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HHRA is conducting a nested case-control study similar to the PROTECT study that will measure herbicide levels in pregnant women and determine if higher exposures are correlated with preterm births or other reproductive impacts.

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  • HHRA Earns Highest Rating from Guidestar/Candid

    By Russell K. King, executive director I’m pleased to announce that the HHRA has earned the Candid Platinum Seal of Transparency for 2023 –an achievement earned by fewer than one percent of US-based nonprofits. The Candid Platinum Seal is the highest level of recognition offered by Candid (formerly known as GuideStar) and is awarded to organizations that meet the highest standards of transparency and accountability. It’s an achievement that’s doubly important for the HHRA. The Candid Platinum Seal demonstrates the HHRA’s commitment to transparency and accountability. Our board, staff, volunteers, and partners believe that by sharing our data, metrics, and strategic priorities with the public, we can build trust and confidence in our organization and our work. To earn the Candid Platinum Seal, non-profit organizations must meet a rigorous set of criteria, including providing complete and accurate information about their mission, programs, finances, and governance on the Candid website, and sharing strategic priorities and information about outcomes. So why is this doubly important for the HHRA?  It’s important for all nonprofit organizations seeking grants and donations because the Candid Platinum Seal is a globally recognized acknowledgement that can inspire a higher level of confidence in the organization among potential grantors and donors–thereby making them far more likely to give. For the HHRA, however, it’s also important because our mission is one that relies on our credibility.  For our work to make a difference in people’s lives, people have to trust our processes, our findings, and our recommendations. The Candid Platinum Seal will help tell the world that, indeed, the HHRA is to be trusted. The leadership of the HHRA has always put integrity of the science first, which sets the HHRA apart in en era awash in willful misinformation and pseudoscience. I’ve long been a fierce advocate for the integrity in science, science reporting, and health information, so I’m proud to carry the torch that’s been passed to me. The HHRA supports researchers willing to seek answers to controversial questions. Our alliance of doctors, researchers, policy experts, and communicators works to answer questions that the government and private sector are too often unable or unwilling to address.  Through it all, we adhere strictly to scientific and ethical best practices to keep our research above reproach. The Candid Platinum Seal is an echo of the values that form the heart of the HHRA.  Let’s wear it with pride as we move forward.

  • Russell King | Executive Director Greetings from the New Executive Director

    By Russell K. King, HHRA Executive Director But yield who will to their separation,My object in living is to uniteMy avocation and my vocationAs my two eyes make one in sight. Robert Frost’s sentiment rang in my ears as I considered adopting the HHRA’s mission as my own. Why, after more than 25 years as a nonprofit CEO, would I take on a challenge of this complexity? Typically, when evaluating a potential professional challenge, you compare the attributes and experiences needed with those you possess. If they align sufficiently, it’s a good omen. I’ve spent more than a decade leading nonprofit organization through transitions, including a foundation that funded scientific research and two associations of medical professionals. I’ve created two development programs and led four others. And I’ve shared my expertise in nonprofit governance and policy, communications, and servant leadership. This constellation of what HHRA needs and what I can offer suggested that this was the direction I should follow. But there was something more. That something echoed Frost’s lines above: The chance to unite that which I enjoy, that which is most meaningful to me, with my work, thus uniting “my avocation and my vocation.” The two principles that have driven both my personal and professional lives have been: 1) we best find our way via the rigors and integrity of the scientific method, and 2) we create the richest meanings for our lives when we strive to help others. The HHRA, using science to improve and protect human health, rings both those bells with vigor. So here I am, eager to help the HHRA build on its illustrious beginnings and move to its next stage of development and growth. I will, of course, need your help. I won’t be shy about asking for it; please don’t be shy about offering it. This mission will require our collaboration, cooperation, and coordination. It will present moments in which we must support, encourage, and inspire each other. Worthy missions always do. For me, it’s the worthiness that matters most. Again, as Frost noted, we do this because it’s the right thing to do: Only where love and need are one,And the work is play for mortal stakes,Is the deed ever really doneFor Heaven and the future’s sakes.

  • A man spraying pesticides California’s Bold Plan to Transform Pest Management Systems is Long on Ambition and Light on Details

    By: Chuck Benbrook, HHRA ED By: Mark Lipson, HHRA Director of Policy and Regulatory Engagement We welcomed the invitation from California’s Department of Pesticide Regulation for members of the public to offer comments and guidance as the State begins to take concrete actions needed to achieve the goals set forth in the new report Sustainable Pest Management: A Roadmap for California. Reviewing the 94-page Roadmap report reminded us how many constituencies, forces, and factors are pushing and pulling farmers, pest managers, and government agencies in multiple directions that are rarely aligned. This Roadmap document describes a very different pest management future that will hopefully become the “de facto” way pests are managed on and off the farm by 2050. If successful by 2050, prevention-based biointensive Integrated Pest Management (bioIPM) will be the norm and there will be minimal if any use of high-risk “Priority Pesticides”. Some thirty-two years ago, DPR hired Chuck Benbrook to carry out a comprehensive evaluation of DPR’s programs and policies to assist in the integration of DPR into the newly-formed Cal-EPA. The resulting report, Challenge and Change: A Progressive Approach to Pesticide Regulation in California, came out in March of 1993. It provides dozens of recommendations intended to do many of the same things that the 2023 Roadmap report hopes to bring within reach. The fact that most pest management systems in California have become more, not less reliant on pesticides over the last 30 years suggests that DPR’s and CDFA’s efforts to achieve Roadmap goals are going to entail heavy lifting, mostly uphill. For this reason in HHRA’s comments, Mark and Chuck describe the nature and substantial scope of changes in laws and policy that will be required to track progress toward Roadmap goals and hopefully, someday, achieve them.

