Adverse Reproductive Outcomes Adverse Reproductive Outcomes Surveillance and Outreach at the Surveillance and Outreach at the

Border: California Teratogen Border: California Teratogen Information Service and the San Diego Information Service and the San Diego

Birth Defects Surveillance ProgramBirth Defects Surveillance Program

Kenneth Lyons JonesKenneth Lyons JonesChristina D ChambersChristina D Chambers

Department of PediatricsDepartment of PediatricsDivision of Teratology/DysmorphologyDivision of Teratology/Dysmorphology

University of California, San Diego, School of MedicineUniversity of California, San Diego, School of MedicineLa Jolla, CaliforniaLa Jolla, California

California Teratogen Information California Teratogen Information Service: GoalsService: Goals

To provide a service to pregnant women To provide a service to pregnant women and their physicians throughout California and their physicians throughout California regarding the effects of various agents on regarding the effects of various agents on fetal development.fetal development.

To gain new information about the To gain new information about the potential teratogenicity of drugs, potential teratogenicity of drugs, chemicals, and environmental agentschemicals, and environmental agents

Hispanic Women Registered (%)Hispanic Women Registered (%)

1998 - 7.5% (>40% of births in CA to Mexican-1998 - 7.5% (>40% of births in CA to Mexican-American women)American women)

1999 – 11% (hired first Spanish speaking 1999 – 11% (hired first Spanish speaking counselor)counselor)

2000 – 18%2000 – 18%

2002 – 26% (received grant to develop 2002 – 26% (received grant to develop strategies for providing information to pregnant strategies for providing information to pregnant women regarding exposures during pregnancy)women regarding exposures during pregnancy)

2004 – 26%2004 – 26%

Future DirectionsFuture Directions

Establish face-to-face, hospital-based teratogen counseling Establish face-to-face, hospital-based teratogen counseling as part of the existing health system that is provided to as part of the existing health system that is provided to pregnant women in Tijuanapregnant women in Tijuana

Establishment of telephone-based Teratogen Information Establishment of telephone-based Teratogen Information Service in Tijuana to provide service to women and their Service in Tijuana to provide service to women and their physicians throughout Baja Norte.physicians throughout Baja Norte.

Acquire fellowship funding to train a Mexican physician in Acquire fellowship funding to train a Mexican physician in Teratology/Dysmorphology who could then extend our Teratology/Dysmorphology who could then extend our research agenda on the Mexican side of the border.research agenda on the Mexican side of the border.

San Diego Birth Defects San Diego Birth Defects Surveillance ProgramSurveillance Program

Part of Slone Epidemiology Center at Boston Part of Slone Epidemiology Center at Boston University.University.

4 sites including Boston, Toronto, Philadelphia, 4 sites including Boston, Toronto, Philadelphia, and San Diego.and San Diego.

Case-control study involving all birthing hospitals Case-control study involving all birthing hospitals in San Diego County.in San Diego County.

Interviews of cases and controls occur in first 6 Interviews of cases and controls occur in first 6 months of life and document over-the –counter months of life and document over-the –counter as well as prescription medicationsas well as prescription medications

Importance of Birth Defects Surveillance that Importance of Birth Defects Surveillance that includes Both Sides of the Borderincludes Both Sides of the Border

Environmental factors that may affect the incidence Environmental factors that may affect the incidence of birth defects in San Diego may impact the of birth defects in San Diego may impact the incidence of birth defects in Tijuana and vice versaincidence of birth defects in Tijuana and vice versa

ExamplesExamples

Congenital rubellaCongenital rubella

Differences in uptake of folic acid supplementationDifferences in uptake of folic acid supplementation

Alcohol consumption by pregnant women – high in San Alcohol consumption by pregnant women – high in San Diego, but not in Tijuana?Diego, but not in Tijuana?

Safety regulations re environmental pollution – more Safety regulations re environmental pollution – more stringent in San Diego?stringent in San Diego?

Availability of teratogenic drugs over-the-counter in Availability of teratogenic drugs over-the-counter in Tijuana, e. g., Ro-accutane Tijuana, e. g., Ro-accutane

Unknown environmental factors that may affect both Unknown environmental factors that may affect both sides of the border, e.g., air quality.sides of the border, e.g., air quality.