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Prenatal Lead and Depression Exposures Jointly Influence Birth Outcomes and NR3C1 DNA Methylation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212169. [PMID: 34831923 PMCID: PMC8620070 DOI: 10.3390/ijerph182212169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 01/01/2023]
Abstract
Many gestational exposures influence birth outcomes, yet the joint contribution of toxicant and psychosocial factors is understudied. Moreover, associated gestational epigenetic mechanisms are unknown. Lead (Pb) and depression independently influence birth outcomes and offspring NR3C1 (glucocorticoid receptor) DNA methylation. We hypothesized that gestational Pb and depression would jointly influence birth outcomes and NR3C1 methylation. Pregnancy exposure information, DNA methylation, and birth outcome data were collected prospectively from n = 272 mother–infant pairs. Factor analysis was used to reduce the dimensionality of NR3C1. Multivariable linear regressions tested for interaction effects between gestational Pb and depression exposures with birth outcomes and NR3C1. Interaction effects indicated that higher levels of Pb and depression jointly contributed to earlier gestations, smaller infant size at birth, and asymmetric fetal growth. Pb and depression were also jointly associated with the two primary factor scores explaining the most variability in NR3C1 methylation; NR3C1 scores were associated with some infant outcomes, including gestational age and asymmetric fetal growth. Pb and depression can cumulatively influence birth outcomes and epigenetic mechanisms, which may lay the foundation for later health risk. As toxicants and social adversities commonly co-occur, research should consider the life course consequences of these interconnected exposures.
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Lillini R, Tittarelli A, Bertoldi M, Ritchie D, Katalinic A, Pritzkuleit R, Launoy G, Launay L, Guillaume E, Žagar T, Modonesi C, Meneghini E, Amati C, Di Salvo F, Contiero P, Borgini A, Baili P. Water and Soil Pollution: Ecological Environmental Study Methodologies Useful for Public Health Projects. A Literature Review. REVIEWS OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2021; 256:179-214. [PMID: 33866420 DOI: 10.1007/398_2020_58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Health risks at population level may be investigated with different types of environmental studies depending on access to data and funds. Options include ecological studies, case-control studies with individual interviews and human sample analysis, risk assessment or cohort studies. Most public health projects use data and methodologies already available due to the cost of ad-hoc data collection. The aim of the article is to perform a literature review of environmental exposure and health outcomes with main focus on methodologies for assessing an association between water and/or soil pollutants and cancer. A systematic literature search was performed in May 2019 using PubMed. Articles were assessed by four independent reviewers. Forty articles were identified and divided into four groups, according to the data and methods they used, i.e.: (1) regression models with data by geographical area; (2) regression models with data at individual level; (3) exposure intensity threshold values for evaluating health outcome trends; (4) analyses of distance between source of pollutant and health outcome clusters. The issue of exposure assessment has been investigated for over 40 years and the most important innovations regard technologies developed to measure pollutants, statistical methodologies to assess exposure, and software development. Thanks to these changes, it has been possible to develop and apply geo-coding and statistical methods to reduce the ecological bias when considering the relationship between humans, geographic areas, pollutants, and health outcomes. The results of the present review may contribute to optimize the use of public health resources.
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Affiliation(s)
- Roberto Lillini
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", Milan, Italy.
| | - Andrea Tittarelli
- Cancer Registry Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", Milan, Italy
| | - Martina Bertoldi
- Environmental Epidemiology Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", Milan, Italy
| | - David Ritchie
- Association Européenne des Ligues contre le Cancer, Bruxelles, Belgium
| | | | - Ron Pritzkuleit
- Institute for Cancer Epidemiology at the University Lübeck, Lübeck, Germany
| | - Guy Launoy
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, Caen, France
- Pôle recherche - Centre Hospitalier Universitaire, Caen, France
| | - Ludivine Launay
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, Caen, France
- Centre François Baclesse, Caen, France
| | | | - Tina Žagar
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Carlo Modonesi
- Cancer Registry Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", Milan, Italy
- International Society of Doctors for the Environment (ISDE), Arezzo, Italy
| | - Elisabetta Meneghini
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", Milan, Italy
| | - Camilla Amati
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", Milan, Italy
| | - Francesca Di Salvo
- Pancreas Translational and Clinical Research Center, Ospedale IRCCS "San Raffaele", Milan, Italy
| | - Paolo Contiero
- Environmental Epidemiology Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", Milan, Italy
| | - Alessandro Borgini