Searching for an Ounce of Prevention

May 25th, 2021
HHRA is conducting a nested case-control study similar to the PROTECT study that will measure herbicide levels in pregnant women and determine if higher exposures are correlated with preterm births or other reproductive impacts.

By: Dr. David M. Haas and Melissa Perry, ScD

Over 18% of the babies born in Puerto Rico in 2011 were preterm, increasing life-long risks for multiple adverse developmental, reproductive, and chronic disease outcomes. In that same year, an NIH-funded birth cohort study was initiated entitled the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT).

The PROTECT birth cohort included 1,028 babies, 10% of whom were born preterm. Multiple papers have been published by the research team reporting on factors associated with elevated risk of preterm birth.

In a 2019 paper reporting PROTECT study results, the team identified links between socioeconomic factors and preterm births, but no other significant risk factors. The last sentence in the paper’s conclusion section reads:

“Environmental factors including chemical exposures may play an important role in the etiology of adverse birth outcomes but have yet to be explored in Puerto Rico.”

Results of a PROTECT nested case-control study were published on May 19, 2021 in Environmental Health Perspectives . Silver et al (2021) report strong associations between preterm birth and levels of glyphosate (GLY) and AMPA in the urine of pregnant women. Aminomethylphosphonic acid (AMPA) is GLY’s major metabolite and a primary source of dietary exposures following food-crop applications of glyphosate-based herbicides.

The new PROTECT study reports an unexpected finding — GLY and AMPA levels in urine late in pregnancy are more strongly associated with preterm birth than exposures earlier in pregnancy.

A woman’s first pregnancy results in about 40% of new births annually. It is widely accepted that first pregnancies tend to proceed differently than subsequent ones, but little was known previously about the reasons why. This led to the design and funding by the National Institutes of Health of a large prospective birth cohort study called the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b).

Over 10,000 pregnant women enrolled in nuMoM2b study sites across the continental US  between 2012 and 2015 (Haas et al 2015). This cohort has produced a plethora of research findings related to preterm birth, hypertensive disorders, gestational diabetes, as well as the impact of sociodemographic factors, disordered sleep, and others on disparities and pregnancy outcomes.

Like the PROTECT cohort, nuMoM2b identified several associations between socioeconomic and health status and adverse birth outcomes including preterm delivery, but environmental factors and chemical exposures had not been examined previously.

Early in 2021, the Heartland Health Research Alliance (HHRA) began a nested case-control study drawing on the nuMoM2b cohort. Our new study is similar to the nested case control study examining GLY and AMPA carried out by the PROTECT team. We too are examining associations between GLY and AMPA levels in the urine of pregnant women and adverse birth outcomes, including preterm delivery.

In our study, we are paying close attention to the timing of exposures during pregnancy to assess whether our study replicates the unexpected PROTECT finding that exposures later in pregnancy play a larger role in preterm delivery than first trimester exposures.

We have already reached out to the PROTECT team to learn more from their work and build upon the methodological advances in their GLY and AMPA study.

Nested case-control studies can produce important new insights more quickly and at lower cost than launching a new birth cohort. Finding ways to merge the results of comparably designed case-control studies enhances statistical power and can accelerate the search for answers. We hope to develop new collaborations with other study teams that have completed birth cohort studies to find more answers faster to these pressing women and infant health issues .

Ultimately, we want to highlight potential new avenues to reduce the risk of and prevent  preterm births. We are focusing our research on regions like the US Heartland where a large percentage of the landscape is sprayed multiple times every year with herbicides to control weeds in agriculture, in backyards, and public spaces.

About the Authors

Dr. David Haas is the Chair of the HHRA Board, a member of the Heartland Study Management Team, and the Director of OGBYN Research at the Indiana University School of Medicine.

Dr. Melissa Perry is a Co-PI of the Heartland Study and Chair of the Department of Environmental and Occupational Health Sciences at George Washington University.


Ferguson, K. K., Rosario, Z., McElrath, T. F., Velez Vega, C., Cordero, J. F., Alshawabkeh, A., & Meeker, J. D.; “Demographic risk factors for adverse birth outcomes in Puerto Rico in the PROTECT cohort;” Plos One, 2019, 14(6), e0217770; DOI: 10.1371/journal.pone.0217770.

Haas, D. M., Parker, C. B., Wing, D. A., Parry, S., Grobman, W. A., Mercer, B. M., Simhan, H. N., Hoffman, M. K., Silver, R. M., Wadhwa, P., Iams, J. D., Koch, M. A., Caritis, S. N., Wapner, R. J., Esplin, M. S., Elovitz, M. A., Foroud, T., Peaceman, A. M., Saade, G. R., Willinger, M., Reddy, U. M., & NuMo, M. b study; “A description of the methods of the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be (nuMoM2b);” American Journal of Obstetrics & Gynecology, 2015, 212(4), 539 e531-539 e524; DOI: 10.1016/j.ajog.2015.01.019.

Silver, M. K., Fernandez, J., Tang, J., McDade, A., Sabino, J., Rosario, Z., Velez Vega, C., Alshawabkeh, A., Cordero, J. F., & Meeker, J. D.; “Prenatal Exposure to Glyphosate and Its Environmental Degradate, Aminomethylphosphonic Acid (AMPA), and Preterm Birth: A Nested Case-Control Study in the PROTECT Cohort (Puerto Rico);” Environmental Health Perspectives, 2021, 129(5), 57011; DOI: 10.1289/EHP7295.

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