]Boston Children's Hospital
                [4]Harvard Medical School
                [5]Harvard T.H. Chan School of Public Health
                [6]Director, National Institute of Environmental Health Sciences,
                [7]Director, National Toxicology Program
                [8]Associate Director, Center for Environmental Research and Children's Health (CERCH)
                [9]Associate Adjunct Professor of Environmental Health Sciences, School of Public Health, UC Berkeley
                [10]Associate Professor, Division of Epidemiology
                [11]Department of Environmental Health
                [12]University of Cincinnati College of Medicine
                [13]Professor of Environmental Medicine, Pediatrics and Public Health Sciences; Acting Chair, Department of Environmental Medicine;
                [14]Director, University of Rochester Medical School Environmental Health Sciences Center
                [15]Associate Professor, Department of Epidemiology,
                [16]Gillings School of Global Public Health University of North Carolina, Chapel Hill
                [17]Sylvia and Harold Halpert Professor and Chair,
                [18]Dept. of Mental Health; Director, Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health
                [19]Chief Science Officer, Autism Science Foundation, Adjunct, Dept. of Pharmacology and Toxicology,
                [20]Rutgers University
                [21]Frederick Lee Hisaw Professor of Reproductive Physiology; Professor of Environmental and Occupational Epidemiology, Harvard T.H. Chan School of Public Health; Professor of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School
                [22]Director, UC Davis Environmental Health Sciences Center; Professor, Department of Public Health Sciences & Medical Investigations of Neurodevelopmental Disorders (MIND) Institute,
                [23]University of California, Davis
                [24]Executive Director, The Endocrine Disruption Exchange (TEDX)
                [25]Assistant Professor Adjunct, Dept. of Integrative Physiology, University of Colorado, Boulder
                [26]Clinician Scientist, Child & Family Research Institute, BC Children's Hospital Professor, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC
                [27]Staff Scientist
                [28]Pesticide Action Network North America
                [29]Adjunct Associate Professor
                [30]University of California, Davis
                [31]Senior Scientist
                [32]Environmental Defense Fund
                [33]Director, A.J. Drexel Autism Institute
                [34]Professor, Epidemiology and Biostatistics,
                [35]Drexel University
                [36]Assistant Professor, Maryland Institute for Applied Environmental Health, School of Public Health,
                [37]University of Maryland
                [38]Professor, Biological Sciences, Center for Human Health and the Environment, WM Keck Center for Behavioral Biology, NC State University
                [39]Professor of Public Health
                [40]Director, Columbia Center for Children's Environmental Health; Professor, Dept. of Environmental Health Sciences, Mailman School of Public Health, Columbia University
                [41]Professor of Epidemiology
                [42]Center for Occupational and Environmental Health
                [43]Fielding School of Public Health, University of California Los Angeles
                [44]Senior Scientist, Natural Resources Defense Council
                [45]Professorial Lecturer, George Washington University
                [46]Professor of Toxicology and Neuroscience, Illinois Children's Environmental Health Research Center; Director, Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana-Champaign
                [47]Professor, Department of Environmental Health, Boston University School of Public Health
                [48]Professor Emeritus, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University
                [49]Professor and Director, Program on Reproductive Health and the Environment, Dept. of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
                [50]Professor of Biology
                [51]Director, Laboratory of Molecular & Cellular Biology,
                [52]University of Massachusetts Amherst
                [53]Robert and Kathleen Scanlon Endowed Chair in Values Based Health Care & Professor, School of Nursing and Health Studies, Georgetown University,
                [54]Visiting Clinical Associate Professor of Public Health University of Texas at El Paso
                [55]Past President, American College of Obstetricians and Gynecologists; Assistant Physician in Chief, The Permanente Medical Group
                [56]American College of Obstetricians & Gynecologists Liaison to American Academy of Pediatrics Executive Council on Environmental Health; Clinical Associate in Obstetrics & Gynecology, U. of Pennsylvania
                [57]Associate Adjunct Professor, Program on Reproductive Health and the Environment,
                [58]Dept. of Obstetrics, Gynecology and Reproductive Sciences, UCSF School of Medicine; Immediate Past President, Physicians for Social Responsibility
                [59]Professor, Neurological Sciences and Pediatrics
                [60]University of Vermont School of Medicine
                [61]Director of Programs
                [62]Alliance of Nurses for Healthy Environments
                [63]Dean for Global Health, Arnhold Institute for Global Health; Professor of Preventive Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai
                [64]Advanced Pediatrics
                [65]Associate Clinical Professor of Pediatrics
                [66]Case Western Reserve University School of Medicine
                [67]Director, University of California San Francisco Pediatric Environmental Health Specialty Unit
                [68]President, Mitchell Environmental Health Associates
                [69]Chair, Council on Medical Legislation and
                [70]Co-Chair, Commission on Environmental Health
                [71]National Medical Association
                [72]President, Innovative Solutions for Disadvantage and Disability; Associate Professor, Dept. of Pediatrics, Morehouse School of Medicine; Co-director, Southeast Pediatric Environmental Health Specialty Unit, Emory University; Medical Director, Developmental Pediatric Specialists
                [73]Science Director
                [74]Science and Environmental Health Network
                [75]President and CEO
                [76]National Council of Asian Pacific Islander Physicians
                [77]Director of Fiscal and Family Support Policy
                [78]The Arc
                [79]National Coordinator, Healthy Babies Bright Futures Vice President of Health Initiatives, BlueGreen Alliance
                [80]Director, Collaborative on Health and the Environment (CHE)
                [81]Executive Director
                [82]Alaska Community Action on Toxics
                [83]Healthy Children Project Director
                [84]Learning Disabilities Association of America
                [85]Executive Director, Children's Environmental Health Network
                Author notes
                []Address correspondence to I. Hertz-Picciotto, University of California, Davis, Department of Public Health Sciences, MS1C, One Shields Ave., Davis, California USA 95616-8500. Telephone: 530-752-3025. E-mail: ihp@ 123456ucdavis.edu ; melissarose6899@ 123456gmail.com

                ACOG supports the value of this clinical document as an educational tool (March 2016)

                Article
                EHP358
                10.1289/EHP358
                4937840
                27479987
                d42cdcaa-11aa-4de2-8d27-aa1531c9c051

                Publication of EHP lies in the public domain and is therefore without copyright. All text from EHP may be reprinted freely. Use of materials published in EHP should be acknowledged (for example, “Reproduced with permission from Environmental Health Perspectives”); pertinent reference information should be provided for the article from which the material was reproduced. Articles from EHP, especially the News section, may contain photographs or illustrations copyrighted by other commercial organizations or individuals that may not be used without obtaining prior approval from the holder of the copyright.

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