- Environmental Epidemiology Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", Milan, Italy
- International Society of Doctors for the Environment (ISDE), Arezzo, Italy
| | - Paolo Baili
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", Milan, Italy
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Dai Y, Huo X, Cheng Z, Faas MM, Xu X. Early-life exposure to widespread environmental toxicants and maternal-fetal health risk: A focus on metabolomic biomarkers. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 739:139626. [PMID: 32535459 DOI: 10.1016/j.scitotenv.2020.139626] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 02/05/2023]
Abstract
Prenatal exposure to widespread environmental toxicants is detrimental to maternal health and fetal development. The effects of environmental toxicants on maternal and fetal metabolic profile changes have not yet been summarized. This systematic review aims to summarize the current studies exploring the association between prenatal exposure to environmental toxicants and metabolic profile alterations in mother and fetus. We searched the MEDLINE (PubMed) electronic database for relevant literature conducted up to September 18, 2019 with some key terms. From the initial 155 articles, 15 articles met the inclusion and exclusion criteria, and consist of highly heterogeneous research methods. Seven studies assessed the effects of multiple environmental pollutants (metals, organic pollutants, nicotine, air pollutants) on the maternal urine and blood metabolomic profile; five studies evaluated the effects of arsenic, polychlorinated biphenyls (PCBs), nicotine, and ambient fine particulate matter (PM2.5) on the cord blood metabolomic profile; and one study assessed the effects of smoking exposure on the amniotic fluid metabolomic profile. The alteration of metabolic pathways in these studies mainly involve energy metabolism, hormone metabolism, oxidative stress and inflammation. No population study investigated the association between environmental toxicants and placental metabolomics. This systematic review provides evidence that prenatal exposure to a variety of environmental pollutants can affect maternal and fetal metabolomic characteristics. Integration of environmental toxicant exposure and metabolomics data in maternal-fetal samples is helpful to understand the interaction between toxicants and metabolites, so as to reveal the pathogenesis of fetal disease or diseases of fetal origin.
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Affiliation(s)
- Yifeng Dai
- Laboratory of Environmental Medicine and Developmental Toxicology, Shantou University Medical College, Shantou, Guangdong, China; Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands
| | - Xia Huo
- Laboratory of Environmental Medicine and Developmental Toxicology, Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou, Guangdong, China
| | - Zhiheng Cheng
- Laboratory of Environmental Medicine and Developmental Toxicology, Shantou University Medical College, Shantou, Guangdong, China; Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands
| | - Marijke M Faas
- Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands; Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands
| | - Xijin Xu
- Laboratory of Environmental Medicine and Developmental Toxicology, Shantou University Medical College, Shantou, Guangdong, China; Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, Guangdong, China.
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Scott-Richardson M, Ruiz MO, Smith RL. Examining the Relationship Between Low Birth Weight Occurrence and Passive Measures of Environmental Arsenic by Census Tract in Escambia and Santa Rosa Counties, Florida. ENVIRONMENTAL HEALTH INSIGHTS 2020; 14:1178630220913053. [PMID: 32341650 PMCID: PMC7169366 DOI: 10.1177/1178630220913053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/14/2020] [Indexed: 06/11/2023]
Abstract
Arsenic is a public health concern because of its widespread distribution and high toxicity, even when doses are small. Low birth weight (LBW) occurrence, birth weights less than 2500 g, may be associated with prenatal exposure of arsenic from environmental factors and consuming contaminated drinking water and food. The objective of this study was to examine whether mothers living in areas of Escambia and Santa Rosa counties with varying levels of background arsenic in surface soil and water were associated with the occurrence of LBW. Inverse distance weight in ArcGIS was used to interpolate arsenic concentrations from environmental samples and estimate arsenic concentrations by census tracts in the two counties. After excluding multiple births and displaced geocoding addresses, birth data were obtained for the years of 2005 (n = 5845), 2010 (n = 5569), and 2015 (n = 5770) from the Bureau of Vital Statistics at the Florida Department of Health to assess temporal differences. Generalized linear models were used to analyze and compare the association between child and maternal demographic information, socioeconomic characteristics, and the environmental estimates of arsenic with LBW. No significant association was found between environmental arsenic concentration and LBW, suggesting that environmental contamination of the pregnant mother's census tract may not be a useful proxy in assessing risk for LBW.
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Affiliation(s)
- Maya Scott-Richardson
- Maya Scott-Richardson, Department of Pathobiology, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, 2001 S. Lincoln Ave., Urbana, IL 61802, USA.
