OBJECTIVES. To examine possible effects on blood pressure, neurological function, and neurobehavioral tests in school-aged children with and without prenatal pesticide exposure in an area where stunting is common.METHODS. In a community of Northern Ecuador with intensive floriculture and a high female employment rate, we invited 79 children attending the 2 lowest grades of a public school for clinical examinations. In addition to a thorough physical examination, we administered simple reaction time, Santa Ana dexterity test, Stanford-Binet copying, and Wechsler Intelligence Scale for Children-Revised Digit Spans forward. Maternal interview included detailed assessment of occupational history to determine pesticide exposure during pregnancy. Recent and current pesticide exposure was assessed by erythrocyte acetylcholine esterase activity and urinary excretion of organophosphate metabolites.RESULTS. All eligible children participated in the study, but 7 children were excluded from data analysis due to other disease or age Ͼ9 years. A total of 31 of the remaining 72 children were classified as stunted based on their height for age. Maternal occupational history revealed that 37 children had been exposed to pesticides during development. After confounder adjustment, prenatal pesticide exposure was associated with a higher systolic blood pressure than in the controls. On neurological examination, 14 exposed children and 9 controls showed Ն1 abnormalities. Of 5 neurobehavioral tests, the Stanford-Binet copying test showed a lower drawing score for copying designs in exposed children than in controls. Stunting was associated with a lower score on this test only, and both risk factors remained statistically significant in a multiple regression analysis with adjustment for demographic and social confounders. Increased excretion of dimethyl and diethyl metabolites of organophosphates was associated with increased reaction time and no other outcomes.CONCLUSION. Prenatal pesticide exposure may cause lasting neurotoxic damage and add to the adverse effects of malnutrition in developing countries. The effects differ from those due to acute pesticide exposure. T HE DEVELOPING BRAIN is particularly susceptible to adverse effects of environmental toxicants and nutritional deficiencies. 1 During fetal development, the placenta offers some protection against unwanted compounds, but it is not an effective barrier against environmental neurotoxicants. 2 Furthermore, the blood-brain barrier, which protects the adult brain from many toxic agents, is not completely formed until ϳ6 months after birth 3 and, therefore, provides no protection during sensitive developmental stages. At the same time, the brain depends on appropriate supplies of essential nutrients, and malnutrition, as apparent from stunted growth, may result in delayed neurobehavioral development. [4][5][6][7][8][9] The vulnerability of the brain originates from the combination of immaturity and ongoing development. 10 For optimal brain development to occur, a numb...