title: Association between maternal serum concentration of the DDT metabolite DDE and preterm and small-for-gestational-age babies at birth.
abstract: BACKGROUND
  DDT (1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane) is highly effective against most malaria-transmitting mosquitoes and is being widely used in malaria-endemic areas. The metabolite, DDE (1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene), has been linked to preterm birth in small studies, but these findings are inconclusive. Our aim was to investigate the association between DDE exposure and preterm birth.
  
  
  METHODS
  Our study was based on the US Collaborative Perinatal Project (CPP). From this study we selected a subset of more than 44000 eligible children born between 1959 and 1966 and measured the DDE concentration in their mothers' serum samples stored during pregnancy. Complete data were available for 2380 children, of whom 361 were born preterm and 221 were small-for-gestational age.
  
  
  RESULTS
  The median maternal DDE concentration was 25 mg/L (range 3-178)-several fold higher than current US concentrations. The adjusted odds ratios (OR) of preterm birth increased steadily with increasing concentrations of serum DDE (ORs=1, 1.5, 1.6, 2.5, 3.1; trend p<0.0001). Adjusted odds of small-for-gestational-age also increased, but less consistently (ORs=1, 1.9, 1.7, 1.6, 2.6; trend p=0.04). After excluding preterm births, the association of DDE with small-for-gestational-age remained.
  
  
  CONCLUSIONS
  The findings strongly suggest that DDT use increases preterm births, which is a major contributor to infant mortality. If this association is causal, it should be included in any assessment of the costs and benefits of vector control with DDT.
authors.affiliation: Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, PO Box 12233 MD A3-05, NC 27709, USA. longnecker@niehs.nih.gov
authors.forename: M P
authors.initials: MP
authors.lastname: Longnecker
authors.forename: M A
authors.initials: MA
authors.lastname: Klebanoff
authors.forename: H
authors.initials: H
authors.lastname: Zhou
authors.forename: J W
authors.initials: JW
authors.lastname: Brock
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D015986:Confounding Factors, Epidemiologic; D003634:DDT / Q000378:metabolism*; D003633:Dichlorodiphenyl Dichloroethylene / Q000009:adverse effects* / Q000097:blood*; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis; D005260:Female; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007306:Insecticides / Q000009:adverse effects* / Q000097:blood*; D016015:Logistic Models; D008297:Male; D007752:Obstetric Labor, Premature / Q000139:chemically induced* / Q000453:epidemiology; D011159:Population Surveillance; D011247:Pregnancy; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D007306:Insecticides; D003633:Dichlorodiphenyl Dichloroethylene; D003634:DDT