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Aelion CM, Davis HT. Blood lead levels in children in urban and rural areas: Using multilevel modeling to investigate impacts of gender, race, poverty, and the environment. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 694:133783. [PMID: 31756823 DOI: 10.1016/j.scitotenv.2019.133783] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/02/2019] [Accepted: 08/04/2019] [Indexed: 05/27/2023]
Abstract
Many studies of children's exposure to lead (Pb) are carried out in urban and industrialized environments. This study analyzed blood lead level (BLL) data collected from 2011 to 2016 from approximately 140,000 children ages <1 to 6 years across South Carolina (SC), including urban and rural areas. Individual-level characteristics included children's age, and race/ethnicity. Block group variables examined included population by race and ethnicity, households below the poverty level, median year homes built, urban/rural classification, and percent road coverage. BLL were higher in urban compared to rural children but increased to a greater extent in rural children from age < 1 year to 2 years. Road coverage was strongly associated with higher BLL in urban areas, and with home age more weakly, but neither road coverage nor home age was associated with BLL in rural areas. Young urban children may receive greater exposure to Pb from house dust and outdoor legacy Pb contamination, and young rural children through diet and drinking water. Black children had higher BLL in urban areas than white children, and the converse was true in rural areas. Population data indicated that rural areas had more poverty than urban areas, but strong associations between increased children's BLL and either ethnicity or socio-economic status (SES) at the block group level was not observed, likely due to distinct characteristics of poverty and geographic distribution by ethnicity in urban as compared to rural areas of SC. Individual demographics and environmental characteristics may be more closely associated with BLL than geographically aggregated SES and race/ethnicity characteristics. Interventions to reduce children's exposure to Pb should occur at as early an age as possible, and differences between rural and urban areas should be considered as interventions are developed to reduce children's BLL.
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Affiliation(s)
- C M Aelion
- University of Massachusetts Amherst, School of Public Health and Health Sciences, Department of Environmental Health Sciences, Amherst, MA, USA
| | - H T Davis
- South Carolina Department of Health and Environmental Control, Bureau of Health Improvement and Equity, Columbia, SC, USA.
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Meng Y, Cave M, Zhang C. Comparison of methods for addressing the point-to-area data transformation to make data suitable for environmental, health and socio-economic studies. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 689:797-807. [PMID: 31280162 DOI: 10.1016/j.scitotenv.2019.06.452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 06/09/2023]
Abstract
Soil lead (Pb) provides an important exposure pathway to the human body through soil ingestion and dust inhalation and is closely associated with human health as well as social behaviour. The challenge of transforming different spatial supports arises when linking point data (Pb concentration) to areal data (health status or social behaviour). A detailed review of methodologies for integrating point and areal data has been carried out. Among a number of methodologies, eight methods: (1) average, (2) median, (3) centroids inverse distance weighted (IDW), (4) average block IDW, (5) median block IDW, (6) centroids ordinary kriging (OK), (7) average block OK and (8) median block OK, have been compared using Pb data set in the Greater London Authority (GLA) area. The results indicated that the method of median block IDW was recommended for further investigation of the relationship between Pb concentration and socio-economic factors in the ward-level of the GLA area. The reasons were (i) spatial interpolations were useful for predicting unobserved values when simple average and median could not work in the locations where there were no samples collected in some areal units; (ii) the median value was more suitable than the average value for a skewed data set; (iii) the block method reduced estimation error and provided more representative values of areal units than the centroid method; (iv) IDW reserved more spatial variation than OK, containing more local maxima (hotspot) and local minima. Despite that it is still hard to decide the optimal method, this study has highlighted the point-to-area transformation issue and provided valuable examples to compare the different methods.
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Affiliation(s)
- Yuting Meng
- International Network for Environment and Health, School of Geography and Archaeology, Ryan Institute, National University of Ireland, Galway, Ireland
| | - Mark Cave
- British Geological Survey, Environmental Science Centre, Nottingham, United Kingdom
| | - Chaosheng Zhang
- International Network for Environment and Health, School of Geography and Archaeology, Ryan Institute, National University of Ireland, Galway, Ireland.
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Delplancke TDJ, Wu Y, Han TL, Joncer LR, Qi H, Tong C, Baker PN. Metabolomics of Pregnancy Complications: Emerging Application of Maternal Hair. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2815439. [PMID: 30662903 PMCID: PMC6312607 DOI: 10.1155/2018/2815439] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/18/2018] [Indexed: 02/01/2023]
Abstract
In recent years, the study of metabolomics has begun to receive increasing international attention, especially as it pertains to medical research. This is due in part to the potential for discovery of new biomarkers in the metabolome and to a new understanding of the "exposome", which refers to the endogenous and exogenous compounds that reflect external exposures. Consequently, metabolomics research into pregnancy-related issues has increased. Biomarkers discovered through metabolomics may shed some light on the etiology of certain pregnancy-related complications and their adverse effects on future maternal health and infant development and improve current clinical management. The discoveries and methods used in these studies will be compiled and summarized within the following paper. A further focus of this paper is the use of hair as a biological sample, which is gaining increasing attention across diverse fields due to its noninvasive sampling method and the metabolome stability. Its significance in exposome studies will be considered in this review, as well as the potential to associate exposures with adverse pregnancy outcomes. Currently, hair has been used in only two metabolomics studies relating to fetal growth restriction (FGR) and gestational diabetes mellitus (GDM).
