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Geoffrey M. Calvert,¹ Walter A. Alarcon,¹ Ann Chelminski,² Mark S. Crowley,³ Rosanna Barrett,⁴ Adolfo Correa,⁵ Sheila Higgins,² Hugo L. Leon,³ Jane Correia,⁴ Alan Becker,⁴ Ruth H. Allen,⁶ and Elizabeth Evans⁶

¹Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA; ²North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA; ³Collier County Health Department, Naples, Florida, USA; ⁴Florida Department of Health, Tallahassee, Florida, USA; ⁵National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; ⁶Office of Pesticide Programs, U.S. Environmental Protection Agency, Washington, DC, USA

Abstract
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]

Address correspondence to G.M. Calvert, National Institute for Occupational Safety and Health, 4676 Columbia Parkway, R-17, Cincinnati, OH 45226 USA. Telephone: (513) 841-4448. Fax: (513) 841-4489. E-mail: jac6@CDC.GOV

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention, the U.S. Environmental Protection Agency, or each author's state or county agency.

The authors declare they have no competing financial interests.

Received 23 August 2006 ; accepted 21 February 2007.