In response to community requests, a Navajo Birth Cohort will be developed to study the prenatal, perinatal,and early postnatal health effects of environmental exposures to uranium and associated mining wastes onNavajo mothers and their offspring through the following specific aims:
Aim 1 : Co-operatively design and conduct a prospective epidemiologic birth cohort study of pregnancyoutcomes and child development in relation to uranium waste exposures among Navajo mother-infant pairs. 1. Solicit community, Navajo and federal agency input, to inform the final study design to ensure it is respectful of Navajo culture and includes appropriate measures to address community concerns 2. Enroll 1,650 pregnant women in early pregnancy (1st or early 2nd trimester, as feasible) and follow them throughout pregnancy and childbirth (assumes a pregnancy loss rate of 10%) 3. Establish a birth cohort of 1,500 offspring of these women who will be assessed and followed for birth, growth, and neurodevelopmental outcomes to 12 months of age (in the initial phase of follow-up) 4. Compare health endpoints (as finalized by the expanded Research Team) among mothers and their children who are more and less likely to be exposed to uranium and associated metals.
Aim 2 : Characterize the cohort with respect to mobility, exposures, co-exposures, demographic and culturalcharacteristics that may influence outcomes 1. Measure/estimate human exposures to uranium and other toxicants, and identify exposure pathways 2. Use geospatial statistics to identify exposure hot spots as surrogates for exposure 3. Collect information on potential modifiers of susceptibility, such as diet and psychosocial stressAim 3: With guidance from our expanded Community Liaison Group (CLG) and collaboration with communityhealth workers, provide extensive outreach on the study goals and results, on prenatal care, available clinicalservices, and mitigation of any exposure-induced health effects on Navajo.
Aim 4 : Work with Navajo agency partners to develop their environmental health capacity and to develop asustainability plan for continued follow-up of the cohort.This work will be accomplished through a cooperative agreement with ATSDR/CDC and involve agencyscientists as well as communities in development and implementation of the final design. The Research Teamcombines scientific expertise in epidemiology, toxicology, mathematics and modeling, and environmentalassessment with participation of Navajo culture and language experts, traditional medicinemen, and NavajoNation agencies as well as clinical care providers to ensure not only respectful design and implementation, buteffective translation of the results to policy, health care, and effective outreach and education for communities.

Public Health Relevance

Navajo communities have been exposed to legacy waste of uranium mining for more than 50 years.Community members are concerned that the exposures have lead to reproductive toxicity as well as impaireddevelopment in their children. Similar concerns have been raised in other communities where uraniumexposures have occurred but no definitive studies have been conducted in humans. In the proposed NavajoBirth Cohort study we will examine the reproductive outcomes in pregnant women; follow and assess theirchildren for 3 months to 1 year of age; and set up a system to allow follow up through childhood age 6 toevaluate the impacts of uranium exposure on biological and psychosocial endpoints. The research will beconducted by a team of research scientists; Navajo and federal agency representatives; clinicians; and Navajoculture and language experts using community-based techniques.

National Institute of Health (NIH)
Agency for Toxic Substances and Disease Registry (ATSDR)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZTS1-SRC (99))
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University of New Mexico Health Sciences Center
United States
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Lewis, Johnnye; Gonzales, Melissa; Burnette, Courtney et al. (2015) Environmental exposures to metals in Native communities and implications for child development: basis for the Navajo birth cohort study. J Soc Work Disabil Rehabil 14:245-69