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Affiliation(s)
- Thibaut D. J. Delplancke
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, Chongqing Medical University, Chongqing 400016, China
- International Collaborative Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, Chongqing 400016, China
| | - Yue Wu
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, Chongqing Medical University, Chongqing 400016, China
- International Collaborative Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, Chongqing 400016, China
| | - Ting-Li Han
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, Chongqing Medical University, Chongqing 400016, China
- International Collaborative Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, Chongqing 400016, China
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Lingga R. Joncer
- International Collaborative Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, Chongqing 400016, China
| | - Hongbo Qi
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, Chongqing Medical University, Chongqing 400016, China
- International Collaborative Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, Chongqing 400016, China
| | - Chao Tong
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, Chongqing Medical University, Chongqing 400016, China
- International Collaborative Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, Chongqing 400016, China
| | - Philip N. Baker
- International Collaborative Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, Chongqing 400016, China
- Liggins Institute, University of Auckland, Auckland, New Zealand
- College of Medicine, University of Leicester, Leicester LE1 7RH, UK
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Mihaileanu RG, Neamtiu IA, Fleming M, Pop C, Bloom MS, Roba C, Surcel M, Stamatian F, Gurzau E. Assessment of heavy metals (total chromium, lead, and manganese) contamination of residential soil and homegrown vegetables near a former chemical manufacturing facility in Tarnaveni, Romania. ENVIRONMENTAL MONITORING AND ASSESSMENT 2018; 191:8. [PMID: 30536078 DOI: 10.1007/s10661-018-7142-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Abstract
Our aim was to assess local population exposure to heavy metals resulting from soil and vegetable contamination in Tarnaveni, Romania, an area located near a former chemical factory. We collected residential soil and vegetable samples from Tarnaveni and measured chromium (Cr), lead (Pb), and manganese (Mn) levels by atomic absorption spectrometry. We evaluated the relationship between soil and vegetable metals and the distance from the shuttered chemical factory, and calculated the hazard index to assess local population metal exposure via contaminated vegetable ingestion. Soil metal concentrations ranged between 15.6 and 525.8 mg/kg for total Cr, between 25.4 and 559.5 mg/kg for Pb, and between 363.1 and 1389.6 mg/kg for Mn. We found average concentrations of 17.8 mg/kg for total Cr, 2.2 mg/kg for Pb, and 116.6 mg/kg for Mn in local vegetables. We found soil concentrations for all three metals that exceeded normal background levels according to Romanian regulations (Pb exceeded 100 mg/kg in some of the samples), as well as measurable concentrations of metals in all analyzed vegetable samples. These preliminary data underscore a need for a more extensive investigation into associated adverse health effects in the exposed population.
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Affiliation(s)
- Razvan G Mihaileanu
- 1st Department of Obstetrics and Gynecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 3-5 Clinicilor Street, Cluj-Napoca, Romania
- IMOGEN Research Institute, Pasteur Street, f.n., Cluj-Napoca, Romania
- Municipal Hospital "Dr. Gheorghe Marinescu", 2 Victor Babes Street, Tarnaveni, Romania
| | - Iulia A Neamtiu
- IMOGEN Research Institute, Pasteur Street, f.n., Cluj-Napoca, Romania.
- Department of Health, Environmental Health Center, 58 Busuiocului Street, 400240, Cluj-Napoca, Romania.
- Faculty of Environmental Science and Engineering, Babes-Bolyai University, 30 Fantanele Street, Cluj-Napoca, Romania.
