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Washington StateThe Collaborative on Health and the Environment – Washington

A Partnership Network for Environmental Health
Established and Coordinated by the Institute for Children's Environmental Health
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Reproductive Disorders

Many environmental contaminants are associated with non-cancer health effects, including reproductive disorders, birth defects, and developmental and neurobehavioral disabilities. We looked for information on 24 non-cancer health outcomes that have "strong" or "good" evidence of environmental causes according to the Toxicant and Disease Database" prepared by the Collaborative on Health and the Environment.

Of these 24 health outcomes, this section specifically addresses reproductive disorders, including altered time to sexual maturation, reduced fertility in men and women, endometriosis, fetotoxicity (fetal death), preterm births, low birth weight, and infant mortality.

Proportion of Reproductive Disorders Attributable to Environmental Contaminants

Unfortunately, there is no scientific consensus on the proportion of reproductive disorders attributable to environmental contaminants. Moreover, the proportion is likely to be significantly different for different disorders.

In its recent report on "Preventing Disease Through Healthy Environments: Towards an Estimate of the Environmental Burden of Disease 2006", the World Health Organization estimated that environmental causes account for 6% of all adverse perinatal conditions in developed countries, with a range of 2-10%.

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Summary of Information on Washington State

From National Organizations:

Preterm Birth, Low Birth Weight and Infant Mortality

National data on births, birth rates, and fertility rates are available from the Centers for Disease Control and Prevention (CDC), including rates for Washington State. For example, a report on "Trends in Characteristics of Births by State: United States, 1990, 1995, and 2000-2002" contains State-level information on births, birth rates, fertility rates, and sex ratio.

The March of Dimes has information on "Preterm and Low Birthweight Births in Washington". This information shows that between 1993-2003 the proportion of preterm births increased from 8.4% to 10.3%. Similarly, the proportion of low birthweight babies increased over the same time period from 5.2% to 6.0%. The March of Dimes also found that during 2001-2003, preterm birth rates were highest for Native American infants (14.5%), followed by blacks (13.3%), Hispanics (10.3%), Asians (9.9%) and whites (9.5%).

From State Organizations:

Endometriosis

There is no information on endometriosis from State organizations, however, one study on the "Epidemiology of Endometriosis" has estimated that nationally, 10% of women and have this condition. Using this proportion and information on Population by Age and Gender, 2004 and 2005" in the Washington State Databook, it can be estimated that approximately 300,000 women in Washington have endometriosis.

Fetotoxicity, Preterm Birth, Low Birth Weight and Infant Mortality

The Washington State Department of Health (DOH) has "Fetal Death Data" for the State, for example, the prevalence of fetal death was 5.3 per 1,000 live births in 2004.

Information on "Low Birth Weight for Singleton Births" shows that in 2003, the low birth weight rate for singletons was 4.6%, compared to a national rate of 6.2%. The overall rate of low birth weight, which includes multiple births, was 6.1% in 2003, compared to a national rate of 7.9%. The overall rate of low birth weight increased significantly from 5.3% in 1990 to 6.1% in 2003. Singleton low birth weight rates were significantly higher among Black women compared to women of other races.

The annual Washington State rate for Infant Mortality was 5.3 per 1,000 in 2004. Infant mortality is defined as the death of a child under the age of one and is calculated per live births. In 2004, infant mortality rates were highest in Chelan County. Infant mortality rates were also highest for Blacks, American Indian/ Alaska Natives, Non-Hispanics, teen mothers, mothers over the age of forty, and male infants.

From Local Organizations:

Infant Mortality

Public Health of Seattle and King County published an article on infant mortality in Public Health Data Watch (2000) titled, "Racial Disparities in Infant Mortality: King County, 1980-1998".

From Academic Institutions:

Male Fertility

A 1996 study "Data from Men in Greater Seattle Area Reveals no Downward Trend in Semen Quality" found that there has been no decline in sperm quality in healthy adult men over the previous 21 years. This finding contrasts with the results of other studies in Sweden and Europe.

Low Birth Weight

A study on "Mercury Exposure from Dental Filling Placement During Pregnancy and Low Birth Weight Risk" found that dental fillings during pregnancy did not increase the riks of low birthweight in Washington.

Poor Birth Outcomes

A study on "Rural Residence and Poor Birth Outcome in Washington State" concluded that rural residence is not associated with a greater risk of poor birth outcomes.

Another study looked at the "Health Status of Urban American Indians and Alaska Natives". It showed that urban American Indians and Alaska Natives had a much higher rate of lower birth weight and infant mortality than urban whites.

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Information on Washington State in Context

The table below compares overall low birth weight rates and infant mortality rates for Washington State with the national rates for 2003, based on information from the March of Dimes. It shows that the State’s low birth weight and infant mortality rates were both lower than the national averages.

WA State Rates

National Rates

Overall Low Birth Weight 2003 (%)

6.0%

7.9%

Infant Mortality 2002 (per 1,000)

5.8

7.0

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Quality of Information on Washington State

Information on preterm birth, low birth weight, and infant mortality are readily available, although the latest information is from 2001. We were unable to find any information relevant to altered time to sexual maturation and female fertility in Washington State. Better data are needed on the relationship between specific reproductive disorders and exposure to environmental contaminants, especially on a state level.

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General Information Sources

Online Resources:

Center for Disease Control and Prevention: www.cdc.gov/

Collaborative for Health and the Environment: healthandenvironment.org/index.php

Endometriosis.org: www.endometriosis.org/

March of Dimes: www.marchofdimes.com/

Office of Financial Management: www.ofm.wa.gov/

Public Health – Seattle & King County: www.metrokc.gov/health/

Washington State Department of Health: www.doh.wa.gov/

Hardcopy Resources:

Carlsen E, Giwercman A, Keiding N, and Skakkebaek N. 1992. Evidence for Decreasing Quality of Semen During the Past 50 Years. British Medical Journal 305:609-613.

Paulsen CA, Berman NG, and Wang C. 1997. Is Male Reproductive Health at Risk? Longitudinal Semen Analysis Studies. Advances in Contraception 13 (2/3): 119-121.

Paulsen CA, Berman NG, and Wang C. 1996. Data from Men in Greater Seattle Area Reveals No Downward Trend in Semen Quality. Fertility and Sterility 65(5): 1015-1020.

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