BackgroundThe C8 Health Project was created, authorized, and funded as part of the settlement agreement reached in the case of Jack W. Leach, et al. v. E.I. du Pont de Nemours & Company (no. 01-C-608 W.Va., Wood County Circuit Court, filed 10 April 2002). The settlement stemmed from the perfluorooctanoic acid (PFOA, or C8) contamination of drinking water in six water districts in two states near the DuPont Washington Works facility near Parkersburg, West Virginia.ObjectivesThis study reports on the methods and results from the C8 Health Project, a population study created to gather data that would allow class members to know their own PFOA levels and permit subsequent epidemiologic investigations.MethodsFinal study participation was 69,030, enrolled over a 13-month period in 2005–2006. Extensive data were collected, including demographic data, medical diagnoses (both self-report and medical records review), clinical laboratory testing, and determination of serum concentrations of 10 perfluorocarbons (PFCs). Here we describe the processes used to collect, validate, and store these health data. We also describe survey participants and their serum PFC levels.ResultsThe population geometric mean for serum PFOA was 32.91 ng/mL, 500% higher than previously reported for a representative American population. Serum concentrations for perfluorohexane sulfonate and perfluorononanoic acid were elevated 39% and 73% respectively, whereas perfluorooctanesulfonate was present at levels similar to those in the U.S. population.ConclusionsThis largest known population study of community PFC exposure permits new evaluations of associations between PFOA, in particular, and a range of health parameters. These will contribute to understanding of the biology of PFC exposure. The C8 Health Project also represents an unprecedented effort to gather basic data on an exposed population; its achievements and limitations can inform future legal settlements for populations exposed to environmental contaminants.

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Serum gamma-glutamyl transferase (GGT), a marker of oxidative stress, has been shown to be associated with diabetes mellitus in some population-based studies, but not all. Also, it is not clear if there is a continuous dose-response relationship in this association, or if this association is evident only beyond a particular threshold level of GGT. We examined the association between serum GGT and diabetes mellitus in a representative sample of US adults aged > or = 20 years, in a cross-sectional study involving 7,976 National Health and Nutrition Examination Survey 1999-2002 participants. Diabetes mellitus was defined as a fasting glucose > or = 126 mg/dl, nonfasting glucose > or = 200 mg/dl, or use of oral hypoglycemic medication or insulin (n = 805). Higher serum GGT levels were positively associated with diabetes mellitus, independent of, alcohol consumption, body mass index, hypertension and other confounders. Multivariable odds ratio (95% confidence interval) comparing quartile 4 of GGT (>33 U/L) to quartile 1 (<15 U/L) was 2.33 (1.59-3.41), P-trend < 0.0001. This association persisted in separate analysis among men and women. In nonparametric models, the positive association between serum GGT and diabetes appeared to be present across the full range of GGT, without any threshold effect. Higher serum GGT levels are positively associated with diabetes mellitus.

Thrombocytopenia is common in pregnancy and is diverse in etiology. Immune thrombocytopenic purpura (ITP) may affect both mother and the newborn. Gestational (incidental) thrombocytopenia in an otherwise fit woman, at term is the most frequent type of thrombocytopenia and poses no clinical consequences for mother or infant. We report six women who presented with severe thrombocytopenia during pregnancy. Five were treated in late pregnancy, either with intravenous immunoglobulin (IVIg), or IVIg followed by steroids. There was no response, and four received a platelet transfusion during delivery. The platelet counts in all the infants were normal and the maternal thrombocytopenia resolved spontaneously after delivery in all cases. Our observations suggest that this is a group of patients with a severe form of gestational thrombocytopenia. The severe form of gestational thrombocytopenia appears to be rare, and recognition is important, as it may recur in subsequent pregnancies and does not require any therapeutic intervention.

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