| | - Molly Fleming
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, One University Place, Rensselaer, NY, USA
| | - Cristian Pop
- Faculty of Environmental Science and Engineering, Babes-Bolyai University, 30 Fantanele Street, Cluj-Napoca, Romania
- Cluj School of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, 7 Pandurilor Street, Cluj-Napoca, Romania
- Physico-chemical and Biotoxicological Analysis Laboratory, Environmental Health Center, 58 Busuiocului Street, Cluj-Napoca, Romania
| | - Michael S Bloom
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, One University Place, Rensselaer, NY, USA
- Department of Environmental Health Sciences, University at Albany, State University of New York, One University Place, Rensselaer, NY, USA
| | - Carmen Roba
- Faculty of Environmental Science and Engineering, Babes-Bolyai University, 30 Fantanele Street, Cluj-Napoca, Romania
| | - Mihai Surcel
- 1st Department of Obstetrics and Gynecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 3-5 Clinicilor Street, Cluj-Napoca, Romania
| | - Florin Stamatian
- 1st Department of Obstetrics and Gynecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 3-5 Clinicilor Street, Cluj-Napoca, Romania
- IMOGEN Research Institute, Pasteur Street, f.n., Cluj-Napoca, Romania
| | - Eugen Gurzau
- Department of Health, Environmental Health Center, 58 Busuiocului Street, 400240, Cluj-Napoca, Romania
- Cluj School of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, 7 Pandurilor Street, Cluj-Napoca, Romania
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Peng Y, Hu J, Li Y, Zhang B, Liu W, Li H, Zhang H, Hu C, Chen X, Xia W, Lu S, Xu S. Exposure to chromium during pregnancy and longitudinally assessed fetal growth: Findings from a prospective cohort. ENVIRONMENT INTERNATIONAL 2018; 121:375-382. [PMID: 30245360 DOI: 10.1016/j.envint.2018.09.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/02/2018] [Accepted: 09/03/2018] [Indexed: 05/04/2023]
Abstract
BACKGROUND Prenatal exposure to chromium may be associated with reduced birth weight; however, critical windows of such exposure for fetal growth are unclear. OBJECTIVE Our study was aimed to assess trimester-specific associations of chromium exposure with fetal growth parameters measured repeatedly by ultrasound and birth size, and to see whether these associations were modified by fetal sex. METHODS We conducted a prospective cohort of 3041 women in Wuhan, China, from 2013 to 2016. Chromium concentrations were measured in maternal urine samples collected in the 1st, 2nd, and 3rd trimesters using an inductively coupled plasma mass spectrometry. We calculated standard deviation scores for ultrasound measured head circumference, abdominal circumference (AC), femur length, and estimated fetal weight (EFW) at 16, 24, and 31 weeks of gestation. Linear regressions with generalized estimating equations were used to estimate the associations of specific gravity-adjusted urinary chromium concentrations in each trimester with fetal growth parameters and birth weight, birth length, and ponderal index. RESULTS Inverse associations of chromium exposure in the 1st trimester with fetal growth parameters at 31 weeks of gestation were observed, resulting in significant reductions in AC of -5.4% (95% confidence interval [CI]: -9.6%, -1.2%) and EFW of -5.6% (95% CI: -9.8%, -1.4%) per unit increase in natural logarithm transformed urinary chromium concentration. Urinary chromium concentration in the 2nd trimester was also associated with reductions in AC of -7.0% (95% CI: -12.5%, -1.4%) and in EFW of -5.0% (95% CI: -10.6%, 0.6%) at 31 weeks, and these inverse associations were evident in boys (reduction in AC of -13.9% [95% CI: -21.1%, -6.7%]; EFW of -9.5% [95% CI: -16.9%, -2.0%]) but not in girls (increase in AC of 2.9% [95% CI: -5.7%, 11.5%]; EFW of 1.5% [95% CI: -6.8%, 9.8%]) (both pineraction < 0.05). Moreover, one-unit increase in urinary chromium concentrations in the 1st and 2nd trimesters were both associated with significant reductions in ponderal index of -0.11 kg/m3 (95% CI: -0.19, -0.03 kg/m3) and -0.15 kg/m3 (95% CI: -0.27, -0.03 kg/m3), respectively. CONCLUSION Our findings suggest that chromium may be a toxic metal for fetal growth. Early and mid-pregnancy seem to be the most vulnerable period for fetal exposure to chromium, but these results need further confirmation.
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Affiliation(s)
- Yang Peng
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Jie Hu
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; Department of Epidemiology, Brown University of Public Health, Providence, RI, USA
| | - Yuanyuan Li
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Bin Zhang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Wenyu Liu
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Han Li
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Hongling Zhang
- School of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, Hubei, People's Republic of China
| | - Chen Hu
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xiaomei Chen
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Wei Xia
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Shi Lu
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
| | - Shunqing Xu
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
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10
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Arrieta A, Guillen J. The birthweight toll of mining pollution: evidence from the most contaminated mine site in the Andean region. BJOG 2018; 125:1272-1278. [PMID: 29700946 DOI: 10.1111/1471-0528.15257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the effect of mining pollution on birthweight. DESIGN A retrospective before-and-after study with an untreated comparison group. SETTING La Oroya, a mining town in the Peruvian Andes, considered the most contaminated town in the Andean region. POPULATION All pregnant women who delivered in the social security healthcare system in years 2005, 2006, 2008 and 2009. A total of 214 983 births records were used, 957 from La Oroya and 214 026 from the rest of the country. METHODS A difference-in-difference estimation is used to assess the effect of mining pollution on birthweight before and after two business policy changes: a partial environmental improvement and a subsequent closure of smelter operations in La Oroya. Birthweight was compared with a group not affected by the environmental changes in La Oroya. MAIN OUTCOME MEASURES Birthweight in grams. RESULTS A steep reduction in mining pollution due to the closure of smelter operations in La Oroya showed an increased birthweight of 71.6 g after controlling for socio-economic and medical characteristics. None of the environmental improvements prior to the closure had a statistically significant effect on birthweight. CONCLUSIONS Mining pollution in La Oroya had a negative impact on birthweight. Partial environmental improvements were not enough to improve birthweight. Only after the closure of all mining and smelter operations in La Oroya was a significant gain in birthweight shown. TWEETABLE ABSTRACT The closure of the most contaminated mine site in the Andean region increased birthweight by 72 g.
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Affiliation(s)
- A Arrieta
- Department of Health Policy and Management, Florida International University, Miami, FL, USA
| | - J Guillen
- Graduate School of Business, ESAN, Lima, Peru
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11
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González-Jiménez J, Rocha-Buelvas A. Risk factors associated with low birth weight in the Americas: literature review. REVISTA DE LA FACULTAD DE MEDICINA 2018. [DOI: 10.15446/revfacmed.v66n2.61577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. El bajo peso al nacer (BPN) es uno de los principales factores de riesgo que afecta la morbimortalidad infantil en todo el mundo; cerca de 1/3 de las muertes neonatales son atribuibles a este.Objetivo. Revisar los artículos más relevantes sobre BPN en las Américas en el periodo de 2010-2016.Materiales y métodos. Revisión narrativa de literatura. La información se obtuvo de las bases de datos PubMed, SciELO, LILACS, Portal Regional da BVS, con el uso de los descriptores DeCS y MeSH.Resultados. La mayoría de los estudios fueron publicados entre el 2012 y el 2015. De los 27 artículos publicados, 11 (40.7%) fueron atribuidos a factores sociodemográficos, 9 (33.3%) a riesgos ambientales, 3 (11.1%) a factores conductuales, 2 (7.4%) a controles prenatales o por cobertura y 2 (7.4%) se interrelacionaban con otros factores de riesgo.Conclusión. La mayoría de los estudios coinciden en la asociación de factores sociodemográficos, biológicos y conductuales. Los estudios que refieren la asociación de BPN con factores de riesgo ambientales están tomando fuerza.
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12
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Rahman ML, Valeri L, Kile ML, Mazumdar M, Mostofa G, Qamruzzaman Q, Rahman M, Baccarelli A, Liang L, Hauser R, Christiani DC. Investigating causal relation between prenatal arsenic exposure and birthweight: Are smaller infants more susceptible? ENVIRONMENT INTERNATIONAL 2017; 108:32-40. [PMID: 28787626 PMCID: PMC5623127 DOI: 10.1016/j.envint.2017.07.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/03/2017] [Accepted: 07/30/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Shortening of gestation and intrauterine growth restriction (IUGR) are the two main determinants of birthweight. Low birthweight has been linked with prenatal arsenic exposure, but the causal relation between arsenic and birthweight is not well understood. OBJECTIVES We applied a quantile causal mediation analysis approach to determine the association between prenatal arsenic exposure and birthweight in relation to shortening of gestation and IUGR, and whether the susceptibility of arsenic exposure varies by infant birth sizes. METHODS In a longitudinal birth cohort in Bangladesh, we measured arsenic in drinking water (n=1182) collected at enrollment and maternal toenails (n=1104) collected ≤1-month postpartum using inductively coupled plasma mass spectrometry. Gestational age was determined using ultrasound at ≤16weeks' gestation. Demographic information was collected using a structured questionnaire. RESULTS Of 1184 singleton livebirths, 16.4% (n=194) were low birthweight (<2500g), 21.9% (n=259) preterm (<37weeks' gestation), and 9.2% (n=109) both low birthweight and preterm. The median concentrations of arsenic in drinking water and maternal toenails were 2.2μg/L (range: below the level of detection [LOD]-1400) and 1.2μg/g (range: <LOD-46.6), respectively. Prenatal arsenic exposure was negatively associated with birthweight, where the magnitude of the association varied across birthweight percentiles. The effect of arsenic on birthweight mediated via shortening of gestation affected all infants irrespective of birth sizes (β range: 10th percentile=-19.7g [95% CI: -26.7, -13.3] to 90th percentile=-10.9g [95% CI: -18.5, -5.9] per natural log water arsenic increase), whereas the effect via pathways independent of gestational age affected only the smaller infants (β range: 10th percentile=-28.0g [95% CI: -43.8, -9.9] to 20th percentile=-14.9g [95% CI: -30.3, -1.7] per natural log water arsenic increase). Similar pattern was observed for maternal toenail arsenic. CONCLUSIONS The susceptibility of prenatal arsenic exposure varied by infant birth sizes, placing smaller infants at greater risk of lower birthweight by shortening of gestation and possibly growth restriction. It is important to mitigate prenatal arsenic exposure to improve perinatal outcomes in Bangladesh.
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Affiliation(s)
- Mohammad L Rahman
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, USA
| | - Linda Valeri
- McLean Hospital, Belmont, Massachusetts, USA, Harvard Medical School, Boston, MA, USA
| | - Molly L Kile
- Oregon State University, College of Public Health and Human Sciences, Corvallis, OR, USA
| | - Maitreyi Mazumdar
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, USA
| | | | | | | | - Andrea Baccarelli
- Columbia University, Mailman School of Public Health, Department of Environmental Health, New York, NY, USA
| | - Liming Liang
- Harvard T.H. Chan School of Public Health, Department of Biostatistics, Boston, MA, USA
| | - Russ Hauser
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - David C Christiani
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, USA.
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13
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Li H, Wang M, Liang Q, Jin S, Sun X, Jiang Y, Pan X, Zhou Y, Peng Y, Zhang B, Zhou A, Zhang Y, Chen Z, Cao J, Zhang H, Xia W, Zheng T, Cai Z, Li Y, Xu S. Urinary metabolomics revealed arsenic exposure related to metabolic alterations in general Chinese pregnant women. J Chromatogr A 2017; 1479:145-152. [DOI: 10.1016/j.chroma.2016.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 08/16/2016] [Accepted: 12/03/2016] [Indexed: 10/20/2022]
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14
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Au F, Bielecki A, Blais E, Fisher M, Cakmak S, Basak A, Gomes J, Arbuckle TE, Fraser WD, Vincent R, Kumarathasan P. Blood metal levels and third trimester maternal plasma matrix metalloproteinases (MMPs). CHEMOSPHERE 2016; 159:506-515. [PMID: 27341154 DOI: 10.1016/j.chemosphere.2016.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 05/10/2016] [Accepted: 06/02/2016] [Indexed: 06/06/2023]
Abstract
While it is known that in utero exposure to environmental toxicants, namely heavy metals, can adversely affect the neonate, there remains a significant paucity of information on maternal biological changes specific to metal exposures during pregnancy. This study aims at identifying associations between maternal metal exposures and matrix metalloproteinases (MMPs) that are known to be engaged in pregnancy process. Third trimester maternal plasma (n = 1533) from a pregnancy cohort (Maternal-Infant Research on Environmental Chemicals Study, MIREC) were analyzed for MMP-1,-2,-7,-9 and -10 by affinity-based multiplex protein array analyses. Maternal metal concentrations (mercury, cadmium, lead, arsenic and manganese) in 1st and 3rd trimesters exhibited strong correlations (p < 0.05). Multivariate regression models were used to estimate odds ratio (OR) for the association between metal concentrations in quartiles and high (90%) and low (10%) maternal MMP levels. Significant (p < 0.05) metal exposure-related effects were observed with the different MMP isoform responses. MMP profiles were specific to the trimester at which the maternal blood metals were analyzed. Our findings suggest that the profiles of these MMP isoforms vary with the type of metal exposure, blood metal concentrations and the trimester at which metal levels were determined. These new findings on maternal metal-MMP relationships can guide future explorations on toxicity mechanisms relevant to metal exposure-mediated adverse birth outcomes.
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Affiliation(s)
- Felicia Au
- Interdisciplinary School of Health Sciences, Faculty of Health Science, University of Ottawa, Ottawa, ON, Canada; Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON, Canada
| | - Agnieszka Bielecki
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON, Canada
| | - Erica Blais
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON, Canada
| | - Mandy Fisher
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON, Canada
| | - Sabit Cakmak
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON, Canada
| | - Ajoy Basak
- Interdisciplinary School of Health Sciences, Faculty of Health Science, University of Ottawa, Ottawa, ON, Canada
| | - James Gomes
- Interdisciplinary School of Health Sciences, Faculty of Health Science, University of Ottawa, Ottawa, ON, Canada
| | - Tye E Arbuckle
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON, Canada
| | | | - Renaud Vincent
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON, Canada; Department of Biochemistry, Microbiology and immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Prem Kumarathasan
- Interdisciplinary School of Health Sciences, Faculty of Health Science, University of Ottawa, Ottawa, ON, Canada; Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON, Canada.
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15
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Hong J, Wang Y, McDermott S, Cai B, Aelion CM, Lead J. The use of a physiologically-based extraction test to assess relationships between bioaccessible metals in urban soil and neurodevelopmental conditions in children. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2016; 212:9-17. [PMID: 26840511 DOI: 10.1016/j.envpol.2016.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/22/2015] [Accepted: 01/01/2016] [Indexed: 05/25/2023]
Abstract
Intellectual disability (ID) and cerebral palsy (CP) are serious neurodevelopment conditions and low birth weight (LBW) is correlated with both ID and CP. The actual causes and mechanisms for each of these child outcomes are not well understood. In this study, the relationship between bioaccessible metal concentrations in urban soil and these child conditions were investigated. A physiologically based extraction test (PBET) mimicking gastric and intestinal processes was applied to measure the bio-accessibility of four metals (cadmium (Cd), chromium (Cr), nickel (Ni), and lead (Pb)) in urban soil, and a Bayesian Kriging method was used to estimate metal concentrations in geocoded maternal residential sites. The results showed that bioaccessible metal concentrations of Cd, Ni, and Pb in the intestinal phase were statistically significantly associated with the child outcomes. Lead and nickel were associated with ID, lead and cadmium was associated with LBW, and cadmium was associated with CP. The total concentrations and stomach concentrations were not correlated to significant effects in any of the analyses. For lead, an estimated threshold value was found that was statistically significant in predicting low birth weight. The change point test was statistically significant (p value = 0.045) at an intestine threshold level of 9.2 mg/kg (95% confidence interval 8.9-9.4, p value = 0.0016), which corresponds to 130.6 mg/kg of total Pb concentration in the soil. This is a narrow confidence interval for an important relationship.
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Affiliation(s)
- Jie Hong
- Center for Environmental NanoScience and Risk, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Yinding Wang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Suzanne McDermott
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - C Marjorie Aelion
- Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Jamie Lead
- Center for Environmental NanoScience and Risk, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
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Zheng T, Zhang J, Sommer K, Bassig BA, Zhang X, Braun J, Xu S, Boyle P, Zhang B, Shi K, Buka S, Liu S, Li Y, Qian Z, Dai M, Romano M, Zou A, Kelsey K. Effects of Environmental Exposures on Fetal and Childhood Growth Trajectories. Ann Glob Health 2016; 82:41-99. [PMID: 27325067 PMCID: PMC5967632 DOI: 10.1016/j.aogh.2016.01.008] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Delayed fetal growth and adverse birth outcomes are some of the greatest public health threats to this generation of children worldwide because these conditions are major determinants of mortality, morbidity, and disability in infancy and childhood and are also associated with diseases in adult life. A number of studies have investigated the impacts of a range of environmental conditions during pregnancy (including air pollution, endocrine disruptors, persistent organic pollutants, heavy metals) on fetal and child development. The results, while provocative, have been largely inconsistent. This review summarizes up to date epidemiologic studies linking major environmental pollutants to fetal and child development and suggested future directions for further investigation.
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Affiliation(s)
- Tongzhang Zheng
- Department of Epidemiology, Brown School of Public Health, Providence, RI.
| | - Jie Zhang
- Department of Epidemiology, Brown School of Public Health, Providence, RI
| | | | - Bryan A Bassig
- National Cancer Institute, Division of Cancer Epidemiology & Genetics, Occupational and Environmental Epidemiology Branch, Bethesda, MD
| | - Xichi Zhang
- George Washington University, Washington, DC
| | - Jospeh Braun
- Department of Epidemiology, Brown School of Public Health, Providence, RI
| | - Shuangqing Xu
- Tongji School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Peter Boyle
- International Prevention Research Institute, Lyon, France
| | - Bin Zhang
- Wuhan Medical & Health Center for Women and Children, Wuhan, Hubei, P.R. China
| | - Kunchong Shi
- Department of Epidemiology, Brown School of Public Health, Providence, RI
| | - Stephen Buka
- Department of Epidemiology, Brown School of Public Health, Providence, RI
| | - Siming Liu
- Department of Epidemiology, Brown School of Public Health, Providence, RI
| | - Yuanyuan Li
- Department of Epidemiology, Brown School of Public Health, Providence, RI; Tongji School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Zengmin Qian
- College for Public Health & Social Justice, Saint Louis University, St. Louis, MO
| | - Min Dai
- China National Cancer Center, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Megan Romano
- Department of Epidemiology, Brown School of Public Health, Providence, RI
| | - Aifen Zou
- Wuhan Medical & Health Center for Women and Children, Wuhan, Hubei, P.R. China
| | - Karl Kelsey
- Department of Epidemiology, Brown School of Public Health, Providence, RI
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